Lifestyle modification is the cornerstone of diabetes management. Regular exercise, and adequate nutrition, in combination with drug therapy, if required, can significantly improve long-term outcomes. There are several eating patterns or diets that may work for a diabetic. However, managing diabetes requires an individualized approach. 

It is imperative to consult a registered dietitian and your doctor before adopting any eating pattern. A dietitian, being a nutrition expert, will assess your overall nutritional status, food preferences, and health goals and will work to create a tailored meal plan that aligns with your treatment goals. 

In recent years, among the different types of diets, the ketogenic (keto) diet has gained considerable popularity among people with diabetes, especially those with excess weight.

Understanding the Keto Diet and Its Effects on the Body

The keto diet comprises high fat, moderate protein, and very low carbohydrate content (usually less than 50 gm in a day). In the keto diet, the dietary macronutrients are given in the ratio of 55% to 60% fat, 30% to 35% protein, and 5% to 10% carbohydrates. 

Carbohydrate is the main source of energy for our body. But when dietary carbohydrate is restricted, glycogen (stored form of glucose) in the liver is broken down to release glucose for energy utilization by the body. After a few days of carbohydrate restriction, liver glycogen stores get depleted and there is a low blood glucose level. In order to meet the energy demands, the body uses an alternate source of energy, ketone bodies, by initiating the process of ketogenesis. 

Ketogenesis involves the breakdown of triglycerides into fatty acids in the liver. Fatty acids are further metabolized into acetoacetate which is converted to beta-hydroxybutyrate and acetone. These are the ketone bodies produced when a person is on a carbohydrate-restricted diet, and are used as body fuel. This metabolic state is called ‘nutritional ketosis’. 

Nutritional ketosis is different from ketoacidosis. In nutritional ketosis, there is no change in blood pH as ketone bodies are produced in amounts that are considered safe. Ketoacidosis, on the other hand, produces ketone bodies in large amounts causing changes in blood pH that can be life-threatening.

Benefits of Keto Diet in Type 2 Diabetes

  • Effect on glucose-lowering drugs: Due to its blood sugar lowering and stabilization impact, the keto diet has been found to lower the dose of hypoglycemic drugs and insulin therapy. Discontinuation of medications and insulin by subjects has also been reported in some studies. 

  • Effect on body weight: Weight loss in obese diabetics has been correlated with improvement in HbA1c levels, and the keto diet is highly effective in reducing body weight. This is because the body uses fat as a source of energy, promoting fat loss and weight loss. The high fat content in the keto diet slows the digestion process and provides satiety for a longer duration. Additionally, ketones produced through the breakdown of fatty acids, have appetite suppression and diuretic (increased urine production) effects. 

Side-Effects of Keto Diet in Type 2 Diabetes

When following a keto diet, your body shifts its fuel source from glucose to fat which is a significant change, and thus it requires time to adapt. After initiating the keto diet, you may experience a group of symptoms, known as ‘keto-flu’, which may last up to 4 weeks. The 

Keto-flu symptoms include:

  • Confusion or slow thinking
  • Lightheadedness
  • Exhaustion
  • Difficulty in sleeping
  • Pounding heart while lying
  • Cravings

By reducing the carbohydrate content gradually over a few weeks, you can lower the effect of keto-flu.

Apart from keto-flu, you may also experience:

  • Changes in bowel habits
  • Loss of electrolytes 
  • Lack of energy
  • Leg cramps
  • Bad breath

All the above side effects are temporary and usually get better within a few weeks.

However, since the keto diet carries the risk of hypoglycemia (low blood sugar) for diabetic people, it is crucial to be closely monitored by an expert, especially during the initial weeks. You should also keep a regular check on your blood glucose level when following the keto diet.

Some people with diabetes may not be suitable for the keto diet including those with:

  • Very low Body Mass Index (BMI)
  • Increased risk of hypoglycemia
  • Complications associated with diabetes

Keto diet has been found to be beneficial in managing blood glucose levels and losing excess body weight in numerous studies. However, it is crucial to consider individual factors. Always consult your doctor and a dietitian before initiating the keto diet.

Moreover, it is very important that those who are on oral hypoglycemic drugs or insulin, before starting the keto diet, should reduce or adjust their medications to avoid hypoglycemia and associated emergency conditions. 

A ketogenic diet in diabetes requires strict self-discipline and careful adjustment of glucose-lowering medications and insulin to minimize the chances of potent side effects and complications. You may speak to a Dietician online or ask a doctor online for more information on this.

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Disclaimer: Information provided on this page is not intended to substitute for proper medical advice provided by your healthcare professional. This is only for informational purposes. 

About the Author

Kanika Kulshreshta

Kanika Kulshreshta is a post-graduate in Food and Nutrition with more than 10 years of experience in the field of medical and health writing. During her career she has been involved in writing for both the digital and print media. She has expertise in writing for in‐depth multimedia (e-Learning) training programs on different disease states, drug pharmacokinetics, scientific abstracts, articles, blogs and web content. Presently, she is working with Ebixcash as a medical writer and associate editor.

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