The Keto Diet and Type 2 Diabetes: A Practical Guide to Getting Started

Introduction

Type 2 diabetes is often described as a progressive, chronic condition — but for many people, that narrative is changing. With the right lifestyle approach, especially dietary changes, type 2 diabetes can often be significantly improved — and in some cases, even reversed.

One dietary approach getting increasing attention is the ketogenic (keto) diet. By drastically reducing carbohydrate intake and emphasizing healthy fats, keto shifts the body into a metabolic state called ketosis, where fat — not sugar — becomes the primary fuel source.

For individuals with type 2 diabetes, this change can lead to:

• Lower blood sugar levels

• Improved insulin sensitivity

• Reduced reliance on medications

• And better weight management

But starting keto can feel overwhelming, especially when you’re already managing a health condition. This article breaks it down simply, offering a clear, practical guide on what keto is, how it helps, what to eat, and how to get started safely — with science at the center of every step.

🎧 Listen to This Episode of The Health Pulse Podcast
Can switching your fuel source help reverse type 2 diabetes? In this episode, we explore how the ketogenic diet is being used as a therapeutic tool to reduce insulin dependence, improve blood sugar control, and even achieve remission for many people with type 2 diabetes.

👇 Tap play to learn how keto works, what the research says, and whether it might be a fit for your metabolic health journey.

What Is the Keto Diet?

The ketogenic diet, or keto, is a low-carbohydrate, high-fat dietary approach designed to shift the body’s primary energy source from glucose (sugar) to ketones, which are produced from fat by the liver. This metabolic state, called ketosis, can offer distinct benefits for people with insulin resistance and type 2 diabetes.

When carbohydrate intake is significantly reduced—typically to under 50 grams per day—the liver begins breaking down stored fat into molecules called ketone bodies, which are then used for energy by the brain, muscles, and other tissues.

According to the Harvard T.H. Chan School of Public Health, the keto diet typically includes:

• 70–75% of calories from fat

• 20–25% from protein

• 5–10% from carbohydrates
  (Harvard Nutrition Source)

This contrasts sharply with the typical Western diet, which often derives 45–65% of calories from carbohydrates.

While similar to general low-carb diets, keto goes further by restricting carbs to a level low enough to consistently trigger ketosis. This results in a metabolic shift from sugar-burning to fat-burning, and for individuals with type 2 diabetes, that change may reduce insulin levels, stabilize blood sugar, and promote fat loss—especially around the liver and abdomen.

A growing body of clinical research now supports the use of ketogenic diets in the management and possible reversal of type 2 diabetes. We'll explore this evidence next.

How the Keto Diet Affects Type 2 Diabetes

Type 2 diabetes is fundamentally a condition of insulin resistance—where the body’s cells no longer respond effectively to insulin, causing blood sugar and insulin levels to rise. The ketogenic diet directly targets this core issue by reducing the body's demand for insulin and helping restore metabolic flexibility.

When carbohydrate intake is drastically lowered, blood sugar levels naturally fall, and the need for insulin decreases. In response, the pancreas can produce less insulin, and the body becomes more responsive to it over time. This improves glycemic control, reduces hyperinsulinemia, and may allow for significant reductions in diabetes medications.

A 2018 study published in Diabetes Therapy followed patients with type 2 diabetes who adopted a ketogenic diet under medical supervision. After one year:

• 94% reduced or eliminated insulin

• 60% had HbA1c below the diabetic threshold without medication

• Over 50% reversed their diabetes diagnosis by clinical criteria
  (Hallberg et al., 2018)

In addition to lowering blood sugar, the keto diet has been shown to:

• Reduce triglycerides and increase HDL cholesterol

• Promote loss of visceral (abdominal) fat, which is strongly linked to insulin resistance

• Improve blood pressure and other markers of cardiovascular risk

The American Diabetes Association acknowledges low-carbohydrate diets, including ketogenic approaches, as viable strategies to manage type 2 diabetes, particularly for individuals interested in reducing medication reliance and achieving better glycemic control (ADA Standards of Care, 2023).

For people living with type 2 diabetes, the ketogenic diet offers not just weight loss, but the possibility of remission—a goal that until recently was considered nearly impossible without surgery or medication.

What the Research Says

Over the past decade, a growing body of scientific literature has explored the ketogenic diet as a therapeutic option for type 2 diabetes. The results consistently show improvements in blood sugar control, insulin sensitivity, weight reduction, and lipid profiles, especially when the diet is followed under clinical supervision.

One of the most comprehensive studies to date is the 2018 Virta Health study published in Diabetes Therapy. In this one-year trial of adults with type 2 diabetes using a medically supervised ketogenic intervention:

• HbA1c decreased from an average of 7.6% to 6.3%

• 94% of insulin users reduced or eliminated insulin

• Over 50% of participants met criteria for diabetes reversal

• Participants also experienced significant weight loss and improvement in liver enzymes
  (Hallberg et al., 2018)

Another study published in Nutrition & Metabolism compared a low-carb ketogenic diet to a low-fat calorie-restricted diet. The ketogenic group had greater improvements in:

• Fasting blood glucose

• Triglyceride levels

• HDL cholesterol

• Medication reduction
  (Yancy et al., 2005)

Meta-analyses have also confirmed that low-carb and ketogenic diets can significantly reduce HbA1c and insulin levels in people with type 2 diabetes, often more effectively than standard dietary guidelines (Snorgaard et al., 2017).

While long-term adherence and individual variability remain important considerations, these studies suggest that for many, the ketogenic diet may offer not just symptom relief—but a path toward remission.

Getting Started — What to Eat and What to Avoid

Transitioning to a ketogenic diet can feel overwhelming at first, especially if you're managing type 2 diabetes. The key is to focus on whole, nutrient-dense foods that help stabilize blood sugar while keeping carbohydrates very low — generally under 50 grams per day.

Here’s a practical breakdown of what to eat and what to avoid when starting keto:

Foods to Eat:

• Non-starchy vegetables: spinach, kale, zucchini, cauliflower, broccoli, asparagus

• Healthy fats: olive oil, avocado oil, butter, ghee, coconut oil

• Fatty fish and seafood: salmon, sardines, mackerel, shrimp

• Meat and poultry: beef, lamb, chicken, turkey (preferably pasture-raised or grass-fed)

• Eggs: ideally free-range or pasture-raised

• Nuts and seeds: almonds, walnuts, chia seeds, flaxseeds (in moderation)

• Low-carb dairy: cheese, plain Greek yogurt, heavy cream

• Herbs and spices: basil, oregano, turmeric, cinnamon, garlic

These foods support ketone production, improve insulin sensitivity, and help control appetite and energy levels.

Foods to Avoid:

• Sugar and sweetened beverages: soda, juice, desserts, candy

• Grains and starches: bread, rice, pasta, corn, cereal, oats

• Most fruits: especially bananas, grapes, apples, and dried fruits (berries in small amounts may be tolerated)

• Legumes: beans, lentils, peas

• Low-fat or fat-free products: often high in hidden sugars and carbs

• Processed snacks: crackers, chips, granola bars

• Vegetable oils high in omega-6: soybean oil, corn oil, sunflower oil

Always read nutrition labels closely — many processed foods marketed as “low-carb” or “diabetic-friendly” still contain ingredients that can spike blood sugar or prevent ketosis.

For those starting out, a tracking app or a simple food journal can be helpful to estimate carb intake and monitor how certain foods affect your glucose levels.

In the next section, we’ll cover important safety considerations and how to approach keto responsibly — especially if you’re taking medications.

Key Considerations and Safety Tips

While the ketogenic diet offers powerful metabolic benefits for people with type 2 diabetes, it also requires careful planning—especially if you are currently taking glucose-lowering medications. Sudden reductions in carbohydrate intake can significantly lower blood sugar, sometimes within days, and this can lead to hypoglycemia (low blood sugar) if medications are not adjusted properly.

Always Consult Your Healthcare Provider

Before starting a ketogenic diet, talk with your doctor or diabetes care team. You may need to:

• Reduce or adjust insulin or sulfonylureas

• Monitor blood glucose more frequently during the first few weeks

• Schedule follow-up labs to track HbA1c, lipids, liver function, and kidney function

In the 2018 Virta Health study, nearly all participants needed their medications adjusted within the first few weeks due to improved glycemic control (Hallberg et al., 2018).

Understand the “Keto Flu”

When transitioning to ketosis, some people experience mild, temporary symptoms such as:

• Fatigue

• Headache

• Dizziness

• Muscle cramps

• Irritability

This is commonly called the “keto flu” and is often due to electrolyte shifts and dehydration. It typically resolves within a few days.

To reduce symptoms:

• Hydrate well with water and mineral-rich fluids like bone broth

• Supplement with sodium, potassium, and magnesium

• Eat enough fat to support energy levels during adaptation

Monitor Blood Glucose and Ketones

Use a glucometer or continuous glucose monitor (CGM) to track your blood sugar, especially in the first few weeks. Some people also measure blood ketone levels (beta-hydroxybutyrate) to assess their level of ketosis.

Many individuals see improvements in fasting glucose, post-meal glucose control, and insulin levels within the first 2–6 weeks.

Recognize That Keto Is a Therapeutic Tool — Not a Lifetime Requirement

For some, long-term keto may be sustainable. For others, it serves as a short-to-medium term intervention to reverse insulin resistance, improve metabolic health, and allow eventual reintroduction of nutrient-dense carbohydrates in moderation.

The key is personalization and ongoing monitoring of metabolic markers and symptoms to determine what works best.

When Keto Might Not Be Ideal

While the ketogenic diet has demonstrated strong benefits for managing type 2 diabetes, it’s important to recognize that no diet is universally appropriate. That said, some concerns about keto—especially regarding its effects on the liver and kidneys—require a more evidence-based and nuanced perspective.

Medical Conditions Requiring Monitoring (Not Automatic Exclusion)

Liver Health
Contrary to outdated beliefs that high-fat diets strain the liver, emerging research shows the opposite may be true. In individuals with nonalcoholic fatty liver disease (NAFLD)—a common complication of insulin resistance and type 2 diabetes—low-carbohydrate diets have been shown to reduce liver fat and improve liver enzyme levels.

As Dr. Robert Lustig has emphasized in his research, excessive carbohydrate—particularly fructose—is more harmful to the liver than dietary fat. Fructose overload promotes hepatic fat accumulation, mitochondrial dysfunction, and insulin resistance (Lustig et al., 2013). A well-structured ketogenic diet, by eliminating refined carbohydrates and reducing liver fat, may support—not hinder—liver function.

A 2016 meta-analysis found that low-carb diets significantly reduced intrahepatic fat in patients with NAFLD without causing liver injury (Properzi et al., 2016). Another trial demonstrated decreased ALT and improved liver function in participants following a ketogenic diet (Jrnl Reg Med Sci, 2016).

Kidney Function
Concerns about increased protein intake harming kidney function in keto diets often stem from a misunderstanding—ketogenic diets are moderate in protein, not high. Still, monitoring is prudent in those with known kidney disease. Importantly, most studies rely on serum creatinine to assess kidney function, which can be misleading.

Cystatin C, a protein less influenced by muscle mass or dietary intake, offers a more accurate estimation of kidney function (eGFR), especially in individuals following diets that affect protein metabolism. According to research published in the New England Journal of Medicine, cystatin C-based GFR equations outperform creatinine-based estimates in detecting early renal impairment (Inker et al., 2012).

Therefore, rather than excluding individuals with liver or kidney concerns from considering keto, a monitoring-based approach using accurate biomarkers is more appropriate.

Special Populations Where Keto May Require Modification

• Type 1 diabetes: Requires careful oversight to avoid diabetic ketoacidosis (DKA).

• Pregnant or breastfeeding women: Higher energy and nutrient demands may not be met with a restrictive diet.

• Those with disordered eating histories: Rigid rules may trigger relapses without proper psychological support.

• People with extremely high physical demands: Athletic populations may benefit more from a cyclical or targeted low-carb approach.

Focus on Personalization, Not Elimination

Rather than blanket exclusion, the key is individualization. With appropriate lab testing—including cystatin C for kidney monitoring and liver enzyme panels—many individuals with metabolic dysfunction can safely implement keto under clinical supervision.

Conclusion

The ketogenic diet is more than just a low-carb trend — for many individuals with type 2 diabetes, it represents a powerful metabolic tool. By reducing carbohydrate intake, supporting fat adaptation, and lowering insulin demand, keto can help improve blood sugar control, reduce or eliminate medication dependence, and address the root causes of insulin resistance.

Clinical studies now show that keto is capable not only of improving symptoms, but in many cases, of helping individuals achieve partial or full remission of type 2 diabetes. While not everyone will respond the same way, and long-term success depends on consistency and support, the evidence is increasingly clear: this approach deserves consideration.

Importantly, starting a ketogenic diet should always be done with medical guidance — especially if you are using glucose-lowering medications. Regular blood sugar monitoring and possible medication adjustments are essential during the first few weeks.

For individuals with liver or kidney concerns, recent data challenges the idea that keto is harmful. In fact, low-carbohydrate diets may reduce liver fat, and cystatin C-based kidney monitoring can offer a more precise picture of renal function when protein intake is a concern.

Ready to get started?
Quick Lab Mobile offers in-home blood testing for fasting insulin, HbA1c, lipid panels, cystatin C, and liver enzymes — making it easier to track your metabolic health and personalize your approach.

When done properly, keto is not a fad — it’s a strategy.
And for many, it’s a gateway to better energy, reduced medications, and truly improved quality of life.

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