There’s no one-size-fits-all diet to help you manage your blood sugar. I learned that the best diet is the one that works for you.

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Photography by Aya Brackett

If you’re living with type 2 diabetes, you’ve undoubtedly heard of the ketogenic (keto) diet, which has been praised for its potential to prevent or cure various diseases, including diabetes. Multitudes of fans swear by it for good blood sugar management.

A recovering lifelong dieter, I never thought I’d be drawn to what seemed like another fad diet. But then my mother died of a heart attack caused by congestive heart failure, a complication of type 2 diabetes.

Though I’d already been living with my own type 2 diabetes for nearly a decade, her death at the relatively young age of 66 was a wake-up call that prompted my own ongoing health journey.

After hearing claims of how people had reversed their diabetes and were able to stop taking medications by following the keto diet, I decided to give it a try.

The keto diet is a low carbohydrate diet that limits your carb intake to approximately 5 percent of your overall daily calories. The rest is made up of 10 to 20 percent protein and 75 to 85 percent fat.

By severely restricting carbs, you force your body to burn fat for fuel rather than glucose, the body’s primary source of energy. The byproduct of this fat-burning process is ketones, hence the name of the diet.

It’s also what makes it appealing for those with type 2 diabetes. After all, logic dictates if one doesn’t consume much dietary glucose (carbs), one’s blood sugar ought to remain relatively low.

Many with type 2 diabetes who follow the keto diet do see their blood sugars and A1C decrease, according to a 2020 meta-analysis in the journal Nutrition & Diabetes.

It’s also what happened for me. However, my A1C didn’t decrease enough to reverse my diabetes.

According to the American Diabetes Association (ADA), type 2 diabetes can’t be cured. Even if no symptoms manifest, the disease is still present and could recur.

However, it is possible to put it into complete or partial remission. This is achieved by reaching A1C levels of nondiabetic or prediabetic ranges without the use of medication.

According to the ADA, a nondiabetic A1C is below 5.7 percent. The prediabetic range is between 5.7 percent to 6.4 percent.

Although following the keto diet helped me reduce my medication, I couldn’t stop taking it. Therefore, I can’t count myself among those able to put their diabetes into remission.

However, I did learn a lot about the nature of diabetes, including how much I can affect my own health through changes to my lifestyle.

After following the diet for nearly 2 years, I believe the reasons keto wasn’t more effective for me come down to three main factors.

Dysregulated gluconeogenesis

Most of us logically think if we don’t eat carbs, our blood sugar will go down. Unfortunately, when it comes to diabetes, things aren’t so simple. Although my blood sugars did go down with keto, they didn’t go down significantly, and I still needed medication to stay in goal range.

At first, I thought the solution was to eat even fewer carbs — as if 20 grams per day (the average consumed on a keto diet) wasn’t low enough!

So, I experimented with fasting as well as the carnivore diet. That’s when I finally discovered what was really happening.

I had some of the highest blood sugars of my life when I was on the carnivore diet and while fasting, despite not consuming any carbs. That’s because my liver was making glucose through a process called gluconeogenesis.

Though the human body is designed to make ketones for fuel when glucose is scarce, it can’t function on ketones alone. Thus, the liver makes a supply of glucose during periods of starvation (including the absence of carbs) by synthesizing it from proteins.

Increased gluconeogenesis is thought to be a primary factor in type 2 diabetes and a cause of hyperglycemia (high blood sugar). Insulin is a key hormone that inhibits gluconeogenesis, but insulin resistance (the body’s inability to properly utilize insulin) causes impaired insulin signaling.

It’s clear the carnivore diet was a poor choice for me, but I had hyperglycemia even while fasting — with no carbs or protein for my liver to synthesize into glucose.

In someone without diabetes, fasting stimulates the hormone glucagon, which tells the liver to release its glucose stores, a process called glycogenolysis. Their body then produces insulin to rebalance their glucose levels.

But someone with type 2 diabetes may not be able to produce enough insulin to compensate for the increased glucose, especially if insulin resistance means they need extra amounts of it. Thus, when I fasted (or ate too few carbs) my blood sugars soared.

Over time, I learned I have a carb “sweet spot.” Too many carbs make my blood sugars go up, but so do too few. For me, keto was too few.

Impaired gut microbiome

After a bad reaction to a diabetes medication that causes slow gastric emptying, I was determined to see if I could heal my gastroesophageal reflux disease (GERD), a condition I had for over 2 decades. I believe GERD was primarily responsible for the reaction.

New research connects GERD with dysfunction in the gut microbiome, including in a 2019 study in the Journal of Thoracic Disease and a 2021 study in the World Journal of Gastroenterology. So I gave a gut healing program a try.

By happy “accident,” not only did I succeed in healing my GERD, but my blood sugars also dramatically improved — more significantly than they had on keto!

I didn’t do the gut program for my diabetes, so I never would have believed the effect if I hadn’t experienced it for myself. But ultimately, it was healing my gut microbiome, not keto, that made the most difference for me.

It lowered my A1C enough that I could move from taking two medications down to just one — metformin, a drug that doesn’t affect insulin production. That means I sufficiently altered my insulin sensitivity such that my body makes enough of its own insulin to manage my blood sugar.

What was most surprising is that I ate more carbs on the gut diet, which allowed starchy vegetables like sweet potatoes and squash, fiber-rich beans, whole grains like quinoa and black rice, and even some lower carb fruits like green apples — none of which are allowed on the keto diet.

This is when I finally discovered I do best on a moderately low carb diet, as long as I have a healthy gut microbiome. In fact, a higher carb allowance lets me feed my gut flora plenty of plant diversity, so I can maintain the good bacteria with prebiotics.

New research supports this for type 2 diabetes. A 2021 study in Life Sciences found that gut dysbiosis (a lack of beneficial bacteria in the gut) could be responsible for as much as 90 percent of type 2 diabetes cases. This is because regulation of metabolism, insulin sensitivity, and blood glucose levels begins in the gut.

When I was disappointed keto didn’t do more for my diabetes, my primary care doctor reminded me, as the ADA points out, there are more genetic factors involved in type 2 diabetes than even type 1 diabetes.

In fact, research shows that if one parent has type 2 diabetes, an individual has a 40 percent chance of developing the condition in their lifetime. If both parents have type 2 diabetes, that risk increases to 70 percent.

Sometimes, we can only influence so much.

This was the most important lesson keto taught me because it allowed me to finally stop blaming myself. Society constantly tells us that type 2 diabetes is a dietary disease when in fact, genetics play a huge role.

Despite knowing diabetes runs in my family, I blamed myself for years for being diabetic. Meanwhile, I watched everything I ate, while my friends and family without diabetes ate all the candy and carbs they wanted.

The self-blame didn’t make much sense, given how well I tried to take care of myself.

Type 2 diabetes is a multifactorial condition, involving both insulin resistance and deficient insulin production, research shows.

Many point to insulin resistance as the primary factor in type 2 diabetes, but this doesn’t tell the whole story. Yet research shows that even the development of insulin resistance, often blamed solely on lifestyle factors, can have a genetic component.

Moreover, because of these genetic factors, a 2016 study in Diabetes Care shows only about 40 percent of those with type 2 diabetes will be able to reverse it through diet and exercise. That leaves about 60 percent of us who can’t.

That doesn’t mean adopting a healthy lifestyle isn’t worth the effort, though. Although I can’t heal my genetics through diet and exercise, my efforts have shown I can influence my insulin resistance.

The work I’ve done to heal my gut microbiome and find the right amount of carbs that work for me has allowed me to keep my A1C below 7 percent on metformin alone. For me, this is major progress, as I was once on three diabetes medications.

Although keto wasn’t the best solution for me, I’m grateful for what it taught me about my type 2 diabetes. It started me on a journey that’s made me healthier than I’ve been in more than a decade.

Though our health may not always be 100 percent within our control, it’s taught me that there are at least a few things we can influence.

It’s also important to remember that everyone’s different. My experience with keto may not be the same as yours. There are thousands of people with type 2 diabetes who swear by the keto diet because it works for them.

My sister is one of them. She also has type 2 diabetes, but unlike me was able to put her diabetes into remission by following the keto diet.

There’s no one diabetes diet recommended by the ADA, and many types of diets can successfully help you manage your blood sugar. It just takes experimenting to see what works best for you.


Sarah Graves, PhD, lives in Ohio with her husband and son. Her work has appeared in print and online publications including USA Today, Money Crashers, Red Tricycle, and others. In addition to writing about personal development, parenting, education, personal finance, and creative entrepreneurship, she loves reading and writing sci-fi and fantasy — especially with her super amazing kid. Follow her on Twitter.