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Ketogenic Diet and Type 1 Diabetes

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Quick Summary tl;dr

There are people who live with type 1 diabetes and follow a ketogenic diet as a safe way to improve quality of life. Controlling carbohydrates may be a vehicle for avoiding large fluctuations in blood sugar and extreme low blood sugar reactions from incorrect guessing on insulin dosing.

A ketogenic diet seems to help maintain a more stable dynamic between at least two critical factors (food and insulin) in Type 1 diabetes care, underscoring its value for clinical use and quality of life in diabetes self-management.

You should always consult with a doctor or other health professional who has expertise in diabetes prior to adopting a new diet, as you may need an adjustment to the medication you are taking.

Table of Contents

What is Type 1 Diabetes?

Type 1 diabetes is an autoimmune disease. The immune system is a defence that guards the body against viruses, bacteria, fungi, parasites and toxins.

A combination of genetics and an environmental trigger (potentially a viral infection, low levels of vitamin D, cow’s milk or increased insulin demand) engages the immune system to attack and destroy the insulin-producing beta cells of the pancreas. After these beta cells are destroyed, the body is unable to produce insulin.

Type 1 diabetes is the result of the inability of the pancreas to produce insulin. In type 2 diabetes, the pancreas produces insulin, although cells are often resistant to its effects

Who Gets Type 1 Diabetes?

Type 1 diabetes can affect all age groups. Although historically 1 diabetes was considered to be a disease that appears during childhood, current research has found that adults are just as likely to be diagnosed with type 1 diabetes; half of type 1 diabetics are diagnosed after age 30 (1).

Yet the rate of Type 1 diabetes in children in the US has increased by almost 60% in 11 years (2), and approximately 1 in 300 children in the US will be affected by type 1 diabetes by 18 years of age ( 3). There are thousands of children who are affected globally.

The highest rates are in northern Europe and in individuals of European decent. Men are more commonly affected in early adult life (2). Data suggests the incidence of T1D has been increasing by 2–5% worldwide (5).

Ketogenic Diet and Type 1 Diabetes

What Happens When Your Body Does Not Make Enough Insulin?

In type 1 diabetes, beta cells in the pancreas are destroyed by the body's immune system. As a result, very little to no insulin is produced (a hormone released by the pancreas) produced.

Without insulin, glucose (sugar) from food cannot enter the cells. Instead of fueling the cells, this excess sugar circulates in the blood causing high blood sugar levels (also known as hyperglycemia).

If there is no insulin to shuttle blood sugar into the cells, excess blood sugar increases critically, and this is called diabetic ketoacidosis (DKA) as opposed to nutritional ketosis. In DKA, severe high blood sugar shifts the blood from having a pH of 7.3-7.45 to a more acidic pH of less than 7.3.

Constant high blood sugar increases risk of diabetes complications such as kidney, nerve and eye disease, heart disease and stroke. Maintaining blood sugar as close to normal is the goal to avoid these complications.

What Are the Symptoms of Type 1 Diabetes?

Until one is diagnosed and lying in a hospital bed, it is unlikely the signs and symptoms of type 1 diabetes will be recognized. This is why, especially for those with a family history, being aware of the symptoms is crucial. If you notice any of these symptoms, schedule a doctor's visit immediately.

  • Extreme thirst
  • Frequent urination
  • Behavior changes (moody, less tolerant)
  • Drowsiness, fatigue or lethargy
  • Increased appetite coupled with weight loss
  • Sudden weight loss
  • Sudden vision changes
  • Fruity odor on the breath
  • Nausea and vomiting

Is There a Cure for Type 1 Diabetes?

There is no cure for type 1 diabetes. A ketogenic lifestyle can help people with type 1 diabetes avoid blood sugar fluctuations and optimize their quality of life.

Living With Type 1 Diabetes

Self care is of the utmost importance in the successful management of type 1 diabetes. Coordinating life skills (activity, nutrition, blood sugar monitoring, medication) — along with increased awareness of low blood sugar symptoms — analytical skills helps to keep blood sugar within target range. Sadly, less than one-third of people with type 1 diabetes in the U.S. are achieving target blood glucose control (6).

Type 1 diabetes can be a life-long burden, but consistency and commitment makes living with diabetes much easier. What you eat has a significant impact on blood sugar and the amount of insulin you need to inject.

Why is Type 1 Diabetes Difficult to Manage?

According to type 1 diabetic Dr. Keith Runyan in this presentation there are two main underlying factors as to why type 1 diabetes is difficult to manage:

1. High Variability of Absorption of Carbohydrates

Digestion and absorption of the different types of carbohydrates (rapid-digesting, slow-digesting, or processed) are almost impossible to time. ( 7)

There may be as much as a 50% variation in carbohydrate absorption from various types of carbohydrates. If you miss that peak blood sugar window of opportunity, the insulin will not be as effective, or work as expected, therefore resulting in blood sugar levels that are either too high or too low.

2. High Variability of Absorption of Insulin

Injected insulin can have as much as a 30% variability in absorption. How is one to determine this factor? Again, this is not easily determined, and in fact impossible to predict accurately.

Why Following a Low Carb Approach Works for Type 1 Diabetes

In essence, the high variability of absorption for both food and insulin makes it almost impossible to target treatment. If you lower carbohydrates and thus lower the amount of insulin required, the variability is less and there is a much better chance you will achieve target blood sugar.

Managing Type 1 Diabetes with the Ketogenic Diet

Health risks for people living with type 1 diabetes significantly decline with consistent and normal blood sugar levels. Life expectancy can also be similar to those without diabetes.

A ketogenic diet helps improve quality of life of patients living with type 1 diabetes. While low blood sugar is always a concern for type 1's, it seems those who use a ketogenic diet find it is much more manageable (compared to the low resulting from an excessive bolus of insulin) because the symptoms are not as overwhelming and mental acuity is not affected.

Consensus amongst type 1 keto dieters seems to be to treat a low blood sugar with one standard glucose tab that provides 4-5 grams of carbohydrates (the total amount will depend on your situation and how low the blood sugar number is) to provide a necessary steady reliable rise in blood.

How to Follow the Ketogenic Diet to Manage Type 1 Diabetes?

Although not actually new, using a ketogenic diet to treat type 1 diabetes is becoming more popular. Importantly, you should work with a knowledgeable healthcare professional when attempting to switch from a high to lower carbohydrate diet to help select the appropriate foods and manage insulin dosing.

Dr. Richard Bernstein uses a very low carb ketogenic diet of 30 grams of carbohydrates per day to manage his and his patients' blood sugars. He found that his blood sugar would stay in the normal range when he minimized his insulin injections consuming a carbohydrate regimen as follows:

  • 6 grams for breakfast
  • 12 grams for lunch
  • 12 grams for dinner

Source: Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars

Ketogenic Menu Examples for Patients with Type 1 Diabetes

Breakfast (6 grams of carbs):

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Ketogenic Diet and Type 1 Diabetes Ketogenic Diet and Type 1 Diabetes Ketogenic Diet and Type 1 Diabetes
Ketogenic Diet and Type 1 Diabetes Ketogenic Diet and Type 1 Diabetes Ketogenic Diet and Type 1 Diabetes

Lunch & Dinner (12 grams of carbs each):

Ketogenic Diet and Type 1 Diabetes Ketogenic Diet and Type 1 DiabetesKetogenic Diet and Type 1 Diabetes
Ketogenic Diet and Type 1 DiabetesKetogenic Diet and Type 1 DiabetesKetogenic Diet and Type 1 Diabetes
Ketogenic Diet and Type 1 DiabetesKetogenic Diet and Type 1 DiabetesKetogenic Diet and Type 1 Diabetes

Other Approaches

Troy Stapleton is another medical doctor using a ketogenic diet for better health (from Dr. Troy Stapleton's presentation: I Manage My Type 1 Diabetes By Eating LCHF). Others consume closer to 50 grams of carbohydrates per day. You'll need to consult your doctor and work with an expert to find a carbohydrate target that works for you.

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Valerie Goldstein, MS, RD, CDE
Author and Health & Blood Sugar Expert

Valerie Goldstein

Valerie is a Dr. Atkins trained registered dietitian and certified diabetes educator. She is acknowledged in his books, "Dr. Atkins New Diet Revolution" and "Atkins for Life".

Valerie always says, "The ketogenic diet provides the most nutrient bang for the calorie buck" and so she uses this nutritional approach and personalizes it for all her medical, weight loss and athletic clients throughout the country.

Expert Article

This article was written by Valerie Goldstein, MS, RD, CDE who is a qualified expert. At KetoDiet we work with a team of health professionals to ensure accurate and up-to-date information. You can find out more on the About us page.

Evidence Based

Evidence-Based articles are based on medical research, and scientific evidence. Our expert authors focus on hard evidence alone and include relevant research references from trusted sources to support their articles. We always aim to deliver relevant, trustworthy and up-to-date information based on trusted evidence and proven research.

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Comments (19)

Hi, New to this site / app and highly appreciate the work and care!!  Can you help with calculating FPU in the ketodietapp?  This is for Type 1 diabetics who need to give insulin on protein and fat using the Warsaw Protocol as follows:
As type 1, we really like the macro view, and are giving insulin using the net carb, protein and fat scores.  It would be helpful to see for each meal (breakfast, lunch, dinner, snacks), the FPU summarized (excluding net carb) such as "4 FPU"  
Thank you for considering this request.

Thank you for your kind words and for using our app! I'll add this option in our to-do list. Thanks again for your feedback!

Thanks you so much for this article, after trying this diet and adjusting my insulin intake, my blood sugar is now nearly perfect ! It is been now 1,5 month that I didnt have any hypoglycemia OR hyperglycemia. My energy level is just now so amazing.
Before that my glycemia was out of control, at least one hyperglycemia everyday, and 2 or 3 hypoglycemia a week. Because I am very active and going to gym 5x a week since young I had to be very careful all the time and if I was training to much I had an hypoglycemia followed by and hyperglycemia with the sugar intake... I was feeling horrible... now I can go to gym without being worried at all because it is the cetone in my body who is giving me fuel not glucose anymore which I had to manage all the time. So even if pancreas is not working my liver is still working and doing is job great ! I am so grateful thank you very much for this precious advise that changed my life.

I am 30 year veteran of type 1 Diabetes and just started keto (20c/day) and eat moderate protein and high fat. It seems that my control has vanished rather then improved ! I have a cgm so I know my blood sugar all the time. I ate 8 carbs, 20 protein and 30 fat for breakfast - blouses for 8 carbs. This was at 10am- no lunch - and at 2pm my sugars climed to 14! Slow and steady climb- makes no sense to me. Has keto made me insulin resistant ????

Hi Stephanie, you may need to fine-tune the amount of carbs and protein but I can't give advice on how to do that. Please, make sure to consult your doctor, especially if you have type 1 diabetes. Have a look at this post: Can the Ketogenic Diet Help Reverse Insulin Resistance?

I'm a type 1 on the keto diet.  I have been using the keto pee test strips to see if I'm in ketosis and they are always dark compared to my non diabetic husband who is also on the diet.  His are in the low to moderate test range.  Is mine higher because I'm a type 1?? My blood sugars are perfect and I'm still on my basil rate but not bolusing with meals since I have less than 40 carbs per day.  I also wear a sensor that monitors my blood sugar 24/7.
Anyone have info on the ketone test strips

Hi Amanda, urine ketone strips are not very accurate (Ketosis & Measuring Ketones: All You Need To Know). If you do want to measure ketones, it's best to use a blood ketone meter. Please, make sure to discuss this with your doctor, especially with T1D.

I have T1, I've had it for 11 years now. I've always been able to maintain a weight within 120-125, but last time I checked, I was 130. It made me feel a little disappointed in myself, and felt it was time to go to a healthier weight. I recently came across the whole Keto diet thing, and honestly I'm confused. I read that yes, it helps T1. But a lot of other articles say that it's dangerous and since the body uses fat to burn, it releases ketones which can cause ketoacidosis. I'm so confused on whether it's safe or not.

Hi Nataly, compared to nutritional ketosis (usually 0.5-3 mmol) which is perfectly safe, ketoacidosis is dangerous and occurs when you get extremely high ketone levels and glucose levels at the same time. Since you are a T1 diabetic, you must consult any dietary changes with your doctor. Any changes in your diet will likely require an adjustment in your medication (your insulin demands will decrease).

I am a type 1 diabetic. I know how hard it is to live with. When I was first diagnosed I was advised by doctors to eat 40% carbs as long as I took my insulin. I put on 15kg's in a month, felt ill and was completely depressed. Ive tried all sorts of eating plans. Then I read dr bernstiens books and found the keto diet.  The keto diet/ lchf is by far the best way to control my blood sugar in conjunction with daily strenuous exercise which includes weightlifting. Now 11 years since my diagnosis my doc recommends low carb high fat to his other patience. 😉

Thank you for sharing Tatiana! Good for you and all the patients that benefit from your doctor's ketogenic diet recommendations. I wish you continued success with your diet and health.
Valerie Goldstein, MS RD, CDE

No mention of the very high risk of ketoacidosis? You're putting people in danger by recommending a diet that could very well kill them. (Ketosis combined with the high blood sugar you can get when you have T1D = ketoacidosis which is very much lethal). Low carb may help some people with T1D (idk, taking your word for it I guess), but I feel your article does not emphasize enough the risks and the ABSOLUTE NECESSITY to do this with the help of a medical professional and a very precise tracking of blood sugar/ketones level.
I'd like to see sources for your claims that keto/LCHF/low carb helps for T1D because this contradicts everything I've read on the subject.

I disagree. Diabetic ketoacidosis is indeed a serious condition in diabetics, however, you are confusing it with nutritional ketosis (0.5 to 3 millimolar). In ketoacidosis, ketone levels are much higher (15 + millimolar) and combined with extremely high blood sugar levels. Also, this article does emphasise the necessity to work with a health professional - you may have not read the whole post. To see what these claims are based on, simply go through the scientific references, including  Dr. Bernstein's book.

Hello OB,
I understand your concern.
Might I suggest you join the Typeonegrit facebook group; its members are type 1 diabetics who use a ketogenic diet to live healthier lives.
Good luck with your diet choice whichever you choose.

I have heard that the risk of ketoacidosis is higher for Type I diabetics.  How would one avoid this?

Hello Muriel,
I agree with Martina.
Just to reiterate, diabetic ketoacidosis (DKA) is the result of dangerously high levels of blood sugar and ketones; the combination makes your blood acidic and is very dangerous. Being in ketosis helps control and normalize blood sugar and does not mean ketone levels are so high that it causes blood to become acidic and reach DKA levels.
I'd also like to add that if you monitor blood sugar and work with a professional who can help you adjust medications, your risk of going into ketoacidosis on a ketogenic diet is lower because eating less carbs (helps to manage blood sugar not raise it) and managing insulin dose (with a medical expert) accordingly will minimize blood sugar fluctuations.

It is incorrect to state that Type 1 diabetes "usually appears during childhood or adolescence".  Onset of type 1 diabetes is just as likely to occur in people older than 30 years of age as in those younger, new research shows.  See this article discussing the research presented at the EASD 2016 meeting: "Half of All Type 1 Diabetes Develops After 30 Years of Age"

Thank you for sending me this link, Susan! Valerie sent me an updated version and I'll upload it soon.

Hello Susan,
Thank you for providing the EASD findings. The information will be changed ASAP.
In good health,