That is very very interesting, thank you, but note the
People with diabetes should avoid ketogenic diets and follow their doctor’s treatment recommendations to prevent ketoacidosis.
I wouldn't go on a ketogenic diet but do find my levels easier to manage on a slightly lower carb one (maybe 60g per day?) But my dietician wants me to have at least 90g (30 per meal).
Given the amount I test (8 times a day?) high levels get dealt with very quickly. Am not sure why I need to avoid very low carb....
personal side note: you probably do run some nonzero ketone level when you wake up. test it if you like. don't worry about the number as long as you feel well and the number is somewhere that doesn't scare you.
None of what I'm about to say is backed up by anything resembling evidence. Take it with a nice fat rock of salt.
"People with diabetes should avoid ketogenic diets[...] to prevent ketoacidosis."
The suggestion has never made mechanistic sense to me either. If you want to go VLC, I say you have no reason not to, as long as your blood sugars stay stable and your ketone level stays between a reasonable pair of numbers as determined by intercurrent conditions which could benefit from ketosis, your previous propensity to ketoacidosis, and the sensitivity of your meter.
Surely because a ketogenic diet would reduce to as near to nothing as makes no meaningful difference one of the myriad variables that affect mealtime insulin requirements (that being carbohydrate, which can actually be wrong by 20% either way on the packet and still be legal, at least in the US), it would actually mitigate the likelihood of entering ketoacidosis (or indeed hypoglycemia) because you would never go as high (or as low) if your injection was not enough (or too much) to cover the rest of the meal, so (for highs) you get less paradoxical glucagon release.
Someone mentioned RKB's law of small numbers, and I think that was what I was expressing in the above paragraph.
It would also be useful to harm-reduce diabulimia because they wouldn't need to take as much insulin (an anti-catabolic hormone - people who want to lose weight fundamentally want to be catabolising) to stay euglycemic for a given amount of food, so they'd still maintain a low weight but have less complications than if they ate a typical diet and were actively diabulimic.
Although, I've heard of eugDKA in some type 1 diabetics (possibly this was caused by SGLT2 inhibitors though...) because their blood sugar maybe goes to 6 or 7, while their ketones run into the 10s or 12s, because they're not taking the insulin to cover the ketones (glucose is not the only insulin-dependent blood nutrient! Ketones demand some insulin too). I've also heard of ketotic hypoglycemia, which is where the brain still works fine (not neuroglycopenic) but the blood sugar is objectively too low (say, 2.1 mM/L). Non-neuroglycopenic hypoglycemia is uncharted water in the world of diabetes treatment.
Also a type 1 diabetic friend of mine has been told by his care team that ketones destroy organs. Like how even?! How, mechanistically, could ketones destroy organs? Humans had them any time we didn't eat for more than a few days back when food availability wasn't guaranteed. We'd not be here talking about treating diabetes of either type if ketones destroyed our organs. Why are not people taught to develop a healthy respect for ketones as yet another fuel source requiring precise regulation with insulin (just as glucose requires)?