Diabetes and keto

As soon as the blood glucose level is consistently lower, the metformin dose can and, if necessary, should be adjusted downward to prevent hypoglycemia (metformin would further reduce the blood glucose level, which is already low due to the ketogenic diet).

As a diabetic, you need to listen to your body even more closely than a person without the disease. Be careful not to slip into hypoglycemia due to incorrectly adjusted medication. A steady supply of energy and low carbohydrate intake with carbohydrates coming mainly from fiber-rich vegetables are the first basis for this. Talk to your doctor to see if you can reduce your medication dose.

As an insulin-dependent diabetic, you should approach the ketogenic diet with extra caution. Both type 1 and type 2 diabetics in the later stages of the disease can be insulin-dependent. As a diabetic, you are probably familiar with the term ketoacidosis. Many doctors even lump ketoacidosis in with ketosis, which is factually incorrect.

Ketosis is a physiological (i.e. natural/healthy) metabolic state in which the amount of ketone bodies is slightly elevated above normal. Ketosis is achieved through fasting or ketogenic diet. In ketosis, for example, one has ketone body concentrations of 3-6 mmol/l. In healthy people, the values cannot rise much above this.

Because: Insulin is the antagonist of ketone bodies!

You certainly know that insulin rises when you eat sugar. But did you know that ketone bodies also attract insulin? If the ketone body level in the blood rises, the insulin level also rises. The insulin causes some of the ketone bodies to be excreted in the urine. Thus, in a healthy person, the ketone body level is always kept within the physiological (i.e. healthy) range. It cannot go any higher.

It is different when the pancreas no longer produces insulin. Ketone body levels rise but do not attract insulin. Suddenly, the ketone body level has no natural limit, no counterpart. This is why ketoacidosis can occur in cases of absolute insulin deficiency (that is, when the pancreas can no longer produce insulin). These are ketone body concentrations of over 25 mmol/l – as high as they can never become in a healthy person.

That’s why, as an insulin-dependent diabetic, you need to monitor not only your blood glucose levels, but also your ketone body concentration. Your insulin dose must be adjusted to regulate both blood sugar and ketone bodies.

This sounds complicated at first – so please inform yourself well and talk to your doctor about the planned change in diet. In the long run, you’ll benefit from a ketogenic diet even if you’re an insulin-dependent diabetic – blood sugar stays consistently low and insulin doses can be reduced. For a moderate start, I recommend trying a moderate low carb diet first (with 50-100 g of carbohydrates per day) and later a moderate ketogenic diet (with 30-50 g of carbohydrates per day). Just see how it makes you feel and how your values change.

Watch the exciting interview with Bettina Meiselbach from “Happy Carb: Diabetes Type 2 – not with me” here and learn more about her success story.