Written by Dr. Matthew Capozzi, DPM, FACFAS, CWS (board-certified foot surgeon and wound specialist) · Medically reviewed by the CircuFiber Scientific Advisory Board · Updated: October 28, 2026
The keto diet can help some people with type 2 diabetes lower their blood sugar and lose weight, but it is not right for everyone and it carries real risks. Cutting carbohydrates sharply reduces after-meal blood sugar spikes, and some studies suggest it can lower HbA1c and the need for medication. The same drop in blood sugar can cause hypoglycemia in people who take insulin or sulfonylureas, very-low-carb eating can raise the risk of ketoacidosis in type 1 diabetes and in people taking SGLT2 inhibitors, and many people find the diet hard to sustain. Talk to your doctor before starting keto so your medications and monitoring can be adjusted safely.
Key Takeaways
- Keto can lower blood sugar in type 2 diabetes by minimizing carbohydrate intake, which can improve blood sugar control and, in some people, reduce the need for medication.
- Insulin sensitivity and weight loss often improve on keto, because the body needs less insulin when it takes in fewer carbohydrates and because weight loss reduces insulin resistance.
- Hypoglycemia is the most immediate risk for people who take insulin or sulfonylureas; doses often need to be lowered before or soon after starting keto.
- Ketoacidosis is a serious risk for people with type 1 diabetes and for people taking SGLT2 inhibitors, who can develop diabetic ketoacidosis even when blood sugar is not very high.
- Long-term sustainability, nutrient gaps and heart health are the main concerns; a moderate low-carbohydrate diet built on healthy fats is a more sustainable option for many people.
- Talk to your doctor before starting keto so a healthcare provider or dietitian can tailor the plan and adjust medications.
What is the keto diet?
The ketogenic, or keto, diet is a high-fat, adequate-protein, very-low-carbohydrate eating plan. Fundamentally, the keto diet involves dramatically reducing carbohydrate intake and replacing it with fat. This abrupt change pushes the body into a metabolic state known as ketosis. In ketosis, the body becomes exceptionally efficient at burning fat for energy, which can lead to weight loss.
Staples of a ketogenic diet include:
- Meats and fish
- Butter, eggs, cheese and heavy cream
- Oils, nuts, avocados and seeds
- Low-carb vegetables
Conversely, high-carb foods like grains, sugar, legumes, rice, potatoes, candy, juice, and even most fruits are significantly limited. For a broader view of carbohydrate targets, see our guide to daily carb intake for diabetics.
Is keto good for diabetics?
Keto can be good for some diabetics, particularly people with type 2 diabetes, but it is not a safe or practical choice for everyone. For individuals with diabetes, the allure of the keto diet centers on its potential to reduce blood sugar levels and improve insulin sensitivity, which is critical in the management of diabetes. By minimizing carbohydrate intake, the expectation is that there will be fewer blood sugar spikes, which are a significant concern for people with diabetes. Also, the diet's high-fat focus can lead to feelings of fullness, which may help with weight management, another important aspect for diabetes care.
Research and expert opinions suggest that a ketogenic diet might offer benefits in the context of diabetes management. Some studies have shown that a keto diet can lead to substantial improvements in blood sugar control for individuals with type 2 diabetes. The diet's impact can vary vastly among different people, and a healthcare professional can help tailor dietary plans that ensure both safety and effectiveness in managing diabetes.
How does the keto diet affect blood sugar and insulin?
The keto diet lowers blood sugar mainly by removing most of the carbohydrates that break down into glucose, and it improves insulin sensitivity by reducing how much insulin the body needs. By altering the body's primary energy source from carbohydrates to fats, this dietary approach targets both blood sugar levels and insulin sensitivity, key concerns for individuals with diabetes.
Improved blood sugar control
By significantly reducing carbohydrate intake, the keto diet can lead to lower blood sugar levels. Carbohydrates typically break down into sugars (mostly glucose) in our body and can cause blood sugar spikes. A keto diet minimizes these spikes, aiding in the maintenance of more stable blood sugar levels over time. Research suggests that this can be particularly beneficial for people with type 2 diabetes, as it enhances blood sugar control and may reduce the need for medication.
Enhanced insulin sensitivity
On a ketogenic diet, because the body consumes fewer carbs, it requires less insulin to process the carbs into energy. Over time, this can lead to improved insulin sensitivity, which is pivotal in managing type 2 diabetes. Improved insulin sensitivity means the body can better use insulin to absorb glucose from the bloodstream, which is a cornerstone in controlling blood sugar levels. Learn more about insulin resistance and improving sensitivity.
Weight loss
Many individuals find that following a ketogenic diet supports weight loss, which is often a recommended strategy for managing diabetes. Excess weight, particularly around the abdomen, contributes to insulin resistance, making it harder to control blood sugar levels. By facilitating weight loss, the keto diet can help reduce insulin resistance and improve the effectiveness of insulin in those with type 2 diabetes. See our article on weight loss strategies for diabetes for other approaches.
Can keto reverse type 2 diabetes?
Keto cannot be relied on to reverse type 2 diabetes, but some studies suggest it may lead to remission in some individuals. Studies indicate that a significant reduction in HbA1c levels, which reflect average blood glucose levels over two to three months, can be achieved through strict adherence to the keto diet. Remission, characterized by blood sugar levels returning to the non-diabetic range without the need for diabetes medication, is a milestone many aim for and may be attainable for some through the keto diet. Remission is not a cure, and blood sugar can rise again if old habits return; read more on whether diabetes can be reversed.
What are the risks of keto for people with diabetes?
The main risks of keto for people with diabetes are hypoglycemia, ketoacidosis, nutrient deficiencies, effects on heart health, and difficulty sticking with the diet long term. Our understanding of nutrition and diabetes management continues to evolve, highlighting the importance of weighing the benefits against possible drawbacks.
Hypoglycemia (low blood sugar)
Hypoglycemia is the most immediate risk for people who take insulin or sulfonylureas, because these medications keep lowering blood sugar even when carbohydrate intake drops. Those on the keto diet may notice a significant decrease in their blood sugar levels, necessitating adjustments in diabetes medications or insulin dosage to prevent hypoglycemia. Know the signs of hypoglycemia and quick fixes before you start.
Diabetic ketoacidosis (DKA)
Individuals with type 1 diabetes face a significant risk when adopting a ketogenic diet. The primary concern is ketoacidosis, a serious condition resulting from insufficient insulin. Ketoacidosis leads to dangerously high levels of ketones in the blood, which can turn acidic and harm vital organs. For those with type 1 diabetes, meticulous monitoring of blood glucose and ketone levels becomes crucial to avoid this risk. People with type 2 diabetes who take SGLT2 inhibitors also need caution, because these medications can cause euglycemic ketoacidosis (DKA with near-normal blood sugar), and very-low-carbohydrate diets may increase that risk. Read more about diabetic ketoacidosis symptoms and treatment.
Nutrient deficiencies
The ketogenic diet may lead to nutrient deficiencies over time. The diet restricts various food groups, including certain fruits, vegetables, and whole grains, potentially leading to deficiencies in vitamins and minerals. These nutrients play vital roles in overall health, and their lack can lead to complications, especially in individuals with pre-existing health conditions.
Heart health
The keto diet's high fat content raises concerns about long-term heart health. Even though some studies suggest improvements in cardiovascular risk factors, such as a reduction in triglyceride levels, the emphasis on fats, particularly if saturated fats are consumed in large quantities, could increase the risk of heart disease over time. It's crucial for individuals to select healthy fats, like those from avocados, nuts, and fish, to mitigate these risks.
Long-term sustainability
The ketogenic diet may not be sustainable for everyone in the long term. It requires strict adherence and significant lifestyle changes, which can be challenging to maintain. Its restrictive nature can challenge long-term adherence, so integrating this diet into one's lifestyle demands thoughtful planning and regular monitoring to avoid adverse effects.
Who should be especially careful with keto?
People who take blood-sugar-lowering medications, people with type 1 diabetes, and people with heart disease risk factors should be especially careful with keto and should only start it with medical supervision. The table below summarizes the main situations to discuss with your doctor.
| Your situation | Main concern on keto | What to do |
|---|---|---|
| Taking insulin or sulfonylureas | Hypoglycemia (low blood sugar) | Ask your doctor about lowering doses before you start; check blood sugar often |
| Type 1 diabetes | Diabetic ketoacidosis; hypoglycemia | Only start with your diabetes care team; monitor blood glucose and ketones |
| Taking an SGLT2 inhibitor | Euglycemic ketoacidosis (DKA with near-normal blood sugar) | Talk to your doctor before starting; learn the symptoms of ketoacidosis |
| High cholesterol or heart disease risk | High saturated fat intake | Choose healthy fats such as avocados, nuts, and fish; ask about lipid checks |
| Finding the diet hard to sustain | Rebound in blood sugar and weight | Consider a moderate low-carbohydrate diet with a dietitian |
How can diabetics personalize the keto diet safely?
Diabetics can personalize the keto diet safely by working with a healthcare provider on macronutrient balance, monitoring blood sugar closely, adjusting medications, and choosing high-quality foods. Each person's body responds differently to dietary changes, making personalization key in leveraging the keto diet's benefits while minimizing potential risks.
Understand your individual nutritional needs
Nutritional requirements vary widely among individuals with diabetes. Factors such as age, weight, activity level, and the presence of any complications related to diabetes dictate the amount of carbohydrates, proteins, and fats one should consume. Consulting a healthcare provider or a dietitian can provide insights into one's specific nutritional needs and help devise a balanced plan that reduces blood sugar spikes and supports overall health. Our guide to crafting a diabetic diet plan is a useful starting point.
Monitor and adjust
Close monitoring of blood glucose levels allows for the adjustment of dietary intake and medications to maintain optimal control. Regular follow-ups with a healthcare provider ensure that medication adjustments are made safely. If you are not sure how often to test, read why to check your blood sugar.
Choose quality foods
Opting for high-quality foods within the keto framework enhances health outcomes. Selecting lean proteins, healthy fats, and low-carbohydrate vegetables can provide the necessary nutrients without excessively increasing saturated fat intake, which is crucial for heart health. Incorporating a variety of foods also helps prevent nutrient deficiencies, a concern with restrictive diets.
Balance keto with long-term health goals
The sustainability of the keto diet in the long term is a common concern. Incorporating flexibility by gradually increasing carbohydrate intake once blood sugar and weight management goals are reached can make the diet more sustainable. This approach encourages a gradual transition to a balanced, low-carbohydrate diet that maintains the health benefits achieved through the initial strict keto phase. A Stanford Medicine study comparing keto and Mediterranean diets in diabetes is a helpful read on how the two approaches compare. Remember, transitioning gradually to a balanced low-carb diet and focusing on quality food choices will help ensure sustainability and overall well-being.
When should you talk to a doctor about keto and diabetes?
Talk to your doctor before starting keto if you have diabetes, and especially if you take insulin, sulfonylureas or an SGLT2 inhibitor, or if you have type 1 diabetes. As we always say when writing our articles about diabetes and your health journey, it is critical for individuals with diabetes considering the keto diet to consult healthcare providers for personalized advice. Once you have started, contact your doctor promptly if you have frequent low blood sugar readings, and seek urgent care for symptoms of ketoacidosis such as nausea or vomiting, abdominal pain, deep or rapid breathing, fruity-smelling breath, or confusion. Learn how to tell hyperglycemia and hypoglycemia attack symptoms apart.
Frequently asked questions about keto and diabetes
Is the keto diet safe for diabetics?
The keto diet can be safe for some people with type 2 diabetes when it is supervised by a healthcare provider who adjusts medications and monitors progress. It is riskier for people with type 1 diabetes and for people taking insulin, sulfonylureas or SGLT2 inhibitors. Talk to your doctor before starting.
Is keto good for type 2 diabetes?
Keto can help people with type 2 diabetes lower blood sugar, improve insulin sensitivity and lose weight, and some studies suggest it can reduce HbA1c and medication needs. The benefits depend on sticking with the diet, and a moderate low-carbohydrate diet may be easier to maintain for many people.
Can people with type 1 diabetes follow a keto diet?
Some people with type 1 diabetes follow a ketogenic diet and report steadier blood sugar, but they face higher risks of hypoglycemia and diabetic ketoacidosis. Anyone with type 1 diabetes should only try keto with their diabetes care team and should monitor blood glucose and ketone levels closely.
Is keto bread good for diabetics?
Keto bread is usually lower in carbohydrates than regular bread, so it may cause a smaller rise in blood sugar, but ingredients vary widely between brands. Check the label for total carbohydrates and fiber, watch portion sizes, and test your blood sugar after eating it to see how your body responds. For other swaps, see our list of foods to avoid with diabetes.
Is a low-carb diet better than keto for diabetes?
A moderate low-carbohydrate diet is often easier to sustain than strict keto while still helping manage blood sugar. It allows a wider variety of foods, including more fruits, vegetables and whole grains, which reduces the risk of nutrient deficiencies. The best diet is the one you can follow long term with your healthcare team's guidance.
References, studies and sources
- Stanford Medicine. Keto and Mediterranean diets in people with prediabetes and type 2 diabetes. https://med.stanford.edu/news/all-news/2022/070/keto-mediterranean-diet-diabetes.html
- American Diabetes Association. https://diabetes.org/
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetes. https://www.niddk.nih.gov/health-information/diabetes
- Mayo Clinic. Diabetes: Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
- MedlinePlus. Diabetes. https://medlineplus.gov/diabetes.html
About the author: Dr. Matthew Capozzi, DPM, FACFAS, CWS, is a board-certified foot surgeon through the American Board of Foot and Ankle Surgery. He is a Diplomate of the American Academy of Wound Management and Fellow of the American College of Foot and Ankle Surgeons. He completed a three-year residency program in Foot and Ankle Reconstructive Surgery at St. Francis Hospital & Medical Center in Hartford, CT in 2010. Dr. Capozzi is a board-certified Wound Specialist® granted by the American Academy of Wound Management.
Healthcare disclaimer: Always consult your physician before beginning any program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. If you experience any pain or difficulty, stop and consult your healthcare provider. CircuFiber socks are a general wellness product intended to promote a temporary increase in local blood flow and circulation; they are not intended to diagnose, treat, cure, or prevent any disease. Individual results vary.
