Ketogenic Diets and Type 2 Diabetes Mellitus

Ketogenic Diets and Type 2 Diabetes Mellitus

The Rising Impact of Type 2 Diabetes and Obesity

Type 2 Diabetes Mellitus (T2DM) is on track to be one of the most consequential diseases of the 21st century, with a nearly 50% lifetime risk for the overall US population and affecting almost 10% of the adults in the US. 1

One of the main culprits of such an increase in Type 2 Diabetes prevalence is the associated increase in obesity, with almost 75% of US adults being obese/overweight. 2 Obesity in and of itself is a major risk factor for earlier mortality, cardiovascular diseases, cancer, etc. and T2DM alone is responsible for an average loss of almost 6 years of life for men and 7 for women if diagnosed at the age of 40 years. 3

Treating Type 2 Diabetes and Obesity with Keto Diet

In light of such dire statistics, many diets and similar dietary methods have been proposed to treat T2DM and obesity. Over the last couple of years, one of the main contenders has become the ketogenic diet, i.e., a very low-carbohydrate ketogenic (VLCK) diet designed to have the body use “ketones” as a fuel source. 

In its simplest form, a classic ketogenic diet is a precise way of eating where most energy comes from fats, a decent amount from proteins, and very little from carbohydrates. The fats are usually obtained from everyday foods, proteins are adjusted based on what is needed for growth, and carbohydrates are kept to a minimum. 

In general, in ketogenic diets, for every 5 parts, 4 parts come from fat, and the remaining 1 part comes from proteins and carbohydrates combined. In simpler terms, about 90% of the energy in this diet comes from fat.

Achieving Ketosis with Dietary Changes

The Keto diet aims to get the body into a state of ketosis. Under normal circumstances, your body uses carbohydrates (converted into glucose) as its primary energy source. However, if you greatly reduce your intake of carbs and replace them with fats, your body has to adapt to use a different energy source. It starts breaking down fat from your diet, and your body’s stores into molecules called ketones, in a process termed ketosis.

Benefits of Ketogenic Diet for Type 2 Diabetes and Obesity

In this context, several meta-analyses (studies compiling all available research) have demonstrated that patients with obesity and type 2 diabetes who adhered to a VLCK diet showed significant reductions in HbA1c (a long-term measure of blood glucose control) and body weight. 

These patients demonstrated a higher increase in serum high-density lipoprotein cholesterol (HDL-C), often termed ‘good’ cholesterol, as well as decreased triglyceride levels compared to those following other diets recommended for type 2 diabetes management, quelling worries about worsening lipid profiles in the face of a high fat intake. 4 

Furthermore, studies have also demonstrated that those on a ketogenic diet were more likely to decrease their antidiabetic medications, even possibly eliminating them. 5 

Challenges and Risks

Like any therapeutic intervention, ketogenic diets aren’t without their challenges or potential risks, especially for individuals with T2DM. People on this diet may face an increased risk of hypoglycemia due to suddenly improved insulin sensitivity and reduced glucose levels, which can be particularly concerning for those on medication, underscoring the need for careful monitoring and adjustment of medicine under the guidance of a healthcare provider. 

Furthermore, ketogenic diets can also be restrictive and challenging to adhere to long term as many foods rich in fiber and specific vitamins and minerals may be restricted, potentially leading to nutritional deficiencies if not appropriately managed. It’s also important to remember that T2D management is multifaceted, and diet is only one component. Regular exercise, sufficient sleep, stress management, and regular medical check-ups are equally important for managing this condition.


In conclusion, while a ketogenic diet can offer potential benefits for individuals with T2D – including improved blood glucose control, weight loss, and better lipid profiles – it is not without its challenges and potential risks. It’s essential for individuals with T2D considering a ketogenic diet to do so under the guidance of a healthcare provider, who can help manage the diet’s potential risks and tailor it to their individual needs and health goals. As research continues, a better understanding of the long-term impacts of a ketogenic diet on T2D will emerge, further clarifying its role in T2D management.


1. Gregg EW, Li Y, Wang J, et al. Changes in Diabetes-Related Complications in the United States, 1990–2010. New England Journal of Medicine. 2014;370(16):1514-1523. doi:10.1056/NEJMoa1310799

2. Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med. Dec 19, 2019;381(25):2440-2450. doi:10.1056/NEJMsa1909301

3. Gregg EW, Zhuo X, Cheng YJ, Albright AL, Narayan KM, Thompson TJ. Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985-2011: a modeling study. Lancet Diabetes Endocrinol. Nov 2014;2(11):867-74. doi:10.1016/S2213-8587(14)70161-5

4. Rafiullah M, Musambil M, David SK. Effect of a very low-carbohydrate ketogenic diet vs. recommended diets in patients with type 2 diabetes: a meta-analysis. Nutrition Reviews. 2022;80(3):488-502. doi:10.1093/nutrit/nuab0405. Alarim RA, Alasmre FA, Alotaibi HA, Alshehri MA, Hussain SA. Effects of the Ketogenic Diet on Glycemic Control in Diabetic Patients: Meta-Analysis of Clinical Trials. Cureus. 2020;doi:10.7759/cureus.10796

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