Quick answer: Keto may support metabolic health by lowering carbohydrate load, which reduces blood sugar spikes and insulin demand. Some studies show improved insulin sensitivity and blood sugar in people with insulin resistance or type 2 diabetes, especially short term. Lower insulin may also encourage cellular cleanup (autophagy). Anyone on diabetes medication needs medical guidance.
Key takeaways
Lowering carbohydrates reduces the demand on the pancreas, which may help people with insulin resistance.
Fewer carbohydrates mean smaller blood sugar swings, and tests such as hemoglobin A1c help track changes with your provider.
Keto can lower blood sugar quickly, so people with diabetes need their insulin and some medications adjusted by their doctor.
Insulin sensitivity
In insulin resistance, cells respond poorly to insulin, so the pancreas produces more. Lowering carbohydrates reduces this demand. See the role of insulin.
Blood sugar control
Fewer carbs mean smaller blood sugar swings. Tests such as hemoglobin A1c help track changes with your provider. See the insulin sensitivity guide.
Cellular repair
Lower insulin and nutrient-sensing signals may encourage autophagy, the body’s recycling of damaged cell parts. See autophagy.
Safety for people with diabetes
Keto can lower blood sugar quickly. Insulin and some medications must be adjusted by your doctor to avoid low blood sugar, and SGLT2 inhibitors carry a risk of ketoacidosis.
Healthy aging lens
Metabolic health, including insulin sensitivity and healthy blood sugar, is one of the strongest foundations of healthy aging. See metabolism and longevity.
When to see a naturopathic doctor
It may be time to see a naturopathic doctor if you have diabetes or take insulin, sulfonylureas or SGLT2 inhibitors (risk of low blood sugar or ketoacidosis), or if you take blood pressure medication or diuretics. The same is true if you have kidney, liver, gallbladder or pancreas disease, or high cholesterol, if you are pregnant, breastfeeding, or have a history of disordered eating, or if you want a keto plan tailored to your labs and goals.
See a medical provider promptly for nausea and vomiting, abdominal pain, confusion, fruity-smelling breath with rapid breathing, or very high blood sugar or ketone readings, which can signal ketoacidosis.
What the research shows
In a 2005 inpatient study by Boden and colleagues, 10 obese adults with type 2 diabetes ate their usual diet for 7 days and then a strict low-carbohydrate diet for 14 days in a hospital research unit. They ate about 1,000 fewer calories a day without being told to, HbA1c fell from 7.3% to 6.8%, and insulin sensitivity improved by about 75%. The authors noted the short duration, small size and lack of a strict control group.
A longer comparison came from a 2008 randomized trial by Westman and colleagues, in which 84 adults with obesity and type 2 diabetes followed either a ketogenic diet (under 20 grams of carbohydrate a day) or a reduced-calorie low-glycemic diet for 24 weeks. HbA1c fell by 1.5% on keto versus 0.5%, weight by 11.1 versus 6.9 kg, and diabetes medicines were reduced or stopped in 95% versus 62%. Only 58% completed the study, and anyone on diabetes medicines needs medical guidance before cutting carbohydrates.
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Questions to bring to your clinician
These questions can help you get the most out of your next visit.
Which markers, such as A1c or fasting insulin, should we track if I try keto?
Could keto help my insulin sensitivity, given my labs?
Which labs should we recheck to see whether keto is helping my metabolism?
How long would it be reasonable to try keto before we review my results?
Frequently asked questions
Does keto improve insulin sensitivity?
Some studies show improvements, especially short term.
Is keto good for type 2 diabetes?
It may help blood sugar, but must be supervised if you take medication.
What is autophagy?
The body’s process for recycling damaged cell parts.
Is keto better than other diets for metabolism?
Long-term results are often similar; sustainability matters.
Sources
- Boden G, Sargrad K, Homko C, et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 2005. PMID: 15767618. https://pubmed.ncbi.nlm.nih.gov/15767618/
- Westman EC, Yancy WS, Mavropoulos JC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond) 2008. PMID: 19099589. https://pubmed.ncbi.nlm.nih.gov/19099589/
- Goldenberg JZ, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data. BMJ 2021. PMID: 33441384. https://pmc.ncbi.nlm.nih.gov/articles/PMC7804828/
- Mizushima N, Komatsu M. Autophagy: renovation of cells and tissues. Cell 2011. PMID: 22078875. https://pubmed.ncbi.nlm.nih.gov/22078875/
- Peters AL, et al. Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium-Glucose Cotransporter 2 Inhibition. Diabetes Care 2015. PMID: 26078479. https://pmc.ncbi.nlm.nih.gov/articles/PMC4542270/
- MedlinePlus: Diabetes Type 2
This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.
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