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Keto and Type One Diabetes: Can They Work Together?

Can t1d’s try the keto diet?

The ketogenic diet has become an increasingly popular approach for weight loss and blood sugar management. But is keto a realistic option for people with type 1 diabetes? While keto takes some extra planning, the answer is yes - you can make keto work with type one diabetes.

What is Keto?

The keto diet emphasizes very low carbohydrate intake (typically under 50g net carbs per day), moderate protein, and high healthy fat. This low-carb state pushes your body into ketosis, where you burn ketones derived from fat as your primary fuel source instead of carbs from glucose.

Benefits of Keto for t1d

When properly implemented, keto offers several potential benefits for type one diabetes:

  • Improved blood sugar stability due to consistent carb intake spread evenly throughout the day

  • Possible weight and/or body fat loss by burning fat rather than carbs for energy

  • Reduction in insulin needs and insulin resistance

  • Fewer episodes of hypoglycemia thanks to steady energy from fat and protein

  • Overall better time in range

How to make keto work safely with t1d

Switching to a keto diet with type one diabetes requires careful monitoring and management to prevent complications.

Some tips to consider: 

  • Check ketones frequently, especially when first starting. Use both blood and urine ketone test strips to monitor and prevent diabetic ketoacidosis.

  • Work closely with your endocrinologist to determine proper basal rate and bolus ratio adjustments. You'll likely need much less insulin on keto.

  • Stay well hydrated by drinking plenty of water and electrolyte-rich fluids. Dehydration increases risks on keto.

  • Choose healthy fats like olive oil, nuts, avocado, and fatty fish. Limit saturated fats which can negatively impact cholesterol.

  • Eat adequate protein for muscle retention and satiety. Eggs, poultry, meat, and Greek yogurt are great options.

  • Supplement mindfully with exogenous ketones like bone broth, MCT oil, or exogenous BHB. Start slowly.

  • Have backup snacks on hand always. Simple carbs for emergencies if needed.

  • Be prepared to course correct. If keto isn't improving your blood sugar management, pivot to an approach that works better.

Potential challenges of the keto diet for t1d’s

With the proper precautions and responsive fine-tuning, keto may offer improved glycemic control for some T1Ds. But, let’s make one thing clear: the keto diet is not a "cure" for type one diabetes.

It should be undertaken cautiously and with full awareness of the potential challenges. You still need insulin and you’re still going to have to carb count, even if at lower doses.

 Some potential challenges the keto diet may pose for t1d’s are:

  • Keto flu - Headaches, fatigue, nausea, and "brain fog" for the first few weeks as your body adapts. In some cases, this can be mitigated with electrolyte supplements, but be sure to ask your doctor!

  • Increased risk of DKA - Meticulous ketone testing is required to prevent this dangerous complication of high ketones without proper insulin.

  • Dietary restrictions - Keto requires strict carb counting and careful meal planning. Dining out and social gatherings become more challenging.

  • Kidney Function - Get kidney function tested regularly, as excess protein and fats can tax kidneys long-term, especially if underlying kidney issues exist.

For many, a less restrictive low-carb diet may provide some benefits without the stringent restrictions of full ketosis. As with any major dietary change for diabetes, work closely with your healthcare team to determine if keto is appropriate for your individual care needs and goals!

Always check with your doctor first

The ketogenic diet can be a viable option for some people with type 1 diabetes looking to better manage their blood sugar. However, it requires careful planning, close medical supervision, and diligent tracking of ketones and insulin adjustments!

For T1Ds interested in pursuing keto, be sure to consult your endocrinologist to develop a personalized plan that accounts for your specific insulin needs and kidney function!

Disclaimer: The information provided in this blog is for informational purposes only. It is not intended as, and should not be taken as medical advice. The content is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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