How the Ketogenic Diet Works for Type 2 Diabetes

Written by Kristeen Cherney | Published on August 13, 2014
Medically Reviewed by George Krucik, MD, MBA on August 13, 2014

What Is the Keto Diet?

Special diets in type 2 diabetes often focus on weight loss, so it might seem crazy that a high-fat diet can be one answer to diabetes. But the ketogenic (keto) diet, high in fat and low in carbs, can potentially change the way your body stores and uses energy, easing diabetes symptoms.

With the keto diet, your body converts fat, instead of sugar, into energy. The diet was created in 1924 as a treatment for epilepsy, but the effects of this eating pattern are also being studied for potential usefulness with type 2 diabetes. The ketogenic diet may improve blood glucose (sugar) levels while also reducing the need for insulin. However, the diet does come with risks, so make sure to discuss it with your doctor before making drastic dietary changes.

Understanding “High-Fat” in the Ketogenic Diet

Many people with type 2 diabetes are overweight, so a high-fat diet can seem unhelpful. The goal of the ketogenic diet is to have the body use fat for energy instead of carbohydrates or glucose  To stay energized, a person on the keto diet gets most of their energy from fat, with a smaller part of the diet coming from carbohydrates and protein.

The ketogenic diet doesn’t mean you should load up on saturated fats, though. Heart-healthy fats are the key to sustaining overall health. Some healthy foods that are commonly eaten in the ketogenic diet include:

  • eggs
  • fish such as salmon
  • cottage cheese
  • avocado
  • almond butter

Effects on Blood Glucose

The ketogenic diet has the potential to decrease blood glucose levels. Cutting carbohydrates is often recommended for people with type 2 diabetes because carbohydrates turn to blood sugar and, in large quantities, can cause blood sugar spikes. If you already have high blood glucose, then eating too many carbs can be dangerous. By switching the focus to fat, some patients can experience reduced blood sugar.

Potential Dangers

Changing your body’s primary energy source from carbohydrates to fat causes an influx in ketones in the blood. For some diabetes patients, this is extremely dangerous. When you have too many ketones, you may be at risk for developing diabetic ketoacidosis (DKA). DKA is most prevalent in type 1 diabetes when blood glucose is too high. Still, DKA is a possibility in type 2 diabetes if ketones are too high.

If you’re on the ketogenic diet, consider testing ketone levels to make sure you’re not at risk for DKA. The American Diabetes Association recommends testing for ketones if your blood sugar is higher than 240 mg/dl. You can test at home with urine strips.

DKA is a medical emergency. If you’re experiencing the symptoms of DKA, see your doctor immediately. Complications can cause diabetic coma.

The warning signs of DKA include:

  • consistently high blood sugar
  • dry mouth
  • frequent urination
  • nausea
  • breath that has a fruit-like odor
  • breathing difficulties

Monitoring Your Diabetes

The ketogenic diet seems straightforward. Unlike a typical low-calorie diet, however, a high-fat diet requires careful monitoring. In fact, you may even start the diet in a hospital. Your doctor needs to monitor both blood glucose and ketone levels to make sure that the diet isn’t causing any adverse effects. Once your body adjusts to the diet, you may still need to see your doctor once or twice a month for testing and medication adjustments.

Even if your symptoms improve, it’s still important to keep up with regular blood glucose monitoring. Ideally, you should check your sugar before and after meals.


The ketogenic diet may offer hope to patients with type 2 diabetes who have difficulty controlling their symptoms. Not only do many patients feel better with fewer diabetic symptoms, but they may also experience a reduced dependence on medications. Still, not everyone has success on this diet. Some may find the restrictions too difficult to follow long-term. Yo-yo dieting can be dangerous for diabetes, so you should only start the ketogenic diet if you’re sure you can commit to it.

While you may be tempted to self-treat with a more “natural” route through dietary changes, be sure to discuss the keto diet with your doctor first. The diet may throw off your blood sugar levels, causing further issues.

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