Ketogenic Diet for Diabetes: Benefits, Risks, Tips, and More

Always talk to your doctor and a registered dietitian before making any drastic changes to your diet to discover the meal plan that works best for you.

How the Ketogenic Diet Works

Following the keto diet means reducing your intake of carbohydrates to less than 50 grams (g) per day while increasing fat and moderating protein intake. It’s known as a low-carbohydrate diet, in that it calls for less than the recommended 130 g of carbs per day.

Possible Benefits of the Ketogenic Diet for Type 2 Diabetes

Study findings on the potential benefits of the keto diet for people with diabetes are mixed. More studies are needed before scientists understand the long-term implications of the eating plan for this group. Here’s how the keto diet may help if you’re managing type 2 diabetes.

“With a higher protein and fat intake, individuals may feel less hungry and are often able to lose weight, since protein and fat take longer to digest than carbohydrates,” says Lori Zanini, RD, CDCES, the Manhattan Beach, California–based author of Eat What You Love Diabetes Cookbook. It may also help keep your energy levels up.

Benefits may include the following:

• Reduced stress on the cells that make insulin

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• Lower blood sugar levels, at times enough to help you reduce type 2 diabetes medications

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• Weight loss

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• Lower blood pressure and cholesterol levels, as a result of weight loss

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Health Risks of the Ketogenic Diet for Type 2 Diabetes

• Elevations in LDL (“bad”) cholesterol

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• Pancreatitis

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• Nutrient deficiencies
• Constipation
• Nausea and vomiting
• Dehydration
• Fatigue, headaches, and dizziness, especially early in the diet
• Decreased bone mineral density in the long term

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Always be sure to keep in close contact with your doctor when beginning a ketogenic diet.

People With Diabetes Who Shouldn’t Try the Keto Diet

Zanini cautions that people with kidney disease need to be especially conscious of their protein intake.

If you have or have had an eating disorder, work with your doctor to determine if this is the right diet for you.

“Because of the severe carb limits imposed by the ketogenic diet, the risks of bingeing, compulsive overeating, and other eating disorders is much higher,” says Sylvia White, RD, CDCES, who works in private practice in Memphis, Tennessee.

How to Start the Keto Diet if You’re Living With Type 2 Diabetes

Start by talking with your diabetes medical team, including your endocrinologist and a registered dietitian, before trying a keto diet. In addition to helping you decide if it is the right plan for you, they can check for potential issues with your medications and existing conditions.

Zanini recommends cutting carbohydrates gradually to avoid the dramatic reductions that could lead to hypoglycemia, especially if you’re on oral diabetes medications or insulin.

Continue to test your blood sugar regularly, as well. Talk to your doctor about testing your ketone levels, as the life-threatening condition diabetic ketoacidosis, a dangerous buildup of ketones when your body does not have enough insulin, is rare but possible with type 2 diabetes, White says.

Consume a balance of nutrients — all those important vitamins, minerals, fiber, and more — as well as the proper amount of calories and healthy fats. “Healthy fats include monounsaturated fats and omega-3s, which may help reduce inflammation in the body and improve cholesterol levels,” White says.

If you’re not sure what to reach for, ask your dietitian. “While this sounds so simple, often people are only thinking about what not to eat,” Zanini says. “They don’t pay attention to the nutritious foods they should be including, like nonstarchy vegetables, healthy monounsaturated fats, lean proteins, and more.”

A Diabetes-Friendly Keto Diet Food List

It’s not easy to get by on the small amount of carbs that the keto diet calls for, Zanini says. Keep in mind that you will want to avoid or limit any foods that are high in carbohydrates while getting enough protein and healthy fats.

“To follow this strict guideline, people must change not only the food they’re eating but also their entire lifestyle,” she says.

Tracking what you eat can help. You can do so either with a written food diary or through various apps on your smartphone.

• Poultry and lean protein
• Fish
• Nuts and seeds
• Eggs
• Nonstarchy veggies

• Refined grains
• Alcohol

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• Sugar in all forms
• Processed food

Are Other Diet Plans Better Than Keto if You’re Managing Type 2 Diabetes?

When in doubt, talk to your healthcare team about the meal plan that might work best for you.

Additional reporting by Melinda Carstensen and Jessica Migala.