Keto diet and type 2 diabetes: what to know

When carbohydrate intake falls sharply, the body uses more fat for energy and the liver makes ketones. Blood glucose may fall, especially when food intake changes while diabetes medicines stay at their previous dose. Weight may change too, but a restrictive eating pattern can make it harder to obtain enough fibre, vitamins, and suitable protein.

The safety question depends on your treatment and health history. Insulin and some glucose-lowering tablets can cause hypoglycaemia when meals contain fewer carbohydrates. Some medicines can increase the risk of ketone-related illness during reduced eating or dehydration. Kidney disease, pregnancy, and a history of eating difficulties also need individual advice.

Speak with your diabetes clinician before starting or making the diet stricter. Review your medicines, glucose-monitoring plan, sick-day instructions, and ketone testing advice. Do not stop insulin or change prescribed doses without guidance. Keep fluids available, choose unsaturated fats and non-starchy vegetables, and include a reliable source of protein.

Record glucose readings, meals, symptoms, and activity while your plan is being adjusted. Shakiness, sweating, confusion, unusual hunger, or weakness can signal hypoglycaemia; treat it according to your personalised plan and seek help if it does not improve. Learn more about [Hypoglycaemia](/conditions/hypoglycaemia/) and [Chronic Kidney Disease](/conditions/chronic-kidney-disease/) if either is relevant.

Get urgent medical help for repeated vomiting, severe abdominal pain, deep or difficult breathing, marked drowsiness, confusion, or inability to keep fluids down. These symptoms can occur with dangerous ketone accumulation, even when a glucose reading does not seem very high. Seek prompt advice for persistent high readings, frequent low readings, or signs of dehydration.

Ask which medicines need review, how often to check glucose or ketones, what to do during illness, and whether your kidney function makes this eating pattern unsuitable. You can also ask how to meet fibre and nutrient needs without excessive restriction.