Keto and Type 2 Diabetes

Inline_Keto_and_DiabetesIf you think of Type 2 diabetes as carbohydrate intolerance, the natural dietary response should be to restrict the offending dietary component. And when this occurs—when diabetic patients restrict carbs—their symptoms improve, often to a greater degree than diabetic patients on other diets. Keto restricts more carbs than even other low-carb diets, so on the face of things, keto seems great for diabetes.

Let’s take a closer look.

Common Features of Type 2 Diabetes

Insulin resistance: Your cells don’t respond as strongly to insulin, and you need more to produce the desired effect.

Hyperinsulinemia: Your insulin levels are always elevated. This inhibits you from releasing fatty acids from your body fat to be burned for energy.

Hyperglycemia: Because you’re not very good at using insulin to remove glucose from the blood, you often have high blood sugar—especially after eating. In fact, postprandial blood glucose is the most common way to diagnose type 2 diabetes.

Excess body fat: Gaining weight often leads to type 2 diabetes.

How Does Keto Affect Those Symptoms?

Insulin resistance: It depends. Keto can actually induce physiological insulin resistance, whereby the tissues become resistant to insulin so that the small amount of glucose you have in your blood is diverted to the areas of the brain that can’t use ketones. This is normal, not pathological, and doesn’t lead to hyperinsulinemia. If you’re losing weight on keto, your insulin sensitivity will improve.

Hyperinsulinemia: Keto lowers insulin levels. For ketosis to even occur, insulin must be low.

Hyperglycemia: It’s hard to spike blood sugar when you’re not eating carbs.

Excess body weight: Keto is an effective way to lose weight.

So far, so good. Theoretically, keto should work really well for people with type 2 diabetes. How does it work in real life folks with type 2 diabetes, though?

What Studies Tell Us

Study #1: Keto (No Control)

In 2005, researchers gathered 28 overweight patients with type 2 diabetes and placed them on a ketogenic diet with fewer than 20 g of carbs per day. Seven patients dropped out; 21 completed the 16 week study. Those who completed it had great results:

  • Body weight dropped by 6.6%, almost 20 pounds.
  • HbA1c dropped by 16%.
  • Triglycerides dropped by 42%.
  • Ten patients reduced their medications. Seven dropped them entirely. In only 16 weeks.

This was a pilot study without a control group, so it can’t be cited to directly compare keto to other diets. But it clearly worked.

Study #2: Low-Glycemic vs. Keto (Patients Who Were Obese and Had Type 2 Diabetes)

In another study, researchers directly compared keto to low-glycemic/carb. They took 84 obese patients with type 2 diabetes, randomly assigned them to either a ketogenic diet or a low-glycemic diet, and tracked their progress over 24 months. What happened?

Low-calorie group:

  • 16% reduction in fasting glucose
  • 6.9 kg bodyweight loss
  • 0.5 reduction in HbA1c

Keto group:

  • 20% reduction in fasting glucose
  • 11.1 kg bodyweight loss
  • 1.5 reduction in HbA1c

Both groups improved, but the keto group made bigger improvements, especially in HbA1c. Low-carb is good, keto might be better.

Study #3: Low-Calorie vs. Keto (Patients Who Were Obese)

Another study compared keto to low-calorie in obese patients, about a third of whom had diabetes. This time, the patients got to choose the diet that most appealed to them. So, it wasn’t random, but it was closer to how diets work in the real world.

Both groups improved markers of glucose control and metabolic health, but the keto group saw greater improvements on every single marker measured:

  • Blood lipids
  • Body weight
  • Waist circumference
  • HbA1c
  • Blood glucose
  • Uric acid
  • Urea
  • Creatinine

The drop in blood glucose in the keto dieters was intense enough that the researchers recommended anyone interested in trying it retain medical supervision.

In addition, only among the keto group were patients able to discontinue medications.

Study #4: Hypocaloric vs. Keto (Patients with Type 2 Diabetes)

In 2016, researchers ran a four month study comparing the effects of two diets in patients with type 2 diabetes. The first diet was your standard hypocaloric approach. The second was a very low carb ketogenic diet.

The keto group lost more body weight, more inches off their waist, and gained better control over their blood sugar. There were no adverse effects; kidney function remained stable throughout the study. Most importantly, the keto group had no trouble staying on the diet.

Standard Diabetic Education

Maybe you’re not convinced. Maybe you’re leaning toward meeting with the dietitian your doctor has recommended. That’s fine. Many medical professionals are waking up to the potential of the ketogenic diet, so you might actually hear similar advice. Just be aware of what else you might hear.

Let’s compare keto to how a Certified Diabetic Educator would feed the “average-sized” diabetic “trying to lose weight.”

  • 45-60 grams of carbs per meal.
  • 15-30 grams of carbs for snacks.

At three meals and two snacks a day, you’re looking at as many as 240 grams of carbohydrates for a person with diabetes who needs to lose some weight. If you follow the authority-sanctioned “expert.”

I read that and I’m completely blown away. It’s really that bad? That’s what your average type 2 diabetic who shows up at the doctor’s office with no clue about nutrition ends up eating? It’s probably even worse than that, because 60 grams of carbs easily turns into 70.

Perhaps that educator goes on to admit that keto is great for weight loss, has been shown to improve diabetic markers, and could even help prevent diabetes if you could “keep the weight off.” But it’s too hard, too restrictive for most people to follow, she’ll likely suggest.

She claims that the stress of watching how many carbs you eat will be “far more detrimental to your health” than going keto will be beneficial. I don’t actually disagree with that completely. If going keto is so stressful that your every waking moment is consumed by thoughts of carbs, and you can’t stick with the diet no matter how hard you try, maybe it’s not for you. That’s okay. I’ve never said everyone has to go keto, or even that everyone can go keto. Nor have I said that once you go keto, you can’t go back or rotate higher carb days into the routine.

So, good to go?

Mostly. Any medical patient should check with their doctor before changing their diet. You may have to adjust your medications (or remove them entirely). And keeping your doctor involved and apprised of your progress could legitimize the diet—if it works. Your doctor may even start recommending the diet to other patients.

Oh, and make sure you’re eating eggs, liver, or taking extra choline. Inadequate choline in the context of a high-fat diet can lead to hepatic fat accumulation, and a fatty liver increases insulin resistance and predicts the development of type 2 diabetes.

To sum up, going keto can be an effective dietary strategy for type 2 diabetes. All the available evidence suggests to me that, as a general guideline, it’s both safe and effective.

What about you? Anyone with type 2 diabetes try going keto? What were your results? And how has it influenced your work with your physician?

Thanks for reading, everyone. Take care!

TAGS:  Keto

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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98 thoughts on “Keto and Type 2 Diabetes”

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  1. I am type 2. I recently was in the hospital for over a week with a heart attack. I am not going to rant because I don’t need that stress on my heart. So I am going to treat this as humor.

    Sixty grams of carbs/per meal. And offered more for snacks. Typical breakfast:
    some scrambled eggs
    Cheerios – 15 grams of carbs
    cream of rice – 15 grams
    fruit, usually grapes or a banana – 15 grams
    low-fat milk – 15 grams
    bad decaf
    Oh, and because diabetic, Splenda not sugar. LOL
    I ate half the carbs at each meal. Don’t lecture me.

    1. Harry very sorry to hear about your issue
      Your post should be re-posted during Halloween for a terror story, good that you chose not to stress about it – hope you get well soon

        1. just a heads up, if you leave a banana on the table it will turn to pure sugar if you eat it.. same

    2. Oh my. When I had my “non specific cardiac event” resulting in 3 stents in my heart I was given proper low carb meals. I was pleased.

    3. I am glad you took this setback with humor, looks balanced to me. So did the diet help your situation?

  2. Husband had very high blood sugar episode last spring. A week of intermittent fasting brought his fbs down to a reasonable level. He has eaten keto (loosely) since. We aren’t tightly tracking macros and I can barely get him to routinely track morning glucose levels for me. When I do get him to track them they are typically still over 100, but his blood sugar after eating barely rises so I’m fine with that. If the lows are high and the highs are low we’re good.

    He has lost 20+ pounds and his blood pressure has lowered. I need to get an hba1c testing kit to see where that sits. We don’t doctor as we have no insurance. Ain’t America great.

    1. sorry to hear about your insurance situation. You can get a A1c test kit from your pharmacy. Usually its kept cool/temperature controlled to avoid having the reagents break down. Another option for care is your local public health department which may have some adult care.

    2. Susanna,

      I don’t want to get too political, but the “insurance” problem in the US is the fault of government.

      That said, there ARE other options you can check out, specifically a Direct Primary Care practice.

      Obviously I don’t know your location, but here is just one site where you can search for a practice:

      DPC often have monthly “subscriptions” in the $50-60 range per adult, and generally include all basic primary care and management of illnesses like diabetes. Some even include medications at nearly wholesale costs, as most states allow Doctors to dispense on site.

      Here is one practice in my state of NH:

      As you can see, they charge a $99 per adult enrollment fee, and just $59/mo for adults 21-69. The membership includes management of diabetes.

      Depending on your situation, if you can afford a bit more per month, look into Health Sharing groups. These are ACA compliant alternatives to “insurance.”

      This one runs just $299/mo for a couple ($449/mo family) for their top level membership, which covers up to $1 million in eligible expenses per incident.

      They even have a phased 4 year path to fully cover pre-existing conditions.

      Hope this helps.

    3. Susanna,

      Well my first reply appears to have been deleted, perhaps due to the links, so here’s Take 2.

      There are other affordable options instead of traditional “insurance.” Specifically, I would look at a Direct Primary Care practice.

      I don’t know where you live but there are sites where you can search for practices by location.

      DPC practices typically charge a monthly “subscription” in the neighborhood of $50-60/month for adults (usually somewhat lower/higher for children/elderly respectively).

      This subscription covers all basic primary care, and usually any procedures that can be done in house. It’s not unusual that they’ll cover testing, medications at nearly wholesale prices (most states allow docs to dispense meds) and management of chronic illnesses like diabetes.

      This is generally covered by the subscription, so there is no copay or fee for visits.

      1. Also, if you can afford a bit more, look into Health Sharing groups. These are ACA compliant alternatives to insurance. One with which I’m familiar covers couples for $300/month at their top level, and families for just $450.

        The one thing to consider with Health Sharing, is that federal law limits them to religious/spiritual groups. Some require adherence to a particular set of beliefs, although some simply follow a more general moral/spiritual belief of an obligation to help others.

    4. I hearbthevword macros but have no idea what it is. Also being a 4 month diabetic I love my meds. I can eat without being scared of food. I do not understand the carb thing. I could never never eat only ikky veggies and meat. I tire of the same food and taking away a major source of food seems crazy.

  3. Dr. Richard Bernstein has a great low-carb diabetes program that prevents the diabetes side effects (e.g. heart attack, kidney failure, blindness, etc) but he advocates high protein with whatever fat comes attached to protein. I can’t figure out why he doesn’t go with high fat because fat barely raises blood sugar levels at all, much less than either carbs or protein.

    1. Actually, Dr. Bernstein doesn’t recommend “high” protein, he recommends a consistent amount of protein at every meal. And the fat that may be present is a freebie. He recommends the protein because that is what we need to maintain muscle mass. “High” as a percentage of the total calories, maybe, since the protein (meat, pork, fish, chicken) is usually higher in calories compared to the rest of the meal. It’s really simple.

      1. Dr Bernstein doesn’t recommend high protein but he does recommend a maximum of 30 carbs a day and does NOT recommend snacking at all. After I started Intermittent Fasting because I simply wasn’t hungry and finally got the sugar-coating off my tongue that I got from the ADA Dumb Diabetic plan of 225 plus snacking plan I had followed for years. his 30 grams carbs with NONE of the starchy carbs at all because they shoot the blood sugars way too high, I fell into a 23/1 Intermittent Fasting because his plan released my tongue from the sugar-fix it had been on with the ADA DDD plan I followed for my first 23 years of diabetes. I also lost the 90 poun ds I had gained, am now non -diabetic with normal A1cs and require 85% less insulin to stay normal. He got me to increase my protein to 95 grams in my daily smoothies which also helped. I use some fat but don’t concentrate on it specifically. Our diabetic bodies will make blood sugars in normal amounts out of fat and proteins so that’s why I’m more normal now that I ever was before on the ADA DDD plan.

        1. 30 carbs a day is starvation. You lose weight because you eat nothing but grass!

  4. a keto diet is very hard to follow if you have eating issues. I am prediabetic and I tried a keto diet for a week. Too restrictive psychologically. So under a low carb diet with 40 grams /day is working for me with many fewer feelings of deprivation.

    1. 40 grams is actually ketogenic for lots of people, depending on individual factors (exercise, etc). Great that you found a balance that works for you and doesn’t have you feeling restricted. 40 grams is still like an eighth of what we’re “told” to eat!

    2. You’re probably in ketosis much of the time. I definitely agree some do better psychologically with more carbs but 40 g a day is still very low carb.

    3. I think you’ll find that puts you in a ketogenic state. Like it’s a keto diet.

    4. I hear you! I found full keto too unhealthy for me. I’m at 50 grams carbs now and doing much better! 🙂

    5. What can you eat as plentiful and nit the same garbage day after day for a mere 40 carbs? I was told a 100 carbs a day. My toast at breakfast is nearly half. I refuse most veggies because they are gross.

  5. The Standard Diabetic Diet is nuts. If you go back and find my Primal Transformation story (the second one), it mostly revolves around my Gestational Diabetes I had during my second pregnancy (8 years ago already). I ate that diet the nutritionist told me to eat for a week after my diagnosis and recorded all my blood sugar readings (4 per day, which was massively annoying) and after every single meal (the 1hr mark) my blood sugar was way way way to high. 150-180, an hour after eating the diet they told me to. So, I decided to stop that and started eating low carb/Primal, even thought we didn’t even know what Primal was yet. What happened, bam, my blood sugars came down, I actually lost 6lbs in a week (much to the dismay of my midwife) and they gave me Ketosis test strips because the didn’t want me in ketosis, and I was ….alll the time! But I decided not to tell them that. I had to have weekly ultrasounds, so I figured if something was not well, they would be able to tell me. And you know what that pregnancy I felt great, tons of energy and little weight gain! The kid (who they thought was going to be giant) came out 7lbs 8oz and has the most rocking metabolism I have ever seen on any person. He is lean and strong and always has been. The best part is that I was given a basically 100% chance at having Gestational Diabetes with future pregnancies, well I had two more kids after my second guy was born, and each of those two pregnancies I DID NOT have gestational diabetes, of course I had discovered the Primal/Paleo world by then and was eating well and low carb! So there is a N=1 experiment for you. They also told me that women who get gestational diabetes are 50% more likely to get full blown Type 2 later in life… I said no thanks, and now I often cycle through times of Keto(20-40g carbs for me) and times of regular low carb (50-75g carbs for me) and I have worked intermittent fasting is which I love!! I think personally that Keto is the CURE for diabetes!

    1. That’s an awesome n=1 experience proving a great nutrition program fixes modern ills brought about by ridiculous food guidelines sanctioned by the “experts”. Good for you in taking control of your health and producing healthy babies.

    2. This was a great post to read, very motivating! Thanks for posting it 🙂
      Just curious: did you go “all in” with the intermittent fasting (restricting the eating window to 6-8 hours) or you just reduced the eating window compared to what you were used to before?

      1. I eat in a 6-7 hour window every day! I really like it. My husband does that on the days he doesn’t lift, on days he lifts he eats a regular three meal day and his fasting window is is roughly 10-11 hrs on lift days. I used to eat breakfast around 7am, snack around 10, lunch around 12, snack around 2 and dinner around 6, so IF changed that a lot for me. No snacks usually and just two big meals. Hope that helps.

    3. “The Standard Diabetic Diet is nuts”. Nuts is not the word. Historically low cab has been the standard treatment for managing and controlling diabetes until a few decades ago.

  6. I had a bad experience with Keto – I was disappointed. But because I am on insulin I had several low BG attacks and had to eat glucose tablets. However, just on my regular diet I stay below 100 grams of what I call hard carbs. I don’t count low carb and leafy vegetables.

    1. Hi Nancy,

      I had a similar experience and lowered my insulin dose until I didn’t need it anymore. Taking insulin while cutting out carbs usually results in considerably lowered dosing.

  7. What recipe book do you recommend for Keto? Do you have one? Thanks.

    1. Kathy Byram, The Keto Reset Diet book has over 100 keto-friendly recipes. Our Primal Kitchen Cookbook has a couple dozen amid other paleo recipes. (There’s a keto label for those specific recipes.) And you might be the first to know here on MDA, but we’re publishing a whole other keto cookbook this fall with over 120 keto recipe choices. More on that to come…

    2. Yeah, totally recommend The Keto Reset Diet for good recipes. Everything I have tried has been amazing…the slow cooker carnitas are the best I have ever had! And the thai soup is so good I made it twice in one week!

  8. A few comments: l was keto at 20 to 30 carbs a day for Two years. My blood morning sugars did come down to around 100 from 184 and usually dipped lower in the day. My A1c came down from 7ish to 6, triglycerides dropped to normal and my weight came down about 15 pounds……you say great, but hear the rest of the story. Not that it’s conversation for public viewing, but it would be good to know if others have had similar results…….while I was keto, I had to take laxitives daily, take large amounts of magnesium and electrolytes because of severe muscle cramping, couldn’t sleep, had itching around the urethra? (Maybe urine ph to acidic?)
    After all of that, I decided to add back fruit, limited grains, reduce fats and increase all vegetables. My blood sugar is now running 120 to 140 most mornings, I still would like lower blood sugar and more weight off (15#), but I feel better and all those negative things have ended. Having both legs in spasm at the same time is horrific! I am not on meds and do not plan to be. I think food is the answer, if we could figure out what’s the optimum diet is? I share these personal experiences with keto because I hope you have the resources to make sense of all the conflicting information.

    1. Those symptoms almost sound like die-off symptoms from pathogenic microbes. I’m reading about SIBO now, and a ketogenic diet deprives those microbes of food, wreaking havic on the digestion.

      1. Wondering if perhaps introducing a few days a week of keto, instead of going “every day” since the very beginning, could help reducing the intensity of this die-off symptoms…?

        1. two years of die-off? come on, guys. same diet doesn’t work for everyone. let’s not get cult-y with it.

  9. The Ketogenic Forum is full of T2 folks who have dramatically improved their insulin sensitivity, gone off of their diabetes medications, and in some cases have had their doctors straight up change their records to reflect their new status: no longer diabetic. I know, I know… just anecdotal. But it’s anecdote after anecdote (there and elsewhere outside of the established standard-of-care practices).

    Reversing T2 is totally possible – but not on 200 grams of carbs/day. Based on everything we know, those recommendations are starting to look criminal.

    1. I started my journey 6 years ago and reversed my T2, losing 4 needles a day, 5 pills, and 40+ lbs! This is my story and I share it with those that are interested, but have learned to only speak when spoken to, as there are a lot of cranky/closed minded people out there. 😉

  10. I’m type II, but I follow a diet based on Low Carb, Adequate Protein and Moderate fat, instead of the high fat version. (Jeff Voek, PHD and Stephen Phinney, MD, PHD). I eat 120 g Protein / 78 g Fat and 20 g Carbs a day. My starting fasting blood sugar was 181 and all this week it has been between 73 and 95. I go back to the doctor’s next month and will have my A1C and will talk about discontinuing Metformin. Started in July 2017, lost 50 lbs so far.

    1. Those are good looking fasting blood sugars! Keep up the good work Ann.

  11. I am a devout follower of the Primal Lifestyle and have been for >8 years. I am also a Nurse Practitioner with a doctorate degree and a certified diabetes educator. My diabetic and overweight (near diabetic) patients all do amazing using Primal principles and I NEVER tell people to eat any carbohydrates other than vegetables. I even warn again fruit as this can pull you right out of ketosis for many people. I just want you to know that CDEs deal with diabetics every day and unless they themselves are educated in low carb, high fat, the ignorance persists.

  12. Ive been doing low carb/keto for diabetes for almost 4 years. I lost 40 pounds and kept it off. My fasting insulin is now normal. My fasting glucose is 87.
    Before I changed my diet my Aic was 7.4 and now it varies between 5.4 and 6 (if I haven’t been careful about my diet) with no treatment. I think keto has put my diabetes into remission and returned me to a hugely healthier pre-diabetic state. I wish more people would realize what a serious disease this is, how very high the heart disease risk is, and how the standard diabetes treatment does not really improve their health. Then maybe they would give changing their diet a try.

  13. Mark nailed my experience with a nutritionist just after being diagnosed with type 2(ish… Could be some rare type). I said I was trying low carb Paleo and the nutritionist’s reaction was concern that it was “hard”. I couldn’t understand why eating very low carbs wasn’t the obvious recommendation for diabetics, but low carb made more sense to me than the ADA recommendation so I tried it (at the time, caring at all about nutrition was new to me). My A1C went from 7 to 5.4 in a couple weeks and has never been above 5.7 in the 5 years since. I probably go into keto frequently but don’t really monitor it. I heard my general situation characterized accurately recently (possibly by Mark?)- I’m not cured of diabetes, but effectively cured of symptoms, as far as I can tell. Meaning, if I eat an entire pizza, my blood sugar will be elevated higher and for longer than a non-diabetic, so I’m still diabetic. But I don’t eat entire pizzas, so I don’t get the symptoms. Five years is decent run time on the experiment… I guess I owe Mark a success story.

  14. When I went to meet with the “dietician” requested by my doctor, she was clueless as to what causes, and how to treat, diabetes. She read from a script from the ADA. I spent the rest of the time educating her. I’ve been watching my carbs for 3 years now. I’ve been off metformin since 2 weeks after reducing my carbs in 2013. My diabetes is completely controlled without medication and I have never been healthier. Still a bit overweight, but no longer obese and my labs are all very good. I’m 65 years old and was on metformin for 10 years before discovering the truth about diabetes. May I also recommend the efforts of Dr. Jason Fung to educate diabetics and their doctors.

  15. Type 2 Diabetes runs rampant in my family. Thankfully, I don’t have it. However, a sibling does. I get blood work done at least once a year. Great informative article. Thank you.

  16. I have gone from an A1C of 11.8, insulin 4 times a day and metformin to an A1C of 4.6, no more insulin and medication for HBP, cholesterol or thyroid. Keto work! I have maintained these great numbers, and I have regained much of what I had lost. I have reclaimed my health and my vitality with keto.

  17. My husband eats low carb, moderate protein and fat, no grains, dairy or sugar. He has had no consistent success in getting his BG down. His doctor has just prescribed Met formin. What no one talks about is how chronic stress and poor sleep undermines any dietary changes. His job is very stressful and has erratic sleep habits, because of the stress. I really don’t see how anyone can reduce their insulin resistance, regardless of the diet, if they can’t get their cortisol regulated. Can anyone speak to this issue?

    1. I agree, stress and lack of sleep can undo or prevent positive changes that might otherwise occur. Based on years of thyroid issues, focusing on sleep and stress reduction had to be top priorities before I saw other improvements. Hard to come by though. You may also want to look into Berberine rather than Metformin. Very similar results but far fewer or no side effects.

  18. So tell me why my FBG goes 120-140 while ketones measure 6.8 while eating keto. Even on extended fasts of 2-3 weeks. Just doing intermittent fasting and keto i can’t lose anything. In fact i steadily gain. 6’1” 170 endurance athlete frame

      1. Evey time ive had my insulin tested its been ridiculously low that there doesnt seem to be a suspension of IR. Ive also had the serum c peptide tested and its also very low.

        1. Hypothyroid? ApoE4? -as in saturated fats will be bad for you. Check out – Also Dr. Steven Gundry gave an interview where he said that his Keto diet for people with ApoE4 has limited animal fats and protein.

        2. Maybe you’re not making enough insulin to cover the calories – lacking beta cells.

  19. There is something to be said about stress, blood sugar, and diabetes. The one thing that supersedes a good diet, or in this case a diet to reverse Type 2, and that is sleep.

    It won’t matter how good or perfect you follow a keto diet, if you don’t sleep enough, sleep properly, or restful enough, your cortisol rises dramatically and thus your blood sugar will go rocketing through the roof. Do this enough and you’re priming yourself for blood sugar issues and Type 2, even in the presence of a keto diet.

    In fact, talk to anyone with Type 2, and ask how their sleeping habits growing up. You will almost always find they were poor to some degree. There is a direct link between poor sleep and Type 2. Now if poor diet is the reason behind poor sleep, then Keto definitely will fix this. However, if the reason behind poor sleep is something completely different, keto isn’t likely to help.

    People really should be evaluating both the time they get to bed on average, how long they sleep, and how exactly restful it is. If it’s not long enough and adequate, why? Is it because they are repeatedly waking up because blood sugar is dropping too low? If so, some carbs before bed might do the trick. Is their current diet giving them some sort of heartburn keeping them up? If so, it’s time to start eliminating the offending foods. Is their other life stressors in the way that’s causing them to stay awake at night with their mind racing? Then it’s time to start addressing those things as best they can.

    To give someone the best fighting chance against Type 2, you want to be sleeping properly, you want to be rested, and you want to be having vivid dreams.

  20. Thoughts on if it’s a functional cure meaning keto must be maintained or if insulin sensitivity can be restored enough to allow eating slightly higher carb?

    1. Great question. My experience has been functional only… Would be hard for me to say insulin sensitivity can be restored and for it to be permanent. There are so many factors, sleep, stress, genetics, exercise amount and type, etc. There are even more than 2 types of diabetes. For me, I don’t think my insulin resistance has gotten any worse in 5 years since diagnosis and a switch to Paleo (and most likely keto). So that is something. The switch also included trying to do all the things that improve insulin resistance, sleep, stress, etc. I’m also curious about others’ thoughts!

    2. Marissa: We do not know yet. Because of my background & having spent the last 2 years looking at what type 2 diabet(es) is….If you add more carbs into your diet, be prepared to do more exercise to burn the energy released off.

  21. I am type 2 and have been for a long time. I have found it very difficult to get in to ketosis and lose weight, even back in the old Atkins days. I can improve my blood lipids by eating that way, but I can’t seem to mobilize the fat stores at all by diet alone.

    On occasion I’ll spill a lot of ketones in my urine after some HIIT. I can’t seem to make it consistent.

    I did pick up a Keto Mojo the other day. Currently my ketones are negligible, so I’ll have to see how that changes over the next month.

  22. Yep, I’m 52, typically considered average to underweight, exercise regularly, and was eating pretty strict Paleo to manage a few autoimmune diseases. Out of the blue I was diagnosed pre-diabetic (family history) and my doc told me I had to either get my blood sugar down or prepare to go on Metformin soon. I chose Keto, and within 3 months was back in the normal range.

    I mostly stay Keto, with an occasional splurge back to Paleo (holidays, etc) and I feel great. My doc is now recommending Keto to other patients as a way to help manage blood sugar issues!

    1. wow you have a real doctor, nice 🙂

      “My doc is now recommending Keto to other patients as a way to help manage blood sugar issues!”

  23. On Keto for 7 months so far A1c has come down from 7.1 to 5.9,waiting for results from a reading last week. Weight has gone down 50+lbs and Trigs have come down.that all will be retested in March.

  24. I was diagnosed with T2 about 20 years ago, and was given one of those 250g/carb low fat, low protein diet sheets (sponsored by a pharmaceutical company that sells insulin and other diabetes meds!). While, with one exception (the week I was on a steroid taper for poison ivy) I never followed a specifically ketogenic diet (or any formal diet plan). I quickly realized that if diabetes was a problem with carbohydrate metabolism, I shouldn’t eat more carbs than I can metabolize. And this is what I’ve done, for approximately 20 years, with no meds. It’s not difficult at all. I probably average 100g carbs/day and 1200 calories (I’m 5’5″ 130lbs and fairly sedentary). I think the main challenge has been finding a bread I can live with, as the low carb/high fiber offerings on the market keep getting discontinued. My menu planning is pretty much deciding what kind of protein to have for dinner and what to add to my lettuce for salad.

    Also, a note to the person who was given the awful diabetic diet in the hospital, I had surgery a few months ago, and the hospital had a room service menu, so dinner was roast chicken, sauteed spinach, and a Caesar salad. (For some reason, they put me down for low sodium, but still gave me an overly salted packet of Caesar dressing.)

  25. “Excess body fat: Gaining weight often leads to type 2 diabetes.” Since the weight gain and the diabetes are almost always caused by the same thing, insulin resistance, I think it might be better to say that weight gain often precedes type 2 diabetes.

    I’m not diabetic but I was running fasting blood sugar numbers in the “prediabetes” range. I lost 30+ pounds and my fbs didn’t change at all.

  26. Hi, I’ve recently been diagnosed with Insulin resistance. I also had a very extensive food sensitivity test done. I’m sensitive to beef, pork, turkey, egg whites & dairy. ? what is your recommendation for weight loss?

    1. Hi Kim, some people find that some of their food sensitivities are due to abnormal intestinal permeability (leaky gut) and/or inadequate stomach acid and enzymes. The GAPs diet website focuses on a back-to-basics approach:

  27. I was diagnosed with T2 diabetes last August with FBG at 132, A1c at 6.8. As of yesterday, after my 6 month check in with the doctor, my FBG was 90 and my A1c was 5.4! I was determined to change my ways and not take any medication. This has been done with low carb, moderate protein, whatever fat I felt like eating, intermittent fasting, moderate exercise, 99.9 percent dedication and 100 percent determination. I have also lost 45 lbs. Needless to say my doctor was very impressed with my results and so am I. It has been quite the learning experience and I am very thankful for that diagnosis since it was the kick in the pants I needed. I feel better than ever.

  28. I was diagnosed last July, with an A1c of 6.9, fasting glucose of 112. I went keto, averaging 20-30 grams of carbs a day. My latest test results were an A1C of 5.2, fasting glucose of 73. I’ve lost 65 pounds and am almost halfway to my goal weight. When my insulin resistance decreases I may increase my carbs, but, I’ve found this way of eating to be very easy to maintain, and I have no desire to change anything.

  29. Great article Mark! The part about the Type 2 Diabetic and the recommended diet is spot on. But it may even be mild in it’s description. Over the past few years, the diabetic medical community has been catching on to the benefits of low carb, and keto diets. But the standard recommendations are still far from optimal.
    What’s worse is what most diabetic educators and doctors say about children and eating. As a whole, but not across the board, it’s still recommended for type 1 children to “eat what you want and cover it with insulin.” So what we now have are type 1 diabetic children who are showing up obese. Not a pretty picture for their futures.
    I belong to a couple of different Diabetic Facebook groups and the horror stories are endless. The “advice” given out is usually predicated on the “It’s just too hard to follow so we don’t recommend that.” And much of the directions given by doctors is more about covering their asses than about keeping the patient healthy. A patient that dies from a low blood sugar is a law suit waiting to happen. But a diabetic patient that gets neuropathy, has a heart attack, loses a limb or two, well, that’s just part of being diabetic. Can’t be sued for that.
    You hit the nail on the head with the part about:
    “But it’s too hard, too restrictive for most people to follow, she’ll likely suggest.” That seems to be the general consensus.
    The word is getting out, but we can do more. I know I am.
    Thanks for the comment section.

  30. Hi all, I just wanted to say that not all Registered Dietitians or Certified Diabetes Educators follow the “rules.” They can be great resources if they choose to educate themselves on the research. It may be more likely that you find a dietitian or CDE that understands the benefits of a keto diet before you meet a practitioner who does. Always ask. 🙂

    1. Hey Janet Moore,
      Sounds like you know your stuff. I would like to ask you a question, or anyone else out there. Would Contrave help me with all my cravings for sweets and bread while trying to get into ketosis? I find the cravings crazy no matter if I do get a little into ketosis. I would gladly eat tons of fat if it stopped cravings but it has not for me. What is a person to do, just run from bacon to eggs, to dishes of butter, and just pray that the need for bread will die suddenly? I consider Contrave as a last resort for my carb addiction but would that even work?


      1. Jojo, you might want to check the list of side effects before you consider taking Contrave. Chances are it wouldn’t work anyway since most cravings are more emotional/mental than physical.

        The best way to get rid of cravings, IMO (having been there), is to totally eliminate all sweets and grain products cold turkey. That means ALL of them, including gluten-free bread products and artificial or alternative sweeteners. You are addicted to those things, and merely reducing consumption or trying to taper off won’t work. All that does is fan the flames of your addiction. Get them out of your house and stay away from places where they are sold. The good news is that the cravings should wane after a few days and then disappear completely within a week or two.

      2. Jojo, it could be that you are having cravings due to using artificial sweeteners. I find if I eat/drink things with the various “replacements” I crave more food, particularly carbs, all day long. They also seem to throw me out of ketosis. It’s just my experience, but I thought I would throw it out there for you – no two cents payment required 🙂

  31. I’m in favor of any diet/lifestyle that reduces or eliminates the need for prescription pharmaceuticals, which are usually nothing but a Band-Aid anyway. Chris Kresser’s book, “Your Personal Paleo Code” teaches people how to get to the underlying cause of many health issues through dietary changes. The first step is a month-long, fairly restrictive reset, similar to the Whole 30 and various other Paleo/Primal approaches. It’s a good read for anyone struggling with intractable health issues.

  32. I resolved my T2 diabetic condition in Oct 2011 by going primal. Keto wasn’t even on the radar back then. Keto IS NOT REQUIRED to resolve T2/pre diabetes. It took 3 days for my daily blood sugar range to go from 6.5 – 13.7 down to 4.2 – 5.4. Yep, 3 days. My A1c went from 8.6 to 5.0 in the first 3 months. A few years ago I became a certified Primal Health Coach so that I can educate others on the ‘power of food’. No need to go keto to resolve diabetes and it is certainly difficult to go keto without being primal for 3-4 weeks so your body can be ‘fat-adapted’ – it relearns how to burn fat for energy. This dietary correction is permanent – don’t think you can resolve your diabetic condition and then go back to eating the way you did (which caused the issue).

    1. Great stuff Tom. I feel a close connection with you. I also went primal in October 2011 and had metabolic syndrome. All perfect health returned within weeks without going Keto. Being fat adapted I can now slip in and out of keto whenever I want, fast for 2 days, eat 100 grams of carbs the next, etc. Very flexible. Keep up the good work!

      1. Nocona, it certainly is amazing to BE THE ONE IN CHARGE, isn’t it! I used to be at the mercy of my doctor, diabetes educators, pharmacist etc. They are only trained to ‘manage’ diabetes (and my many other health issues) – not to address the root cause. Food, and food alone resolved my health issues – you can read my Marks Daily Apple success story at: After I became certified as a Primal Health Coach I founded and educate others on the ‘power of food’. Most people do not want to change their diet and they are blindly happy to continue to manage diabetes while they continue on the path to heart & kidney disease, neuropathy, retinopathy, amputations etc. Absolutely astounds me that people willingly choose illness over health.

  33. I was 5’4″ 120lbs very healthy eater. Gluten free due to colitis. I was very surprised to be diagnosed with type 2 diabetes. My endocrinologist recommended daily insulin injections when my A1C reached 7.6. I received a dexcom glucose monitor and was able to see what foods spiked my glucose. I changed my diet accordingly and ended up on a keto diet since May 2017. My physical in December showed that my A1C dropped to 5.2… I personally would much rather live in ketosis than on daily injections!!!

    1. Hi…so much talk on here about T2 diabetes….to the people that are not overweight (like you) I’d suggest having antibodies checked for type 1.5 which is LADA-latent autoimmune diabetes of adults. It’s not insulin resistance. It will wreak havoc with BG levels though because it’s due to your pancreas not producing or under producing insulin. Both my paternal grandmother and my dad were diagnosed in their early 80’s with what they were told was type 2. Neither was overweight, both had excellent diets. I’m getting checked soon for the antibodies as well. If I have them it doesn’t mean I’ll develop the disease but I’ll be 2 steps ahead of it. I’ve been Keto for about 2 years now, do intermittent fasting regularly too. I believe I have physiological insulin resistance as my FBG is always about 90, 2 & 4 hrs after eating it’s never more than 110. I want my fasting insulin tested also. I fired my endocrinologist…the last time he argued with me reminding me HE was the dr…to which I replied “and I’M the patient!” Since then I’m in control of my health.
      Good luck to all here and happy eating! ?

  34. I started eating Ketogenic Aug 4th 2017. In 2007 I found out I was diabetic. I had an infection in my leg after clearing it at the hospital, insuring it was not a dvt, they told me I was not managing my diabetes well and my blood sugar was 22. That’s how I found out I had diabetes. I was 375 pounds.

    Lost 30 pounds by removing sugared drinks and performing. Thought I had it solved but my AC1s averaged 10-14. Insulin in my future for sure.

    Since starting Keto (Aug 4 2017) I have lost 50lbs, and stand at a current weight of 245. My blood pressure is high side of normal, kidney and liver function good, but here’s the kicker.

    AC1 is 5.7.

    The Canada food guide is a joke. People are dying or being lighted at hospitals losing limbs to diabetes. Keto is saving my life, there is zero doubt about it. I have gained some willpower, in fact Im amazed at what Im capable of despite how I have acted in the past. Telling diabetics to eat balanced meals is insanity. Sorry. I do not work out but have a much higher activity level then before.

    Good luck to anyone who decides to make a change. #eatwell

  35. I’m a male and 50 yo. I was able to get my A1C from 5.7 down to 5.3 (Dec 2017). I tried keeping my carbs low (below 30 g) and protein moderate (80g – 120g). I did intermittent fasting for an average of 20 hours seeing I read your body benefits more if you fast at least 18 hours. Plus, I noticed I am able to stay within my calorie limit by limiting myself to eat within a 4 hour window. I believe the intermittent fasting improved my blood sugar and also noticed this winter my psoriasis on my calf was a lot better. I’m experimenting to see if the intermittent fasting is more effective, keeping alcohol to less than 7 drinks per week, and not be as concerned about eating keto. I plan on taking my A1C in March. My blood sugars stays between 110 – 120 in the morning until noon. I notice I can function better once the blood sugar is below 100.

  36. I just cure T2D (doctors words, not mine). one year on Keto I lost 60 pounds, have an A!C of 5.2, blood pressure from 138 to a steady 118, complete control of my cholesterol. Off 7 medication as per my doctor.
    That is proof to me that Keto works after trying many other diets.
    There is possibly a down side. In that year my PSA jumped from 3.1 to 6.1. I am 70 years young, so it could be a coincidence, but I am reading some studies that some compounds in certain veggies feed specific cancers. I would appreciate any comments on that subject.

  37. I am a type 2 diabetic, who also has high cholesterol. I have tried several medications (for both my diabetes and my high cholesterol) but just hated the side effects. I found this for alternative treatments. After changing my lifestyle quite a bit and doing everything in the book for nearly 3 months, I had my annual checkup. I did not say a word to my doctor about what I had been taking. When the lab results came back, he personally called me and I could tell that was obviously very excited. He asked me What the heck I had been doing because my glucose reading had gone down 32 points and my cholesterol profile had significantly improved as well. You’ve made a believer out of me and my doctor. Soi personally recommend you

  38. How about adults with type 1 diabetes who control their insulin intake? Are there any studies on Keto eating with this autoimmune disease?

  39. Just diagnosed with Type II diabetes in January. I have been walking 40 miles per week on my treadmill for two years but am still overweight. Even though I have limited calories and eaten a balanced diet. I believe my carbohydrates have undermined weight loss and caused my sugar levels to spike. My carbs will come from only vegetables that grow above ground ; ) and no grains. Fruit is limited to a few occasional berries. I’ve ordered keto strips and downloaded added a keto app to help me track the carbs and ensure I take in the right amounts of fat and protein. I’ll report back with my results.

  40. Type 2. Diagnosed in 2010 at A1c 9.2, down to 5.8 in 5 months, currently 5.3. Not terribly strict, keeping carb intake under 50 gr per day with a low glycemic slant.

    30 lbs lighter than I was at diagnosis.

    I haven’t actually tested for ketone levels, but it seems that I’m probably there.

  41. Mark, would Alpha GPC be a good form of choline too and would taking inositol with it be a good idea?

    My liver is already fatty and before I start this I want to protect it from further damage.

    Thank you for discussing choline’s importance!!

  42. Type 2 Disney’s about nine years
    Keto for 4 almost five

    Within two months of starting, I was taken off every medication I was on.
    Blood pressure , acid reflux, statin.
    I had previously had an adverse reaction to metformin and had to stop taking it. (Think the normal greater issues times fifty bazillion!!
    Could not leave the house for a week.
    Stopped the medicine, better in the days
    Started again, symptoms returned immediately
    Did thought it was the stomach flu
    But I refused to start it again, been medication free ever since)

    Diagnosis was 566 mg/do
    A1c was 14.8%
    I had been seen comatose at home all day thinking I was just super sleepy.

    Was legally blind for three months due to glucose crystals in my eyes.

    My last known a1c was 5.4
    Due to insurance failures, I’ve not seen the doctor in almost two years and I can’t get the home tests kits for it any more.

    Last lipid panel died that hdl had almost doubled, leak was still a pain. Trigs had fallen to 130

    For for yesterday I’ve remained weight stable better 160-175 lbs with most of the weighings shooting 165
    That’s down from my high of 245 before diagnosis

    I eat 20-30 total grams daily
    From approved keto carbs only, Dr Westman’s list
    Have not ate off plan since going keto
    Why would I?
    Keep is right up my alley!!!
    I loved fresh food and my favorite dessert was always another plate of food. I just had to clean up whichI ate. No biggie for me.
    I do not do grass fed or organic
    I can’t afford it and the options here for that are extremely limited unless you buy from a farmer and I can’t afford that either.
    If it were an option I surely would
    I focus on adequate protein and high whole natural fats p none of that bottled death for me thank you.

    I have zero complications
    My vision returned and is perfect for someone who is closer to fifty than they want to admit. Lol

    I have had the joy of having very physical jobs so I don’t work out as I should but I have little iTunes working the guys in my machine into the ground every night.

    I am founder of a Diabetes group on Facebook and we finished in it for type two and we have strong for members in our 4% A1c club and stand 150 in our 5% A1c club.

    We’ve seen drastic reductions in medicine
    Recently seen a member taken off her doctors kidney disease diagnosis
    We have members who have lost up to 130 lbs

    I have to admit Mark
    I was about fearful to read this article
    Keep is under attack from every angle these days seems like
    But I can tell you that for me and for those in our group
    There is no other way to do it.

    Some have called us ketotards but I’ve been called worse by better people and as long as the results and the science day it works, I’m all over it

    Dwayne R

    Please forgive any typos
    My tablet and autocorrect love making me look like a bafoon

  43. keto is of course just one type of diet that may be helpful for diabetics and therapeutic for a handful of other conditions too. But its far from the only diet that has been found to be effective for diabetics. The cherry picking of studies above is misleading in terms of low carb, high carb low fat seems to work well too

  44. Thanks for sharing such a useful blog! As many people are unaware of the above mentioned facts, this post will really help them a lot. The keto diet is one that encourages consumption of generally unprocessed foods with a whopping 70+% of total calories from fats (rather than the recent crop of high protein/low carb diets, like Paleo and Primal). Carbs are limited but can be included up to 20 grams per day. Keto diet is really beneficial for the type 2 diabetes.

  45. After feeling a little off for a while, and casting about for answers in the more quackish corners of the medical world (biontology, anyone?) I agreed to let a diabetic friend of mine test my blood sugar. I had had some M&Ms in the car on the trip up to his home in Shasta County, and a couple of beers on arrival.

    Blood sugar: 389. This was July 9, 2018, and I was a confirmed diabetic.

    The next day I was in the high 200s, and a quick read online revealed that the way to go was probably to stop eating/ carbs. Over the next couple of days blood sugar came down to right under 200.

    Back at home some more study revealed that the thought leaders on diabetes 2 were Drs. Sarah Hallberg and Jason Fung. Hallberg has a web site, Fung has a book. I absorbed the information in both. Upshot: diabetes is at its root hyperinsulinemia. Deal with the sugar intake, roll back the weight gain, and improvement is likely.

    I went to the doctor on July 25 and had my A1C checked: 9.0. Not great.

    After more reading I went on a ketogenic diet and a battery of supplements. After some time I cut out the supplements. I am now fasting every other day, and eating less than 20g of carbs a day. I am in ketosis, which I confirm with urine strips.

    This morning’s fasting blood sugar: 115.

    I have begun seeing readings under and around 100, down to 95 in the evenings. I have lost ten pounds so far. I still have a gut, and it’s not welcome anymore.

    I don’t know how long I have been in a diabetic state, but I do know that I won’t be staying that way.

    Keto and fasting works for me. I estimate that I will be back to normal glucose metabolism in maybe 3–4 months.

  46. I have type 1 diabetes and use insulin pump therapy for my treatment. Type 2 patients can also benefit from a low carb, high healthy fats (keto diet) diet. I’ve been on this diet for 6 months now and have lowered my A1C to 6.4% from 7.1% and have much more energy. Thank you, Kenny 🙂

  47. I have just last week been diagnosed with type II diabetes. Because of the Corona virus, so cannot meet with the nutritionist about what to eat when. She is located in the hospital which is closed to non-essential traffic. I need to get with someone who can send me sample meals and info on carbs and sugar. Can you help me?