Is Keto Diet Good for Diabetics?

Dr. Jugal Gada

Over the last decade or so tremendous amount of research has been done in the field of obesity.

We have understood we are, “What we eat”, “When we eat” and “How much we eat”. With not many pills to tackle obesity we have realized the hidden potential of food as medicine.

Keeping above in mind, multiple diet regimes have been evolving over a period, and one such has been “Keto diet”.

Let us first understand what Keto diet is all about.

A ketogenic diet is a very low-carb diet with around 30g of carbohydrates per day with a moderate protein and high fat intake (70-80% calories). There are multiple variations by which people do it.

Is Keto Diet good for Diabetes

Why a Keto Diet? And How does it Work?

Going back in history, traditionally keto diet was first used in the 19th century, mainly to help control diabetes. In 1920 it was introduced as an effective treatment for epilepsy in children in whom medication was ineffective.

  • Thereafter it has also been tested and used in for cancer and Alzheimer’s disease.
  • Carbohydrates are the prime source of glucose and thus energy for all the cells in the body.
  • Dietary carbohydrates are the main driving force for insulin secretion too.
  • Keto diet keeps the body in a carbohydrate deprived state. It hence encourages the body to get its energy from burning body fat by producing an energy source known as ketones.
  • Reducing carbohydrate intake may lead to a decrease in insulin requirement, improvement in insulin sensitivity and a reduction of postprandial glycaemia.
  • The diet helps to lower the body’s demand for insulin which has benefits for people with diabetes.

Do we have enough research to use it for all?

The ketogenic diet has been shown to produce beneficial metabolic changes in the short-term. (1, 2)

Insulin resistance, high blood pressure, and elevated cholesterol and triglycerides all have improved in patients with a keto diet in obese patients with diabetes. (1, 2)

Other improvements that are seen are:

  • Increased satiety
  • Decreased hunger. Satiating effect with reduced food cravings due to the high-fat content of the diet.
  • Increased calorie expenditure due to the metabolic effects of converting fat and protein to glucose.
  • Promotion of fat loss versus lean body mass, partly due to decreased insulin levels.

But there are potential Pitfalls…

  • Challenging to maintain the high-fat diet for a longer duration.
  • Hunger, fatigue, low mood, irritability, constipation, headaches, and brain “fog” due to extreme carbohydrate restriction that may last for weeks.
  • Increased fatty deposition in the liver
  • Deranged lipid profile.
  • The long-term ketogenic diet has been linked to increased risk of kidney stones and osteoporosis and increased blood levels of uric acid.
  • Possible nutrient deficiencies
  • Cost involved

Coming to the scientific evidence (2) for the keto diet, in the short term studies of up to 4 months, there is a benefit in terms of sugar control, weight loss and metabolic parameters, however, longer studies up to 2 years have not shown added advantage over the low carbohydrate diet.

One concern involves the relative lack of data about long-term safety, adherence, and efficacy of Keto diet in patients with diabetes.

Because Keto diet results in ketosis, these meal plans are not suitable for some patients with T2D, including women who are pregnant or lactating, people with or at risk for eating disorders, or people with renal disease.

Moreover, due to the increased risk of diabetic ketoacidosis (DKA), patients taking SGLT-2 inhibitors should avoid very-low-carbohydrate/ketogenic diets.

With type 1 diabetes, the ketosis could be detrimental and hence currently not advisable to do a keto diet.


It is well said ‘A calorie is a calorie’ and ‘every time you eat is a chance to overeat’. Each patient of diabetes is different, and hence their nutritional needs are also different. Thus ‘one size fits all’ does not work well.

Consult your endocrinologist or nutritionist before embarking upon the keto diet journey.