How the Ketogenic Diet Works for Type 2 Diabetes

The keto diet is gaining traction around the world.

Researchers are looking into the keto diet to determine its many beneficial effects.Nutritionists are implementing this diet right, left, and centre.

People from all walks of life are scrambling to get the ketogenic lifestyle going in their own lives.

Elite athletes, people looking to lose weight, children with epilepsy, and adults with cancer have all used this diet.

So what’s all the buzz about?

Is this simply a trend that will fade as the years go by?

Researchers may have something to say about that.There is a lot of evidence to show the benefits of the ketogenic diet. Let’s talk about the keto diet and diabetes.

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What is the keto diet?

The ketogenic diet is often shortened to the keto diet. This diet was designed a century ago. It usually involves less than 50 grams per day of carbs and more than 75% fat. This is a low carbohydrate diet. There is normally a low to adequate amount of protein. The amount of calories does not change.

The ketogenic diet promotes physiological ketosis. It ensures that the body uses lipids. It induces fasting like effects.

The ketogenic diet was originally used for children with refractory epilepsy.

This diet is usually animal protein based. Nutritionists often recommend multivitamin supplementations. More recently, nutritionists are proposing ketone supplements as super metabolic fuel.

The Atkins diet gained popularity years ago for being low in carbohydrates. The ketogenic diet is also low in carbs, but uses high fat for optimal results.

Understanding “high-fat” in the ketogenic diet

Fat is the largest energy reserve in the human body. Fat induces fasting like effects and results in the production of ketone bodies.

Evidence shows that the ketogenic diet is a safe and effective way to reduce glycemia in diabetic patients.

It also doesn’t produce any significant cardiovascular risks.

Most studies on the keto diet specifically restrict carbohydrates, since it is a low carb diet.

This tends to lead to higher protein intake. That reduces the effects of nutritional ketosis. However, diets that limit protein and carbohydrates end up having a very high fat composition.

These types of diets appear to be even more effective. They help to reduce glucose and whole body glucose metabolism in humans.

Technically a ketogenic diet following the proper fat ratio can still be effective. However, there should be an emphasis on healthy fats.

Effects on blood glucose

Research shows that the ketogenic diet helps with diabetes.

It also helps with “diabesity”, a condition involving both diabetes and obesity. These two conditions are often concomitant.

Clinical studies show that carbohydrate restriction and weight loss can improve hyperglycemia, obesity, and type 2 diabetes.

Reducing carbohydrate intake leads to increased ketogenesis. This lower carb intake level is typically below 50 grams. This helps to provide fuel for the body.

Low carb ketogenic diets were used to treate obesity and diabetes in the 19th and 20th centuries.

Recent clinical research has reinvigorated the use of the ketogenic diet for obesity and diabetes.

Chronic hyperglycemia characterizes type 2 diabetes. However, the underlying causes are high insulin levels and insulin resistance/reduced insulin sensitivity. These are usually a result of increased energy intake leading to obesity.

The ketogenic diet substantially reduces the glycemic response from dietary carbohydrates. It also improves the underlying insulin resistance.

The current treatment of type 2 diabetes emphasizes drug use and a higher carbohydrate diet. However, the ketogenic diet is an effective alternative that relies less on medication. It may even be a preferable option when diabetes medications are not available.

One trial looked at subjects who followed a keto diet and changed several lifestyle factors. These factors included physical activity, sleep, positive mood, and mindfulness. The study found that this helped overweight people with type 2 diabetes or prediabetes lose weight. It also helped them to improve glycemic control.

Another study looked at safety and tolerability of the ketogenic diet in treatment of type 2 diabetes.

This study involved a weight loss program that also included lifestyle and behavioural modification support. This was called the Diaprokal Method.

This study looked at 89 men and women between the ages of 30 and 65 years. They all had type 2 diabetes and had a BMI between 30 and 35 kilograms per metre squared. This was a clinical trial that went on for four months.

Researchers randomly assigned 45 subjects to the keto diet and 44 to a standard low calorie diet.

There were no significant differences in the laboratory safety parameters between the two study groups. Changes in the urine albumin to creatinine ratio in the keto group were not significant. They were also comparable to the control group. Creanine and blood urea nitrogen did not change significantly compared to baseline or between groups. These are important values because they represent kidney function.

Weight loss and waist circumference reduction were significantly larger in the keto group than the control group. Decline in hemoglobin a1c and glycemic control was larger in the keto diet group. No serious adverse events occurred.

Researchers concluded that the keto diet is more effective in reducing body weight and improving glycemic control compared to a standard hypocaloric diet. A ketogenic diet is also safe and type 2 diabetes patients tolerate it well.

Some patients claim that the keto diet can help cause diabetes remission.


Exercise capacity

One study investigated the effect of a 31 day keto diet on submaximal exercise capacity and efficiency.

This randomized, repeated measures, cross over study took place in eight trained male endurance athletes.

Researchers randomized participants to receive their normal diet (43% carbs and 38% fat) or a keto diet (4% carbs and 78% fat). Participants performed a fasted metabolic test two days before the study began and on day 29. They ran to exhaustion at 70% VO2 max the day before the study began and day 31. This was after having either a high carb meal or a low carb high fat meal.

The study found that participants were able to maintain exercise efficiency on a ketogenic diet when exercising at less than 60% of their VO2 max.

Another study looked at the effects of the keto diet on endurance exercise capacity. Researchers looked at mice’s running performance after consuming the keto diet for eight weeks.

Mice eating the keto diet dropped weight dramatically, even though they ate more calories. They also had enhanced running time without aggravated muscle injury.

The potential mechanism is a keto adaptation enhanced capacity to transport and metabolize fat. The keto diet also demonstrated a potential preventive effect on organ injury from acute exercise.

Researchers in this case concluded that the keto diet may contribute to prolonged exercise capacity.

Another study found that eight weeks on the keto diet increases capacity of endurance exercise in mice. These mice also didn’t have aggravated muscle injury. This was despite the decrease in absolute muscle volume.

Once again, researchers figured that the mechanism behind this is the enhanced ability to mobilize and use fat.

Exercise recovery

This study looked at whether a keto diet influences post exercise recovery. Researchers measured blood bio markers, muscle and liver oxidative states, and fatigue recovery. They found that several biochemistry markers showed exercise induced injury improved form a keto diet.

They didn’t observe any liver damage. The blood biomarkers also showed that mice were able to recover more quickly after exhaustive exercise.

Lactate concentration is a marker often used as an exhaustion index. The keto diet was able to lower lactate concentration. An open field test showed that the keto diet contributed to increased locomotion after exhaustive exercise.

There is robust evidence showing increases in fat oxidation from the keto diet. These even occur in elite athletes. They happen within three to four weeks of the keto diet. They have even been reported as soon as five to ten days of adhering to the keto diet.

The ketogenic diet can double exercise fat use to 1.5 grams per minute. Maximal rates of oxidation can shift from 45% to 70% of maximal aerobic capacity.

Different types of exercise

One study looked at the keto diet in endurance trained athletes. After three to four weeks, they were able to maintain moderate VO2 max (46 to 63%). They were also able to maintain vigorous intensity (64 to 90%) VO2 max endurance exercise.

They saw beneficial effects in the 2000 metre sprint. Moreover, they also saw benefit in the critical power test for short duration at vigorous intensity. They saw benefits with the six second sprint as well.

The keto diet group lost more body fat.

The researchers concluded that the keto diet has benefits during short duration vigorous and sprint bouts of exercise.

All this evidence shows that the ketogenic diet can potentially prevent fatigue and promote recovery in endurance athletes.

Other benefits

Aside from the above, the keto diet can also have the following benefits:

  • Refractory epilepsy

  • Cancer management

  • Weight loss

  • Cholesterol levels

  • Heart disease risk factors (i.e. high blood pressure)

  • Cardiac ischemic preconditioning

  • Improves oxygenation in patients with respiratory failure

  • Beneficial impact on polycystic ovarian syndrome


Kidney damage

Studies have found possible kidney damage from the ketogenic diet. This damage is caused by significant excretion of nitrogen. This was found in animal models. This was also due to the effects of acidosis. Increasing triglycerides and cholesterol levels in ketogenic diets are also concerning.

Endurance decrement in elite athletes

There is also a risk of endurance decrement in elite athletes on the ketogenic diet. Endurance athletes can have unavoidable depletion of carbohydrate stores.

Lower ability of muscles to use glycogen for oxidation

Ketogenic adaptation may impair muscles’ ability to use glycogen for oxidation. This compromises the use of a more economical energy source when the oxygen supply is limited. This means that performance at higher exercise intensity (more than 80% of maximal aerobic capcity) can suffer.

At intensities higher than 70% of maximal oxygen volume, increases in fat oxidation are associated with increased oxygen consumption. This means a decreased oxygen economy. In some cases, these can lead to higher ratings of perceived exertion and heart rate.

Keto flu symptoms

Many people report feeling ill while first experiencing the keto diet. This is termed the “keto flu”. The symptoms include fatigue, headache, nausea, and constipation. They tend to go away after two to seven days.

Other diets


The keto mediet combines the benefits of a keto diet and a Mediterranean diet. This is a pyramidal model. It is rich in various vitamins. It also substitutes coconuts for saturated fats from animals.

This approach encourages adherence to healthy diet and lifestyle changes. That includes exercise.

One study looked at subjects from 40 to 75 years of age. Those who complied with the keto mediet significantly enhanced their knowledge and adopted a healthier lifestyle. Those who stuck to modern eating patterns were typically less healthy.

Nordic diet

The Nordic diet emphasizes the intake of plant foods, including whole grains such as rye, barley, as well as oats, berries, legume, and fatty fish.

One study looked at nutrition therapies for type 2 diabetes. Recent short term studies show that similar beneficial outcomes are present after different diets. Different approaches seem to result in comparable weight loss and impacts on metabolic factors.

Researchers believe that they should consider more individualized approaches in nutrition therapy. They concluded that individualized nutrition is good for type 2 diabetes and that clinical guidelines should reflect this.

Researchers also said that more studies are necessary to find the impacts of diets on different health parameters. They stated the need to prioritize these studies because of the growing prevalence of type 2 diabetes. They added that dietary changes may have greater benefits than what they previously believed.

Create Your Plate diet

The American Diabetes Association has what they call a “Create Your Plate” diet. This is a certified diabetes diet plan. One study looked at overweight adults with a BMI over 25. They all had type 2 diabetes with a hemoglobin A1c of 6.5 to 9.0%.

Researchers randomized subjects to a 32 week keto diet or the “create your plate” method. The goal was to assess the impact of each intervention on glycemic control and other health outcomes.

At 32 weeks, the keto diet group reduced hemoglobin A1c levels more than the “create your plate” group. More than half the keto group participants lowered their hemoglobin A1c to less than 6.5%. This is substantially more than the 0% of the “create your plate” group that was able to do the same.

Participants in the keto group lost more weight than those in the “create your plate” group. A greater percentage of participants lost at least 5% of their body weight in the keto group versus the “create your plate” group.

Participants in the keto group lowered their triglyceride levels more than the participants in the “create your plate” group.

Dropout was 8% for the keto group and 46% in the “create your plate” group. This means that something about the ketogenic diet was easier to stick to.

Monitoring diabetes

It is important to monitor your diabetes and maintain blood sugar control. You don’t want to have high blood sugar or low blood sugar. This is one way of helping to prevent diabetic ketoacidosis.

One important measure for blood sugar level is what’s called fasting blood glucose. This is the amount of glucose in your serum before consuming a meal.

Fasting blood glucose in an average healthy person is around 100 mg/dL (5.6 mmol/L). For those with diabetes, a good fasting blood glucose level to aim for is between 4.0 and 7.0 mmol/L.

Another way of measuring blood sugar is by looking at what’s called postprandial blood glucose. This is the amount of sugar in your serum two hours after eating. This value should be between 5.0 and 10.0.

If your HbA1c targets are not being met, however, you’ll want to aim for 5.0 to 8.0 postprandial blood glucose. What is HbA1c? This is yet another way to measure blood sugar, but this value shows your blood sugar status over a longer period of time. Your target HbA1c should be 7.0% or less.

So it doesn’t look like the keto diet is just a trend after all.

There is robust evidence to support using the ketogenic diet in several different kinds of people.


If you have diabetes, you may want to consider trying the ketogenic diet.

Please note that the keto diet is not right for everyone. For example, if you have type 1 diabetes or gestational diabetes this may be better managed in a different way. For type 1 diabetes you may require insulin injections. Everyone is an individual. It’s important that you talk to your doctor.

It is important that you talk to a health care provider first to see if it is a good choice for you.

Speak to your health care provider today, and ask them about the ketogenic diet.

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