Ketogenic Diets for Type 2 Diabetes

More than 530 million people worldwide are living with type 2 diabetes (T2D), and tens of millions more are at risk.  The hallmarks of T2D include high blood sugar (hyperglycemia), overproduction of sugar from the liver, and insulin resistance. Obesity is a major risk factor for T2D. Uncontrolled T2D can lead to complications of the eyes, kidney, brain, and heart. 

T2D is typically managed with medications to lower blood glucose levels or improve insulin sensitivity in addition to lifestyle modifications (e.g. diet and physical activity). The American Diabetes Association (ADA) recommends adoption of diets which control overall calories and intake of carbohydrates.

Ketogenic (keto) diets involve strict restrictions of carbohydrates with high consumption of fats, and moderate consumption of protein. This promotes a state called ketosis where the body uses ketones as a source of energy instead of glucose. 

Clinical Evidence

Several studies examined the effect of keto diets in T2D of which 2 will be summarized here.

One study consisted of 28 subjects with T2D and obesity who were put on a keto diet for 4 months. The average HbA1c (a test which estimates your blood sugar level over the past 2-3 months) significantly decreased by 15% (from 7.4% (diabetic) to 6.3% (pre-diabetic). Diabetes medications were stopped in 7 of the subjects, and the doses were reduced in 10 subjects. Body weight decreased by 6.5%.

Another study involved 262 T2D patients on a keto diet for a year. Average HbA1c decreased from 7.6% to 6.3% and an average body weight reduction of 12%. For patients taking insulin, 94% either reduced the dose or stopped administration. 


Strict long-term adherence to the keto diet is required for the long-term benefits. Consultation with a licensed healthcare practitioner to manage diabetes medications and dosing is strongly recommended as the keto diet may increase the risk of low blood sugar (hypoglycemia) in patients who are on insulin or sulfonylurea.

Links and References

For keto diet recipes, check out the links below: 


Chester B, Babu JR, Greene MW, Geetha T. The effects of popular diets on type 2 diabetes management. Diabetes/metabolism research and reviews. 2019 Nov;35(8):e3188.

Hallberg SJ, McKenzie AL, Williams PT, Bhanpuri NH, Peters AL, Campbell WW, Hazbun TL, Volk BM, McCarter JP, Phinney SD, Volek JS. Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study. Diabetes Therapy. 2018 Apr;9:583-612.

Westman EC, Tondt J, Maguire E, Yancy Jr WS. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert review of endocrinology & metabolism. 2018 Sep 3;13(5):263-72.

Yancy WS, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutrition & metabolism. 2005 Dec;2(1):1-7.