The ketogenic (keto) diet for diabetes has gained popularity as a way to manage blood sugar levels, reduce insulin use, and support weight loss. Originally developed in the 1920s for epilepsy treatment, keto is now being studied for diabetes, obesity, and heart health.
But like any diet, it comes with benefits and potential risks — especially for people with diabetes.
Key Highlights on the Ketogenic Diet & Type 2 Diabetes
- Improved cholesterol profile: The ketogenic diet showed higher HDL (“good” cholesterol) levels and lower triglycerides compared to control diets.
- No big difference in blood sugar or weight loss: Over 2 years, keto did not significantly improve glycemic control or body weight compared with other diets.
- Kidney safety: No major changes in renal function were seen between keto and control diets, suggesting that the ketogenic diet is likely safe for kidneys.
Table of Contents
Diabetes Diet: What to Eat When You Have Type 2 Diabetes
Being diagnosed with type 2 diabetes can feel overwhelming. Between medical appointments, lifestyle changes, and managing medications, one of the first questions people ask is: “What should I eat?”
The good news is that there’s no single “diabetes diet” — but there are proven ways of eating that help control blood sugar, support weight loss, and lower the risk of complications like heart disease and stroke.
What Is a Diabetes Diet?
- Limiting added sugars and refined carbs (white bread, pastries, sugary drinks).
- Eating more whole foods — vegetables, fruits, legumes, nuts, and whole grains.
- Including lean proteins and healthy fats (like olive oil and fish).
- Controlling portion sizes to support weight management.
Fact checks: There’s no need to buy foods labeled “diabetic” or avoid fruit. Whole fruit contains natural sugar but also fiber, vitamins, and antioxidants that support overall health.
Diabetes Diet Goals You Can Set
- Reach and maintain a healthy blood sugar level.
- Improve cholesterol and blood pressure.
- Achieve a healthy weight or even remission in early diabetes.
- Lower risk of heart disease and strokes.
Tip: Write your personal goals down — you’ll be more likely to stick to them.
Best Eating Plans for Diabetes
Research shows that several diets can be effective for diabetes, especially if they reduce processed carbs:
- Mediterranean diet: Plant-based, with whole grains, legumes, olive oil, fish, and vegetables.
- Low-carb diet: Limits carbs to improve blood sugar and support weight loss.
- Ketogenic diet: Ultra-low-carb and high-fat, but may be harder to sustain long term.
The Mediterranean diet for diabetes is often easier to follow and provides more fiber and nutrients compared to the stricter ketogenic diet.
Breakfast - Wholegrain cereal with milk
- Wholegrain toast with avocado and egg
- Natural unsweetened yogurt with berries
- Oats topped with nuts and seeds
Lunch - Chicken or tuna salad sandwich on wholegrain bread
- Pasta salad with vegetables
- Salmon steak with leafy greens
- Homemade soup with legumes and a side salad
- Roast chicken with vegetables
- Beef stir-fry with brown rice
- Salmon with noodles and steamed veggies
- Chickpea curry with brown rice
- Lasagne made with wholegrain pasta
Can You Snack With Diabetes?
Snacking isn’t always necessary, but if you do, choose smart snacks like:
- Carrot sticks with hummus
- A handful of nuts
- Dark chocolate rice cakes
- Fresh fruit
Takeaway: The best diabetes diet is not about cutting everything out, but about eating smarter. Focus on whole foods, limit refined carbs, and choose a style of eating — like the Mediterranean diet — that you can follow long term.
What Makes Keto “High Fat”?
- 55–60% fat
- 30–35% protein
- 5–10% carbs
This doesn’t mean loading up on unhealthy saturated fats. The focus should be on heart-healthy fats, such as:
Eggs • 
Salmon • 
Avocado • 
Cottage cheese • 
Olive oil • 
Nuts & seeds
Benefits of the Keto Diet for sugar patients
- Blood sugar control – Research shows keto may improve HbA1c levels and reduce blood sugar spikes.
- Less medication – Some people require lower doses of insulin or diabetes medications.
- Weight loss – Especially useful for type 2 diabetes linked to obesity.
- Lower inflammation – May reduce diabetes-related complications.
Risks and Side Effects of ketosis for diabetics
Switching to keto changes how your body uses energy, which may cause short-term side effects known as the “keto flu”:
- Nausea, fatigue, headache
- Dizziness, insomnia, constipation
- Low blood sugar (hypoglycemia) if you’re on insulin or other medications
- High LDL cholesterol in some individuals
- Difficulty sustaining the diet long-term
Keto and Diabetic Ketoacidosis (DKA)
- Dietary ketosis ≠ DKA → With proper monitoring, nutritional ketosis is safe.
- DKA risk is higher in unmanaged diabetes, especially type 1 diabetes.
Seek urgent care if you notice:
fruity-smelling breath, extreme thirst, nausea, or difficulty breathing.
Bottom Line: Should People With Diabetes Try Keto?
The ketogenic diet for diabetes management can:
- Lower blood sugar
- Reduce medication needs
- Support weight loss
But it also comes with risks like hypoglycemia and cholesterol changes.
If you have diabetes, never start keto without medical supervision. Regular blood sugar and ketone monitoring are essential. For some, keto may work best as a short-term strategy rather than a lifelong diet.
9 Key Challenges of the Ketogenic Diet for Diabetes in 2025
The ketogenic diet for diabetes has become one of the most talked-about topics in recent years. Many people try keto to control blood sugar, lose weight, or even achieve type 2 diabetes remission. But while studies show promising results, there are still major challenges to applying keto universally for diabetes management.
Let’s break it down simply.
One of the biggest problems is that there’s no single definition of the ketogenic diet.
- Some studies call <50 g carbs/day keto.
- Others allow up to 100 g carbs/day.
- Fat and protein limits also vary.
This makes research results hard to compare and confusing for both doctors and patients.
A practical way to define it: a diet that leads to nutritional ketosis (ketone levels above 0.5 mmol/L).
Not everyone reaches ketosis at the same carb level.
- Some people need <30 g carbs.
- Others can eat more and still make ketones.
- Too much protein may also block ketosis because the body can turn protein into glucose.
Even in studies, many participants struggled to sustain ketosis long-term, which limits results.
There isn’t just one keto diet. Common versions include:
- Classic ketogenic diet – strict, very high fat.
- Modified keto diet – slightly more carbs, less fat.
- MCT keto diet – uses medium-chain triglyceride oil to reach ketosis with fewer carb restrictions.
- Very low-calorie keto diet – combines calorie restriction with carb restriction.
Each version works differently, making it harder to create universal guidelines.
Type 2 diabetes is not the same for everyone. People differ in:
- Insulin sensitivity
- Beta-cell function
- Physical activity levels
- Age, sex, BMI, ethnicity
For example, an active athlete may reach ketosis on 80 g carbs/day, while a sedentary person may need less than 30 g. This means the ketogenic diet must be personalized rather than prescribed the same way for all.
- Certain genetic types may have higher cholesterol on keto, raising heart disease risk.
- High saturated fat intake may worsen heart, kidney, or cancer risk in some patients.
That’s why medical supervision is essential for anyone with type 2 diabetes considering keto.
Most studies on keto and diabetes last less than a year.
- Benefits like lower blood sugar, reduced medications, and weight loss are strongest in the first 6–12 months.
- After 6 months, many people stop following the diet strictly, and results weaken.
Another open question: Should keto be a short-term therapy or a lifelong lifestyle?
If carbs are reintroduced too quickly, blood sugar and cholesterol can worsen again.
The typical keto diet is animal-based (meat, eggs, dairy). But many people are vegetarian, vegan, or avoid certain foods for cultural or religious reasons.
- Plant-based keto alternatives (nuts, seeds, tofu, avocados) are possible but harder to balance.
- Many patients find keto restrictive and difficult to follow long-term.
- Keto can improve blood sugar, insulin resistance, triglycerides, and weight in the short term.
- Some studies show improvement in cholesterol markers, while others show increased LDL (bad cholesterol).
- There is no long-term population-level evidence yet proving keto is superior to other diabetes diets.
The ketogenic diet for diabetes is not a universal solution. It may work wonders for some, but not for everyone.
Benefits:
- Lowers blood sugar
- Reduces diabetes medications
- Supports weight loss
- Difficult to sustain
- Risk of cholesterol changes
- No “one-size-fits-all” definition
Best Approach: Treat keto as a personalized therapy under medical guidance, rather than a blanket prescription for all people with type 2 diabetes.
The ketogenic diet is powerful, but it’s not magic. For now, it may be most useful as a short-term strategy (up to 1 year) for improving blood sugar and weight in type 2 diabetes, with careful monitoring. More research is needed to know whether it should be a lifelong prescription.
Atkins Diet and Diabetes: What You Need to Know in 2025
The Atkins diet, created by Dr. Robert Atkins in 1972, is one of the most well-known low-carb, high-protein diets. While it’s often compared to the ketogenic diet, there are some important differences.
Unlike keto, the Atkins diet doesn’t specifically push for high fat intake, but by limiting carbs and eating more protein, fat consumption may still increase. This approach may support weight loss, which can help improve blood sugar control in people with type 2 diabetes.
✔Possible Benefits
- Weight loss may improve glucose levels
- Lower carb intake may reduce blood sugar spikes
- Increased saturated fat intake
- Hypoglycemia (low blood sugar) if on insulin or medication
- Keto vs. Atkins: Keto focuses on high fat and ketosis, while Atkins emphasizes protein with flexible fat intake.
- Evidence: Limited research directly links the Atkins diet with diabetes management.
- Mediterranean diet
- Plant-based diets
- Low-glycemic index (GI) diet
- Low-carb variations
Bottom line: While the Atkins diet may help some people with diabetes, it’s not a one-size-fits-all solution. Always consult a doctor or dietitian before starting low-carb diets for diabetes to ensure they fit your health needs.
Atkins Diet vs. Keto Diet for Diabetes: Key Differences in 2025
Both the Atkins diet and the ketogenic (keto) diet are low-carb eating plans, but they’re not the same — especially when it comes to managing diabetes.
How They Work
- Keto diet: Very low carb (5–10% of calories), high fat, moderate protein. Its main goal is to put the body into ketosis, where fat becomes the main fuel source instead of glucose.
- Atkins diet: Low carb, high protein, with fat intake varying by stage. It doesn’t always aim for ketosis, but instead focuses on carb restriction and gradual reintroduction.
- Support weight loss, improving blood sugar control
- Lower HbA1c levels by reducing carb intake
- Reduce the need for some diabetes medications
- Keto diet: May cause side effects like the “keto flu,” high cholesterol, or hypoglycemia in people on insulin.
- Atkins diet: May increase saturated fat intake and still carries a risk of low blood sugar.
Atkins vs Keto for Diabetes
Bottom line: Both diets can help manage blood sugar levels and support weight loss, but the keto diet is stricter and focuses on fat, while the Atkins diet is more flexible and protein-heavy. Always consult a healthcare professional before trying either diet for diabetes management.
Ketogenic vs. Mediterranean Diet: Which Low-Carb Plan Works Better for Diabetes?
Low-carbohydrate diets are often recommended for people with type 2 diabetes or those at risk. But how low should carbs go? And which diet is easier to follow in the long run?
A Stanford Medicine trial compared two popular low-carb diets — the ketogenic diet (keto) and the Mediterranean diet — to see their effects on blood glucose, weight, cholesterol, and long-term adherence.
- Ultra-low-carb, very high-fat diet
- Carbs limited to 20–50 grams/day
- Encourages fat as the main energy source
- Cuts out legumes, fruits, and whole grains
- Often used for quick weight loss and blood sugar control
- Low-carb, moderately high-fat diet
- Focuses on vegetables, fruits, whole grains, legumes, olive oil, nuts, and fish
- Flexible and more plant-based
- Encourages long-term sustainability
Researchers tested both diets on adults with type 2 diabetes or prediabetes:
Blood Sugar Control
- Both diets lowered HbA1c (9% keto, 7% Mediterranean)
- Fasting glucose and insulin improved similarly
- Similar results: ~8% on keto vs. ~7% on Mediterranean
- Keto diet: LDL (“bad” cholesterol) went up, but triglycerides dropped more
- Mediterranean diet: LDL went down, offering better heart protection
- Keto diet lacked fiber and several vitamins (B6, C, D, E)
- Mediterranean diet provided a more balanced nutrient profile
Which Diet is Easier to Follow?
- Both diets were easier when food was delivered.
- Once participants cooked on their own, keto was harder to maintain due to its strict carb limits.
- After the trial, most people leaned toward a Mediterranean-style eating pattern.
Takeaway: The Best Low-Carb Diet for Diabetes
- Keto may work faster but is restrictive and harder to follow long term.
- Mediterranean diet is more flexible, nutrient-rich, and sustainable — making it a better everyday choice for people with type 2 diabetes or prediabetes.
The focus should be on cutting added sugars and refined grains while keeping healthy carbs like legumes, fruits, and whole grains.
Conclusion:
- Insulin sensitivity
- Beta-cell function
- Physical activity levels
- Age, sex, BMI, ethnicity
