Is Keto the Answer to Managing Diabetes?

by Sarah Limbert, RDN, LD

Last Updated: July 13, 2020

Is following a ketogenic diet the answer to managing diabetes? This is a common question, especially as people have more time to contemplate their health during the COVID19 pandemic. The logic seems to fit; significantly decrease overall carbohydrate and sugar intake and high blood sugar will no longer be a worry. Although this theory may appear simple, the human body is very complex. First, let’s take a look at how the ketogenic diet works.

What is a ketogenic diet? A ketogenic (or keto) diet is a very low carbohydrate, high fat eating pattern. General recommendations include 70-80% of calories from fats, 5-10% of calories from carbohydrates and moderate intake of protein. Originally developed for seizure control in pediatric patients with epilepsy, the goal of the diet is to allow the body to enter a state of ketosis. Ketosis occurs naturally during times of starvation as the body breaks down fat stores to be used for energy when glycogen stores are no longe What is diabetes? Diabetes occurs due to a lack of availability of insulin or insulin resistance. Insulin is the key to allow glucose, the building blocks of carbohydrates, into our cells. Without insulin, our bodies are not able to unlock our cells to allow this entry which causes blood sugar to increase. When diabetes is present, it is important to watch for signs of low and high blood sugar as both can be detrimental to health and even life threatening. Is keto the solution? According to the 2019 American Diabetes Association's Standards of Care, the best approach to managing diabetes is dependent on the individual’s personal preferences, needs, and goals. This standard of care allows for flexibility in macronutrient distribution. Our bodies utilize carbohydrates as the most readily available source of energy and typical recommendations are to consume approximately 50-55% of daily calories from carbohydrates. This is approximately 45-60gm for women and 60-75gm for men at each meal, but can vary per individual. A low-carbohydrate diet may recommend 45% or less calories from carbohydrates, but there is currently no agreed upon definition for low-carbohydrate diets. Following a ketogenic diet does not allow the body to utilize this source of energy, causing fatigue, as well as restricting access to many vital vitamins and minerals. A ketogenic diet may be effective in lowering blood sugar but is not necessary for blood sugar control and may be difficult to follow. When selecting fats on the keto diet, be sure to include healthy/unsaturated fats as high levels of saturated fat intake can increase heart disease risk in those with Type 2 Diabetes. It’s important to note that anytime you are in a state of ketosis it is important to consult a physician. This is even more important when diabetes is present. What does this all mean? To ensure steady blood sugar control, the Academy of Nutrition and Dietetics recommends eating a carbohydrate controlled, well-balanced, individualized diet with a focus on intake of fruits, vegetables, whole grains, lean proteins and low-fat dairy products. Currently, research is inconclusive on the long-term effects of ketosis on the body and overall health. Although there are differing beliefs regarding a ketogenic diet and its effect on managing diabetes, it is recommended to follow a well-balanced, carbohydrate-controlled diet to manage diabetes until long-term effects are known.

Disclaimer: This information is educational only and not providing healthcare recommendations. Please see a healthcare provider.


Sarah Limbert, RDN, LD

Sarah Limbert, RDN, LD

Sarah has experience working with patients on everything from weight loss to fertility, to seizure management. She’s a true expert on how patients can benefit from ‘food as medicine,’ all while maintaining their lifestyle and livelihood. In her spare time, she leads a non-profit focused on providing basic needs and creating a future for children in India, Kenya and locally in Cincinnati.