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Keto Diet for Type 1 Diabetes Mellitus

Keto Diet for Type 1 Diabetes

Keto Diet is now widely followed by patients with Type 2 Diabetes Mellitus. Keto for Type 1 Diabetes is a dilemma. 

A keto diet can be beneficial in lowering blood glucose in patients with Type 1 Diabetes patients, but it can also increase the risk of DKA (diabetic ketoacidosis) and hypoglycemia.

Nutritional ketoacidosis and diabetic ketoacidosis are also different entities. Nutritional ketoacidosis is good for health while diabetic ketoacidosis is a serious condition.

diabetic ketoacidosis (DKA) quiz
DKA Quiz

Diabetes Type 1 and Keto Diet:

Type 1 diabetes is an autoimmune illness caused by the body’s inability to produce the insulin hormone.

Insulin controls blood sugar levels by transporting glucose from the bloodstream to cells, where it is used as energy. Insulin injections more than once a day are used to treat type 1 diabetes.

It is commonly assumed that because type 1 diabetes is an autoimmune illness, dietary changes cannot have a substantial impact on its prevention.

keto ice cream
keto ice cream

However, food can help avoid autoimmunity and play an important role in the management of type 1 diabetes.

Before the discovery of insulin, low-carb keto diets were the only treatment available for type 1 diabetes.

Even now when we can inject insulin, dietary carbohydrates and the insulin requirement are inextricably linked.

The greater the intake of carbohydrates, the greater the need for insulin. This is why keto diets may help lower blood glucose in T1DM.

What should be the daily carb intake of a person with type 1 diabetes?

The daily carbohydrate intake differs among people and it is difficult to assume an amount that is fit for all.

However, limiting carbohydrate intake to less than 100 g/day has been shown to improve blood glucose levels and is associated with less occurrence of hypoglycemia.

Very-low-carb approaches might offer better glycemic control and also require little insulin resulting in blood sugar regulation within the healthy ranges.

type 1 diabetes mellitus insulin dependent diabetes mellitus ozempic for type 1
Type 1 Diabetes Mellitus

Keto Diet and T1DM:

A majority of scientific research has focused on the effect of keto diets on type 2 diabetes leaving little data about the impact of keto diets on type 1 diabetes.

However, according to recent studies, a keto diet may be beneficial in T1DM patients, if patients are properly selected.

A study in 2016 discovered that carbohydrate restriction (75-100 g) in T1DM patients for 12 weeks led to a significant decrease in Hba1c and blood glucose levels.

The study also discovered a significant trend toward weight loss among overweight participants  [Ref].

Another recent study suggests that a low-carb, high-protein diet decreases glucose fluctuation and reduces the risk of hypoglycemia [Ref].

In an observational study, 11 participants with T1DM followed a keto diet, the study reported that the keto diet was associated with good Hba1c and reduced glucose variability [Ref].

type 1.5 diabetes lada diabetes
type 1.5 diabetes

Is it safe to follow a keto diet with Type 1 Diabetes?

Following a keto diet with type 1 diabetes requires careful monitoring of not only carbohydrate requirements but also involves making adjustments to your insulin dosage.

The best strategy is to monitor your sugar levels before and after meals, keep a record and evaluate the results.

The fewer carbohydrates you ingest, the lesser the need to inject insulin.

At mealtimes, protein should also be considered as it has been shown that protein might also increase blood sugar levels.

diabetes mellitus difference type 1 and 2

Possible side effects of the keto diet:

The most prevalent concerns concerning carb-restricted diets for patients with type 1 diabetes are that they are difficult to maintain, cause diabetic ketoacidosis, and increase the risk of hypoglycemia.

Diabetic ketoacidosis

People who follow a keto diet or a low-carb diet regularly enter ketosis. However, there is a distinction between nutritional ketosis and diabetic ketoacidosis (DKA).

DKA is an emergency situation in which there is insufficient insulin, resulting in extremely high blood glucose and ketone levels. This illness can potentially cause severe dehydration.

Nutritional ketosis, on the other hand, is a typical situation in which ketone levels are modest and blood glucose levels are within normal ranges.

keto type 1 diabetes Nutritional Ketosis Vs Diabetic Ketoacidosis
Nutritional Ketosis Vs Diabetic Ketoacidosis

People with type 1 diabetes who follow a keto diet must exercise extreme caution to avoid complications. While on a keto diet, glucose levels should be checked on a frequent basis.


Fears of hypoglycemia are frequently associated with keto diets, it is known that, while better glycemic control reduces the chance of developing diabetic complications, it also increases the incidence of hypoglycemia.

The hypoglycemia associated with keto diets should be appropriately managed by carbohydrate counting in every meal and adjusting insulin accordingly. This method pretty much minimizes the chance of low blood sugar levels.

keto hypoglycemia
keto hypoglycemia

How to treat hypoglycemia while on a keto diet?

Although hypoglycemic episodes can be reduced with a low-carb diet, periodic lows are unavoidable for patients with type 1 diabetes.

Whatever diet you follow, fast-acting carbohydrates (such as glucose pills) are required to elevate blood glucose to a safe level.

However, if you consume low carbs, you are likely to have less insulin in your bloodstream and may discover that treating with 15 g of fast-acting carbs raises your blood glucose too much.

Some persons with type 1 diabetes who follow a low-carb diet find that a single glucose pill is enough to swiftly bring their blood sugar back into the healthy range.

emergency treatment of hypoglycemia
emergency treatment of hypoglycemia


The safety of keto diets in type 1 diabetes depends on various factors, including how efficient the treatment is, a history of hypoglycemia, changes in body weight, and malabsorption issues.

With adequate healthcare guidance, the keto diet can be a relatively safe choice for some people with type 1 diabetes, while others should avoid it.

To see how your body reacts, start slowly and consider a lower-carb diet before implementing a complete ketogenic diet.

What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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