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Can A Diabetic Do The Keto Diet

How To Know If Your Treatment Plan Is Working

One way to see how well your plan is working is by tracking your A1C levels and aiming for specific blood sugar levels throughout the day.

Your target A1C goal may vary depending on your age and various other factors, but the American Diabetes Association generally recommends that A1C levels should be below 7 percent. A1C testing is one of the best indicators of how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your insulin regimen, meal plan or both. This measurement should be taken at least every three months.

In addition to the A1C test, the doctor will also take blood and urine samples periodically to check your blood sugar levels, cholesterol levels, thyroid function, liver function and kidney function.

The goal is to keep your daytime blood sugar levels before meals between 80 and 130 mg/dL and your after-meal numbers no higher than 180 mg/dL two hours after eating.

As long as you are not plagued by unexpected stress, blood sugar and A1C levels will decline while you are on the ketogenic diet. However, even when both A1C and blood sugar levels are normal, it is still important to monitor blood sugar levels and administer the appropriate amount of insulin.

When insulin is not used in the proper amounts at the right times, an unhealthy amount of ketones can build up in the blood and cause diabetic ketoacidosis.

Con: May Increase The Risk Of Death From Any Cause

This 2018  of 24,825 participants of the US National Health and Nutrition Examination Survey revealed a negative link between low carbohydrate diets and total and cause-specific death, based on individual data and pooled results of previous studies over a decade. Professor Banach, the study author, said, “The findings suggest that low carbohydrate diets are unsafe and should not be recommended.”

The study divided Americans into four quartiles, from lowest- to highest-carb diets. They noticed that participants in the bottom 25% the ones who ate hardly any carbohydrates, had a 32% greater risk of death from any cause than those with the highest intakes of carbohydrates.

Additionally, the low-carb bunch had a 51% higher risk of death from heart disease and a 35% increased risk of dying from cancer relative to the top 25% of carb eaters.

And it didn’t stop there.

The data was then compared with dietary data of 447,506 people worldwide and observed that on the whole, those on low carb diets had a 15% higher risk of dying. Interestingly, those who ate a moderate amount of carbohydrates were more likely to live longer than low-carb or high-carb dieters.

Is The Keto Diet Good For Diabetes

First it was low-fat. Now it’s high-fat. Is the ketogenic diet the way to go if you have diabetes? We take a look at the latest research and interview experts to see what this diet does to your blood sugar and if it’s safe for diabetes.

If you have diabetes you know that carbohydrates are important. So it may seem like an ultra low-carb diet, the ketogenic diet, is the solution to managing your diabetes with food. But is keto all its cracked up to be? Plus, is it safe to “go keto” if you have diabetes? We take a look at the latest research around keto and diabetes and what the ketogenic diet does to your blood sugar.

Related: Healthy Low-Carb Recipes for Diabetes

Ketos Promising Effects On Blood Glucose Levels

Dietary ketosis works for so many diabetics because it naturally lowers blood sugar and increases insulin sensitivity.

One convincing study from 2016 found that a low carb diet improved blood glucose levels and helped with weight loss in adults suffering from Type 2 diabetes.

Each subject was required to consume no more than 30 grams of carbs per day while increasing fats and proteins. In other words, they followed a ketogenic diet . Several smaller studies show similarly positive results.

How A Ketogenic Diet Works

Keto Diet for Type 2 Diabetes in Hardcover by Amy Moore

On a ketogenic diet, blood glucose levels are kept at a low but healthy level which encourages the body to break down fat into a fuel source known as

The process of breaking down or burning body fat is known as

People on insulin will typically require smaller doses of insulin which leads to less risk of large dosing errors.

The diet helps burn body fat and therefore has particular advantages for those looking to lose weight, including people with or those otherwise at risk of type 2 diabetes.

Reductions In Diabetes Medications

Diabetes medications all have the same goalâto reduce elevated blood sugar. The common classes include:

  • Insulin
  • Sulfonylureas
  • GLP-1 receptor agonists
  • Metformin

When your blood sugar is no longer chronically elevated, these blood-sugar-lowering medications are no longer necessary. An ongoing study has shown that sustained nutritional ketosis can lead to the permanent removal of these medications. Medications that rapidly reduce blood sugar need to be removed first, such as insulin and sulfonylureas, sometimes in as little as 2 days to 2 weeks. Other medications like SGLT-2 inhibitors, DPP-4 inhibitors, GLP-1 receptor agonists, and metformin can be removed as long as you maintain normal blood sugar.

If you are on diabetes or blood pressure medications, Virta highly recommends that you get medical supervision before making any dietary changes.

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The Ketogenic Diet For Type 2 Diabetes: How Does It Work And What Can You Eat

Joanna Filipowska, PhD

Diet is certainly one of the main factors deciding about our health, together with our genes and the level of physical activity. Someone once said: You are what you eat, and it seems very true if we think about our inappropriate eating habits often leading to diseases like obesity or diabetes, sometimes occurring together as and currently being a of the modern, Western societies. 

Bad eating behavior has its health consequences. On the other hand, a properly adjusted diet can help control different diseases. In the context of Type 2 diabetes, well-designed diets that focus on healthy meals including lean protein, vegetables, nuts, and fruits, may help better regulate high blood glucose levels, reduce weight, and prevent cardiovascular complications related to elevated cholesterol levels and hypertension. Nowadays, many diets are being recommended as a remedy against diabetes, including Mediterranean, vegetarian, or vegan eating plans. Among many options available today, one particular diet is catching the attention of both clinicians and patients with type 2 diabetes. It is the so-called ketogenic diet,  which was originally developed in the 20th century to treat . 

How does the keto diet help with diabetes?

What are the effects of the keto diet on diabetes management?

A keto diet may also lead to improvements in blood lipids. A 2020 found that the keto diet significantly reduces blood sugar levels and increases high-density lipoprotein .

Relationship Between Type 2 Diabetes And Carbs

Type 2 diabetes means that the body doesn’t respond to insulin like it should. The hormone insulin helps your body utilize blood sugar, or glucose, for energy. For patients with insulin resistance or type 2 diabetes, insulin is still produced but it may be in insufficient amounts or the body doesn’t use insulin properly. This causes blood sugar levels to increase. If not treated, chronically high blood sugar levels can lead to heart disease, kidney damage, nerve damage, eye damage, sleep apnea, and more.

To keep diabetes under control, you want to keep your blood sugar levels as close to normal as possible, says Osama Hamdy, MD, an associate professor at Harvard Medical School and senior staff physician at the Joslin Diabetes Center in Boston. 

“Glucose in blood comes predominantly from carbohydrates, so eating more carbohydrates increases blood glucose and reducing carbohydrates reduces blood glucose.”

That’s why the carb-cutting keto diet might be helpful for people with type 2 diabetes.

Two Important Considerations For The Ketogenic Diet & Type 1 Diabetes

If we look closely at the paleolithic-ketogenic diet that the 19-year-old male implemented, we can find some clues to his outstanding success. The researchers made two important adjustments to the classic ketogenic diet that helped the subject halt disease progression, restore some insulin production, and manage type 1 diabetes without any medication.

1. Vitamin D Supplementation

Vitamin D helps modulate the innate and adaptive immune responses. This means that it can help prevent and reverse the autoimmune issues that commonly cause type 1 diabetes.

In fact, it is important for everyone to supplement with vitamin d3 or daily sun exposure due to the potential consequences of Vitamin D deficiency.

For example, infants and young children who are vitamin D deficient may be imprinted for the rest of their lives with increased risks of type 1 diabetes, multiple sclerosis, rheumatoid arthritis, and many common cancers.

The simplest way to obtain vitamin D is from moderate exposure to sunlight. For more specific guidelines, many experts suggest supplementing daily with 4,000 IU vitamin D3 without sun exposure or 2,000 IU plus 1215 minutes of midday sun.

2. The Elimination of Immune System Provoking Foods From The Diet

Wheat and cows milk have been reported to cause strong immune system reactions in type 1 diabetic patients. Something that occurs less often in nondiabetics.

What Happened In Type 2 Diabetes Study: Saslow

“If you follow the ketogenic diet, it’s a very efficient way of losing weight and managing your blood glucose and getting off your glucose-lowering medicine,” says Dr. Saslow, PhD, the study leader.

The study was a follow-up to earlier research in which she and her team also found that those on the ketogenic diet lowered their HbA1c while those on the conventional low-fat diet did not.4 Just as in the current study, those on the low-carb keto diet also lost more weight.

The more recent study was conducted online to ascertain if this online approach proved effective in eliciting weight loss.1 Dr. Saslow’s team randomly assigned the 12 participants to the Keto diet and lifestyle improvement group and another 13 individuals to the traditional low-fat diet known as the Plate Method,1 supported by the American Diabetes Association. 

For the ketogenic eating plan, participants were instructed to reduce non-fiber-containing carbohydrates to between 20 and 50 grams a day, with no calorie restriction. The group following the plate method were told to eat their meals on a nine-inch plate, filling half of it with non-starchy vegetables , ¼ of the plate with whole grains and adding lean protein to the last quarter of the plate.1

Is Keto Safe For Women With Gestational Diabetes

Gestational diabetes manifests in pregnant women around the 24th-28th week of pregnancy. It causes high blood sugar levels and insulin resistance, which is dangerous for mom and baby.

Developing GD doesnt mean you had diabetes before you got pregnant or that youll have it after. But it does raise your odds of getting Type 2 diabetes down the line.

Theres some debate on the best diet for women with GD.

The general safe consensus among mainstream health experts is that you should not follow a ketogenic diet while pregnant.

But the truth is, being in ketosis is a natural part of being human and while there arent many studies on GD and the ketogenic diet, if you dig around, youll find several positive anecdotal accounts.

So the answer isnt so straightforward. Adopting a ketogenic diet might help mitigate symptoms of gestational diabetes, but it should be done with extreme caution and medical supervision.

Eating a low carbohydrate diet may be a better approach to help prevent and manage gestational diabetes. Just be sure to consult with your obstetrician before making any dietary changes so they can help guide you through the process.

Safety Of Nutritional Ketosis

Is a Ketogenic Diet Safe for Diabetics?

Reversing diabetes with nutritional ketosis is fairly simple in theory, but very complex in practice. A ketogenic diet causes rapid improvements in blood glucose, blood pressure, and changes in how the body processes electrolytes and minerals in important ways. To avoid problems with over-medication, these changes typically require daily physician monitoring of your bodyâs response to carbohydrate restriction in order to deliver prompt modifications and reductions in diabetes and hypertension medications. In addition, certain conditions such as prolonged QT-interval can make nutritional ketosis dangerous. This condition is uncommon, potentially linked to magnesium depletion, and can only be diagnosed with an EKG.

Citations and Footnotes

The Evidence Points To The Ketogenic Diet For Type 1 Diabetes

The first line of evidence for an ideal type 1 diabetes diet is a pair of case studies: one with a young girl and another with an adolescent male.

The young girl in the first case study had epilepsy and type 1 diabetes, which is more prevalent in children with epilepsy. Researchers sought after an effective diet for this complicated case, so they put the girl on a classic ketogenic diet for 15 months.

The results were promising. Since the start of the ketogenic diet, no clinically overt seizures were reported. The girl was even being much more active and reaching significant developmental achievements that she wasnt reaching before the ketogenic diet.

The researchers also tracked the girls A1C levels and glycemic control, the two most important measures for type 1 diabetics. Both of them improved significantly without any adverse side effects. These results indicate that the ketogenic diet may help manage type 1 diabetes and epilepsy simultaneously.

The results of the other case study were even more incredible. In the study, a 19-year-old male with newly diagnosed type 1 diabetes was put on a special type of ketogenic diet for 6.5 months. During this period, he was able to discontinue insulin use and restore some of the insulin production in his pancreas.

The researchers went on to conclude that:

No, it was not a honeymoon period. But he decided to stop the diet and therefore had to go back to insulin. Another patient with a much longer follow-up: Case Study

Mechanisms Of The Ketogenic Diet

The ketogenic diet is high fat, low carb and only adequate protein.  There are several mechanisms in the body that allow the ketogenic diet to benefit those with type-2 diabetes.  If you want to get to the root of the problem, instead of simply using medication to help it, but never solve it, then read on about what the keto diet does in the body.

So Is The Ketogenic Diet Safe For People With Type 1 Diabetes

One study from 2005 followed 22 people with Type 1 Diabetes for 12 months. The difference here however is they consumed 70-90 grams of carbohydrates per day versus the restrictive less than 20 grams per day on the Ketogenic Diet. Remember my motto? Moderation is the key! The results were positive; less hypoglycemia, insulin requirements were reduced and their A1c dropped from 7.5% to 6.4%.

Does The Ketogenic Diet Benefit People With Diabetes

The jury is still out on this important question! In my humble opinion, the limited research we have so far simply does not support that it does.

There have not been very many studies done and of these studies, the data is very limited or they have serious flaws.

Either there are very few participants in the studies, they dont have an even number of males vs. females, or they dont last but a few months. One study only looked at 28 people; only 21 completed the study and 20 of these participants were men. On top of this, they were only followed for 16 weeks. Okay, so we see that 20 men can limit their carbohydrates severely for 4 months and lose weight which automatically makes their A1c come down. Great! So, the real question is, how long can these 20 men stay on this diet for the rest of their lives? How long would you like to go without eating any fresh fruit? Im craving some now, so Im taking a break to go grab a snack now!

Ok, I feel better! Lets finish this up!

In a study that was sponsored in part by the Atkins Foundation in 2004; 105 participants with Type 2 diabetes were followed for one year. Half followed a low carb diet , the other half a low fat diet.

The suspense is killing you isnt it? No real differences in either A1c or weight loss in the two groups; in other words, they lost about the same amount of weight and no change in their A1c levels.

Some interesting stats

Insulin concentration before and after diets:

Further reading:

What Does Ketogenic Mean

All of our cells need fuel to function. This fuel comes from three sources: fat, carbohydrates and protein, called macronutrients. Too much protein without fat puts us at risk for a handful of complications, so protein can never healthily serve as a primary source of fuel. We are left then with fat and carbohydrates as the main providers of energy the energy that allow us to do everything from breathing and blinking as we veg out on the couch to swimming the English Channel. Our cells preferred fuel comes from carbohydrates, which are easily converted to glucose, which, in turn, is readily converted to energy. This is why athletes carb load before they compete. Peak performance occurs when the body has plenty of glucose and glycogen stores available at hand. When glycogen runs out, thats when the body turns to fat. When there is no more blood sugar for our cells to consume, they seek an alternative form of energy. This energy comes from ketones, which are compounds our body produces from stored fat. So a ketogenic diet is one that is high in fat and very low in carbohydrates, resulting in the production of ketones to be used for fuel instead of glucose.

Putting It All Together Into A Type 1 Diabetes Diet And Lifestyle

Having a normal life with type 1 diabetes is possible. In fact, most people with type 1 diabetes can manage the condition in such a way that they can reduce insulin requirements and improve their health and well-being.

Here is a quick recap of the diet and lifestyle:

  • Determine an effective treatment plan with your doctor.
  • Implement a ketogenic diet that limits dairy and wheat consumption.
  • Check blood sugar levels frequently throughout the day .
  • Supplement with vitamin D3 by getting sun exposure and taking a supplement every day.
  • Exercise daily, but make sure you monitor your blood sugar and check for hypoglycemia symptoms.
  • Get your A1C levels tested every three months to determine the effectiveness of your treatment plan.

For more on the ketogenic diet and how to get started, check out our beginners guide.

P.S. Have a look at the Keto Academy, our foolproof 30-day keto meal planner. It has all the tools, information, and recipes needed for you to succeed.

+ The food will always fit to your macros and cooking preferences!

Listen To Your Body And Your Doctor

If you are taking insulin, you may immediately need to lower your intake anywhere from as soon as you enter ketosis. For those living with Type 1, this can significantly help with controlling highs and hypos.

As with any diet, precautions need to be taken. Pregnant women and those with kidney disease are not good candidates for this diet, and some people with diabetes may find that the diet increases their insulin resistance. Dairy can often spike blood sugar, so avoiding the dairy in a keto diet and taking a Vitamin D supplement might be a better option for some people. Its important to pay attention to the way your body responds and realize that no diet is a one-size-fits-all model.

The trick to reaping the benefits of the keto diet is to stay in ketosis, which means keeping your carbs at or less of your calories. The 5% can fall anywhere between 20-50 grams a day. However, if an insulin shot is missed while in deep ketosis, theres a good chance you will find yourself quite sick, so its probably best to avoid the risk and keep carbs on the upper end of this spectrum.

This diet might be untenable as a long-term way of life for many people, but if you have iron willpower and the desire to try a restrictive diet that still allows you to indulge yourself with fatty meats and oils, a keto diet might very well be the way for you to help manage your diabetes while managing weight.

What Is Type 2 Diabetes

25 Best Can Diabetics Do the Keto Diet

Type 2 diabetes is a metabolic disorder characterized by high blood sugar and insulin levels. Often, the risk of type 2 diabetes is increased by obesity, and may additionally lead to high blood pressure, and high triglyceride levels. This state of metabolic unrest can also be known as metabolic syndrome.

When someone has type 2 diabetes their risk for chronic disease skyrockets. This means a higher risk of heart disease, cancer, Alzheimers, and many other degenerative conditions.

At its core, the problem of type 2 diabetes is a problem with insulin function. Insulin is your blood sugar boss. It gets released by the pancreas after you eat to store excess blood sugar as either glycogen or fat.

But when blood sugar keeps spiking , your glycogen storage capacity in muscle and liver tissue quickly fills up, like an overhead compartment stuffed with luggage. As a result, insulin has only one place to shove the excess sugar when you over-consume calories or simple carbs: Into the belly of the plane as body fat.

In other words, the cells that normally hold blood sugar as glycogen stop listening to insulin. They just cant store any more of it! But fat cells still can.

This is called insulin resistance, and its at the center of type 2 diabetes. When someone is insulin resistant, blood sugar stays high, insulin levels stay high, and runaway fat storage ensues.

Deep Dive: Insulin Resistance, Inflammation, and Obesity

Where Keto Comes In

How To Enter Ketosis Naturally

Disclaimer: Its important to consult with your primary physician before starting a ketogenic diet, especially if you are on any medication.

Getting into nutritional ketosis isnt complicated, but it can be tough to get through the first couple of weeks.

To get into ketosis, you have to restrict your total carbohydrate intake and replace those carbs with healthy fats and a moderate amount of protein.

After a while, you will deplete your glycogen stores . Once youre out of glucose and you continue to restrict carbs, your body will begin to make ketones from fat and use those ketones as energy.

This transition period when your body is switching from using glucose to burning fat is called keto-adaptation. And it can be rough. Stick it out if you really want to see the benefits of becoming fat adapted.

The longer you stick to keto, the more efficient your body will be at metabolizing fats as its main source of fuel.

Is The Ketogenic Diet Safe For Other Types Of Diabetes

With the overwhelming evidence supporting the ketogenic diet as a way to prevent diabetes, there are some precautions to consider.

If you have kidney disease, for instance, you need to regulate the amount of protein you eat. Too much or too little can cause complications.

The keto diet is traditionally a low- to moderate-protein diet, but some experts claim that you dont need to limit protein intake to stay in ketosis. In any case, talk to your doctor about your optimal protein intake if you have kidney disease.

What about other forms of diabetes? Is ketosis still safe? Or even beneficial?


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