Ketogenic Diet for Diabetes: Cure or Danger?

Studies have shown that diabetics who follow a ketogenic diet over a longer period of time can lower their long-term blood sugar levels (HbA1c) and reduce their diabetes medication.

The ketogenic diet and low-carb diet are two popular classic diets that have been touted as a miracle diets. The low-carb diet advertises avoiding spikes in blood sugar and insulin, while the low-fat diet wants to reduce the intake of saturated fatty acids in order to avoid inflammatory processes and increased cholesterol. If you have diabetes or a pre-diabetes stage, then it could be advantageous to avoid carbohydrates. The ketogenic diet (carb content max. 20-50g/day) affects diabetes and interacts with other aspects of health.

What does ketogenic or ketosis mean?

We prevent the body from utilizing carbohydrates, which are typically our main source of energy, by following the ketogenic diet (in the form of glucose). As a result, the body switches from carbohydrate metabolism (glycolysis) to fat metabolism after a few days (when the carbohydrate stores are depleted) (lipolysis). And the liver begins converting fats into ketones. 

The blood and mitochondria, or the power plants inside our cells, are then both exposed to ketones. Here, they now replace the lost sugar as a source of energy (glucose). Here, we’re referring to the metabolic state of ketosis. Our body can use ketone bodies as an energy source. Ketone bodies, in particular, can be used by the brain to produce energy. When we fast, the same holds true. A diet that mimics fasting is another way to describe the ketogenic diet.

Biochemical Effects of Ketosis:

  • Mitochondria are the cell organelles in which energy production takes place. If the energy is not obtained from glucose here, but instead from fat, then fewer free radicals are produced as part of this combustion process . This also reduces overall oxidative stress and inflammation in the body.
  • The metabolic switch to fasting causes a special enzyme (AMPK) to be activated. As a consequence, this stimulates autophagy ( cell purification ), cell protection and stimulates mitochondrial and energy production
  • The performance of the immune cells improves (so-called T-cell immunity)
  • The cellular dependence on glucose decreases
  • The ketone body butyrate has an anti-inflammatory effect
  • Fat burning is increased

What is the difference between a ketogenic, low-carb and Mediterranean diet?

The low-carb diet is an umbrella term for a variety of diets, such as the Mediterranean diet, which has been proven to reduce the risk of stroke or heart attack. The ketogenic diet is an extreme variant of the low-carb diet, with the goal of switching the metabolism to fat burning. Good results have been achieved and proven for the ketogenic diet with regard to weight loss.

  • Successful and sustainable weight loss
  • Stable blood sugar regulation and reduction of insulin requirements in diabetics
  • Successful treatment of epilepsy
  • Improved endurance performance in athletes
  • Presumed beneficial effects on various neurodegenerative diseases
  • Presumably alleviating the symptoms of PCOS (polycystic ovary syndrome)
  • Initial pilot studies show improved cognitive function in Alzheimer’s patients

In addition, the ketogenic diet is a diet that has been described for cancer patients in specialist literature for over 100 years. Because cancer cells absolutely need sugar to grow. Cancer cells, on the other hand, cannot do much with fats and ketones.

Can a ketogenic diet have a positive effect on diabetes?

Type II diabetics can benefit from a ketogenic or very-low-carb diet, leading to weight loss and reduced blood fat and sugar levels. People with insulin resistance respond better to a low-carb diet than those without.

How can these positive effects be explained?

The sensitivity of the cell to glucose, or more specifically, to insulin, is compromised in diabetics. Because insulin is required for glucose to enter the cell and function as an energy source. Therefore, diabetics gradually require increasing amounts of insulin. 

The need for insulin will, however, diminish once more if the cell no longer requires any glucose at all because it is able to produce energy from ketones instead. Additionally, since insulin also inhibits the body’s ability to break down fat stores, weight loss is the natural result of a ketogenic diet with reduced insulin release.

Benefits of a ketogenic diet for diabetics:

  • Fat from the body cells is broken down and used to generate energy -> weight reduction
  • Due to the very low intake of carbohydrates, blood sugar remains stable and less insulin is required
  • Less cravings and a high feeling of satiety thanks to the high fat and protein content

Are there also disadvantages or dangers of a ketogenic diet in diabetes?

The ketogenic diet is a radical change in diet that can cause symptoms such as tiredness, weakness, headaches, cravings or digestive problems. It is important for diabetics to keep a close eye on their blood sugar levels, as it can lead to lower blood sugar and insulin levels. If a high proportion of animal products is consumed, 

it can lead to overacidification of the organism and the formation of kidney stones. Additionally, there is a risk that the cholesterol level and inflammation parameters will increase in the long term. To avoid these negative effects, it is important to consider one’s own physical weaknesses and take into account when choosing food.


The scientific community is still divided on the long-term health effects of a ketogenic diet. In the case of diabetes, it is important to create an individual therapy plan and closely monitor laboratory values. Personal nutritional preferences and habits should also be taken into account in nutritional therapy. Carbohydrates and fats are not inherently good or bad, but which we choose is the most important factor. Vegetables, whole grain products, white flour and sweets contain plenty of carbohydrates, but the most important thing is which we choose.



4th Professional Medical Student. Karachi Medical and Dental College.

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