Ketogenic diet is a high-fat, low-carbohydrate diet, limiting starchy items and products with many simple sugars. Small amounts of fruits containing less sugar are allowed, such as strawberries, raspberries, and blueberries; while green leafy vegetables such as arugula, spinach, kale, corn salad, and salad provide key nutrients. Other than root vegetables, the majority of vegetables can be consumed on this plan. Proteins come from meats, fish eggs and dairy (in lesser amounts), while healthy fats are sourced from avocado, olives, nuts and olive oil/butter/cream. Including fatty acids that contain Omega-3s provides an anti-inflammatory effect too. It’s essential to stay hydrated with mostly water or tea/coffee; furthermore special focus should be placed on meal planning for diabetes patients due to the potential for glucose fluctuations.

It is important to have supervision from both a dietician and medical doctor.

In the initial stage of a ketogenic diet, it is beneficial to pay particular attention to hydration and electrolyte (magnesium, sodium, and potassium) supplementation in order to reduce the possibility of experiencing ”keto-flu” symptoms that arise from increased water excretion. Patients should also consistently measure their glucose concentration in their blood and the ketone bodies in serum. People with diabetes should minimize physical activity when starting out on this diet to prevent potential hypoglycemic episodes. Those taking medications or insulin must consult with a medical specialist about their diet, with further pharmacological management. Reducing medication doses or discontinuing them entirely (e.g., insulin) can be considered as options. It is important to bear in mind that returning to a high-carbohydrate diet may result in an increase in glycemia thus it should be done gradually under supervision of an experienced nutritionist and doctor.

Diabetes mellitus

Diabetes mellitus is a rapidly increasing disorder, with more than 460 million patients worldwide and estimates of 700 million by 2045. Two primary types are usually distinguished, both showing similar signs but caused by different mechanisms. Type 1 diabetes is typically diagnosed in children, characterised by damage to the insulin-producing pancreatic beta cells due to an autoimmune reaction within the body. This leads to an inadequate amount of insulin being produced and impairs the transport of glucose into cells, which is detected in elevated serum glucose concentrations. Type 2 diabetes involves a failure for cells to respond appropriately to insulin rather than an outright shortage, and is generally seen in adults after years of buildup. It is diagnosable through various parameters – a fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L), random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) or a 2-hour plasma glucose reading with OGTT ≥ 200 mg/dL (11.1 mmol/L) or HbA1c≥ 6.5% (48 mmol/mol).

The perspective of drug-dose reduction or its complete withdrawal only makes the topic more interesting and calls for further exploration. Although carbohydrate reduction in the diet is beneficial on its own, it appears that the attainment of a ketosis state is necessary to obtain its therapeutic effects. This observation applies to both types of diabetes; however, the majority of data refers to T2DM.

According to the current literature, a ketogenic diet can be used to treat diabetes.

Diabetes and the ketogenic diet

Studies suggest ketogenic diets could be advantageous for those with type 2 diabetes over standard dietary recommendations. The numerous potential benefits likely outweigh the impacts of sticking with regular guidelines. Ketogenic diets have been seen to reduce and stabilize glucose and insulin levels, decrease glycated hemoglobin levels, lower HOMAR-IR scores, lessen insulin resistance, and facilitate weight loss. What’s more, this diet may also act as an anti-inflammatory agent in conjunction with a caloric deficit and does not pose a high risk when administered properly. On the contrary, any apprehensions about negative effects are disproportionate to what has been observed in practice. In conclusion, accurate monitoring of patients is paramount in ensuring safety while using this diet.

According to the available data, it might be reasonable to apply the ketogenic diet to type 1 diabetes (T1D). In spite of limited literature evidence, a ketogenic diet may be beneficial in treating type 1 diabetes because of its anti-inflammatory effects, glycemic stabilization, and pancreatic effects.

Published studies indicate that diabetic ketoacidosis and severe hypoglycemia episodes are rare, but still should be taken into consideration when a patient is under medical supervision. Further research is needed to make a definitive judgement on the efficacy of a ketogenic diet. Despite initial positive indications, more information is required to give the go-ahead, such as longer follow-up studies or conclusive findings.

In short, it appears that the ketogenic diet could provide benefits for patients with diabetes, and there appears to be some positive outcomes for type 1 diabetes patients too. Further research is needed in this area; however, the results of current studies are sufficiently promising enough to potentially influence recommendations for those living with diabetes, which could improve their quality of life significantly.