Is a Ketogenic Diet Good for Type 2 Diabetes?

The ketogenic diet (or “keto diet”) stresses eating fats and proteins and severely limits carbohydrates and sugars. Because controlling carbs is important to managing Type 2 diabetes, it may seem that keto would be a go-to diet for people living with diabetes.

While the keto diet may be effective for some people living with Type 2 diabetes, there’s a lot more to consider, says registered dietitian Melissa Matteo, RD, LD.

Let’s learn more about the pros and cons of the keto diet for people with diabetes.

The keto diet and diabetes

When you’re on the keto diet, you avoid foods that contain carbohydrates — including grains and most fruits — and instead, load up on proteins and fats (think meats, eggs, cheese, oils, nuts and seeds). The goal is to have your body convert fat into energy instead of eating up those easy-to-convert carbohydrates.

When your body is running on fats (in a state of ketosis), you’ll burn off more calories. That means you ultimately lose weight because your body is putting in some serious work to keep the juices flowing.

While research shows that the keto diet is effective for managing Type 2 diabetes by lowering blood sugar (glucose) and promoting weight loss, researchers also caution that the keto diet can be notoriously difficult to stick with. Plus, research on keto’s long-term effectiveness and risks is still in its early stages.

Is the ketogenic diet safe for people with diabetes?

The keto diet can be done safely and effectively for some people living with diabetes. Matteo says determining whether it’s right for you is a question of weighing the pros and cons and talking with your doctor.

“Diabetes is a lifelong condition, so you need to consider the sustainability of such a restrictive eating pattern,” she advises. “Restrictive meal plans like keto can be effective, but it’s not always the right choice when it comes to the long term.”

Potential benefits

The ketogenic diet may help people living with Type 2 diabetes:

• Manage their blood glucose
• Lose weight
• Reduce their dependency on diabetes medication and insulin

Potential risks

The ketogenic diet does pose some potential risks. It may:

• Increase risk of hypoglycemia (low blood sugar)
• Increase risk of ketoacidosis (a lack of insulin in your body) in unmanaged diabetes, primarily in Type 1 diabetes, but it can also occur in Type 2 diabetes
• Be difficult to stick to long-term
• Lack essential nutrients and lead to a vitamin deficiency
• Cause constipation

By cutting carbohydrate intake to essentially zero, following a strict keto diet has been shown to lower blood sugar levels. But for people with diabetes, Matteo cautions that low blood sugar should be avoided.

“For people with diabetes, there’s cause for concern if their blood sugar drops too low,” she continues. “Low blood sugar is especially a risk if you’re also on certain diabetes medications or taking insulin.”

Monitor your blood glucose levels regularly and speak with your doctor if you notice signs of hypoglycemia, like:

• Weakness or shaking
• Moist skin or sweating
• Fast heartbeat
• Dizziness
• Confusion
• Unsteadiness
• Nightmares, bad dreams or restless sleep
• Blurred vision
• Headaches and seizures

“Hypoglycemia is a potentially dangerous condition that can occur for people with diabetes when your food intake is reduced or if the medication type or dose isn’t the right fit,” she stresses.

Key takeaways

“Before you start any restrictive eating pattern on your own, you should talk with your doctor or registered dietitian,” Matteo emphasizes. “They can help you understand your options, advise you on whether any particular diet could benefit you and help you understand any risks.”

The bottom line? The best diet for Type 2 diabetes is the one that manages your diabetes, works for your lifestyle and is sustainable.

“Managing diabetes with diet truly takes an individualized approach,” Matteo notes. “There’s a lot to consider, in terms of your health needs and your goals. Keto can help some people manage their diabetes, but it’s not right for everyone.”