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The Keto Diet and Diabetes

A healthy diet is important for a healthy life, as stated by the old saying “You are what you eat.” This is even more important in today’s world where diabetes and obesity are epidemics. In recent decades, low carbohydrate diets (LCD) and ketogenic diets (KD) have become widely known and popular ways to lose weight. These diet approaches are effective for losing weight, but there is growing evidence suggesting that caution is needed, especially when these diets are followed for extended periods of time, or by individuals of a young age or with certain diseases.

The keto diet aims to adjust what fuel the body uses. Instead of using sugars from carbohydrates (grains, vegetables, fruits) the body uses ketone bodies that the liver produces from fat. The keto diet as a solution for weight loss and diabetes management is a newer concept.

A keto diet limits the amount of carbohydrates an individual consumes to 20 to 50 grams a day to force the body into ketosis. To put this into perspective 1 medium - size banana has about 27 grams of carbohydrates. It takes the body a few days of consistent low carbohydrate and high fat intake to reach ketosis. When the body can maintain ketosis, it begins to burn fat that is stored to produce ketones to use for energy, this is referred to as nutritional ketosis. Nutritional ketosis can be beneficial for lowering blood glucose levels and aiding in weight loss which can have a positive impact on diabetes management.


When following a keto diet there are risks to be concerned with. Ketoacidosis is the most serious risk to be aware of and work to prevent by getting a recommended amount of carbohydrate, so the body does not produce too many ketone bodies. Symptoms of ketoacidosis can include excessive thirst, confusion, urinating often, weakness, or fatigue. If an individual experiences these symptoms, they should contact their doctor right away.

SHORT-TERM EFFECTS (up to 2 years)

The keto diet causes rapid and sensible weight loss along with favorable biomarker changes, such as a reduction in A1c in patients with diabetes. However, it also causes a substantial rise in LDL, “bad” cholesterol levels, and many physicians are therefore hesitant to endorse it. This diet is recommended to be followed for a minimum of 2 weeks and up to 12 months.

The keto diet does not have many short-term side effects. The most common short-term side effects include nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, referred to as keto flu.


It is still unclear if the keto diet is the best way to manage your diabetes long-term, due to limited literature.

Long-term side effects that can have a major impact:

  • Hepatic steatosis: increased buildup of fat in the liver

  • Hypoproteinemia: very low levels of protein in the blood

  • Kidney stones: small, hard deposits of minerals and salts that form in kidneys

  • Vitamin and mineral deficiencies

It is always recommended to talk to your physician before switching over to the keto diet. For some, this diet could be beneficial and accomplish the weight loss goals they are looking for. For others, this could make their diabetes worse. Either way, this is a big lifestyle decision, and your physician should be involved in helping you get started.

Tria Health Can Help

If you are diagnosed with diabetes or concerned about developing diabetes and considering the keto diet, Tria Health can assist you in managing your medications and discussing treatment plan options. Diabetes is a disease that can be managed and prevented if you know what to do. At Tria Health, our pharmacists are certified diabetes care and education specialists (CDCES). Tria Health ensures patients are taking the right medications, at the right dosage for the most affordable cost. Pharmacists also provide additional support through our remote monitoring device, iGlucose. This allows patients who need to monitor their blood glucose to do so easily while sharing their data directly with their care team. For patients that need additional nutrition counseling, Tria Health offers consultations with a health coach to help individuals with diabetes get on track. Patients also have access to the Tria Health portal where they can utilize various diet and lifestyle resources.

For select groups, Tria Health offers a weight management program called Choose to Lose. This structured weight loss program provides you with a dedicated health coach, industry leading calorie tracking app, and a pharmacist. This program is not only helping patients work on changing their lifestyle and building long-lasting habits but is also improving health literacy so they can continue to make healthy decisions in the future.


Contact the Tria Health Help Desk at 1.888.799.8742


Reviewed by

Annie Tribble, PharmD, CDCES Maggie Lewis, PharmD, CDCES


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