Diabetes and keto

Written by Marina Lommel
4 minutes reading time
17. July 2023 zuletzt aktualisiert am 1. August 2023 von
Ketogene Ernährung bei Diabees

Reader question: Is ketogenic diet suitable for diabetes?

To answer this question, one must first look at what type of diabetes is present. Is it type 1 diabetes or type 2 diabetes?

Type 1 diabetes is an autoimmune disease in which the pancreas of the affected person can produce no or only little insulin. Type 1 diabetics are therefore dependent on insulin injections.

Type 2 diabetes is a chronic metabolic disease in which glucose (“sugar”) levels in the blood are elevated. The cause is insulin resistance of the cells – they do not respond (or respond only to a limited extent) to the signal from insulin and therefore do not let the “sugar” into the cells. To lower blood glucose levels, the drug metformin is often administered. As the disease progresses, the pancreas becomes damaged and gradually loses the ability to produce insulin. Then a type 2 diabetic must also inject insulin.

If you are a diabetic and want to eat a ketogenic diet, be sure to talk to your doctor. Because most likely, after a certain time, your medication will need to be adjusted – for example, the metformin or insulin dose.

A ketogenic diet will help keep blood sugar levels consistently low so that the damage that can occur from always having elevated blood sugar levels can be avoided.

With the right diet, ideally combined with some exercise, you can reverse type 2 diabetes in its early stages. The positive influence on your metabolism succeeds especially well if you possibly reduce existing excess weight. The ketogenic diet makes it particularly easy to lose excess pounds – without cravings and without the yo-yo effect. This improves metabolic health quite tremendously (the health of your metabolism).

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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.

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Foto: Shutterstock / Durch Maya Kruchankova

This article was written by

Marina Lommel

Marina gründete Foodpunk nach ihrem Abschluss in Ernährungswissenschaften und ist aktuell CEO des Unternehmens. Während ihres Studiums arbeitete sie in verschiedenen Bereichen, darunter in der Wissenschaftsredaktion beim Radio, Redaktion beim TV und Uni-Wissensmagazin sowie im Labor am DZNE in der Parkinsonforschung. Marina ist außerdem Autorin von 5 ernährungswissenschaftlichen Sachbüchern.

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