Choosing a ketogenic diet for diabetes management offers a range of valuable benefits.
Research shows that being in a state of nutritional ketosis notably leads to significant improvement in blood glucose control and weight loss.
Other common benefits provided include:
- Reduced dependence on medication
- Improvements in insulin sensitivity
- Lower blood pressure
- Usually improvements in cholesterol levels
In this guide, we review the science behind the ketogenic diet and how it works to provide all of these different benefits.
Weight loss and maintenance
A primary benefit of the ketogenic diet is its ability to achieve rapid weight loss Restricting carbohydrates enough to be in a state of ketosis leads to both a significant reduction in body fat and an increase or retention of muscle mass.
Studies show that low-carb, ketogenic diets are able to achieve strong weight loss over an extended period. An Australian study showed that obese people were able to lose, on average, 15 kg over a period of a year. This was 3 kg more than the low-fat diet used in the study achieved.  
Blood glucose control
The other main reason for people with diabetes to follow a ketogenic diet is its ability to lower and stabilise blood sugar levels
Carbohydrate is the nutrient (macronutrient) that raises blood sugar the most. Because ketogenic diets are very-low in carbohydrate , they eliminate the larger rises in blood sugar.
Studies into ketogenic diets show them to be very effective at reducing HbA1c – a long-term measure of blood glucose control. A 6-month study ran by Eric Westman and colleagues in 2008 showed an average reduction in HbA1c levels of 17 mmol/mol (1.5%) for people with type 2 diabetes.
People with other types of diabetes, such as type 1 diabetes and LADA , should also expect to see a strong reduction in blood sugar levels and an improvement in control.
Note that if an improvement in blood glucose control is maintained over a number of years, this can reduce the risk of complications occurring.
Reducing reliance on diabetes medication
Because they’re so effective at reducing blood sugar levels, ketogenic diets have the additional benefit of helping people with type 2 diabetes to reduce their dependence on diabetes medication
In the study by Westman mentioned above, 95% of the people in the study were able to reduce, or come off completely, their diabetes medication.
People on insulin and other hypo-causing medication (such as sulphonylureas and glinides ) may need to reduce their doses in advance of starting a ketogenic diet to prevent hypos. Speak to your doctor for advice on this.
A ketogenic diet has been shown to help restore insulin sensitivity , as it eliminates the root cause of insulin resistance – which is too high levels of insulin in the body.
This diet helps promote sustained periods of low insulin, as low levels of carbohydrate mean lower levels of insulin.
A high carbohydrate diet is like putting petrol on the fire of insulin resistance High carbohydrate means a greater need for insulin and this make insulin resistance worse.
By comparison, a ketogenic diet, turns insulin levels down, as fat is the macronutrient that requires the least insulin
Getting the levels of insulin down also helps with fat burning, because high insulin levels prevent the breakdown of fat. When insulin levels drop for a number of hours, the body is able to break down fat cells.
High blood pressure control
It is estimated that 16 million people are living witha high blood pressure in the UK.
A range of health conditions are associated with high blood pressure, such as heart disease, stroke and kidney disease. It is also a feature of metabolic syndrome
A number of studies have shown that a ketogenic diet can decrease blood pressure levels in people that are overweight or with type 2 diabetes. 
Overall, ketogenic diets usually result in improvements of cholesterol levels. It is usual for LDL cholesterol levels to go down and HDL cholesterol levels go up, which is healthy.
One of the strongest measures of healthy cholesterol is the ratio of total cholesterol to HDL. This can be easily found by taking your total cholesterol result and dividing it by your HDL result.
If the number you get is 3.5 or lower, this indicates a healthy cholesterol. Research studies show that ketogenic diets are usually effective at improving this measure of cholesterol health. 
Note that some people may show an increase in LDL and total cholesterol after starting a ketogenic. This is usually regarded as a negative sign but if your total cholesterol to HDL ratio is good, this does not necessarily represent a worsening in heart health
Cholesterol is a complicated topic and your doctor is the best source of advice if your cholesterol levels change significantly on a ketogenic diet.
In the UK you should have your cholesterol levels monitored at least once per year so that any negative effects on cholesterol can be spotted and dealt with appropriately.
Stronger mental performance
Mental clarity, an increased ability to focus and a better memory are other commonly reported benefits of eating a ketogenic diet.
Increasing intake of healthy fats with omega-3, such as those found in oily fish like salmon, tuna and mackerel, can improve mood and learning ability. This is because omega-3 increases a fatty acid called DHA that makes up between 15 to 30 per cent of our brain. 
The production of beta-hydroxybutyrate, a form of ketone, helps support long-term memory function.
Ketogenic diets have positive effects on appetite. Once the body adapts to being in a state of ketosis, it gets used to getting energy from breaking down body fat and this can reduce appetite and cravings.
They are effective at:
- Reducing cravings
- Helping you feel full for longer
- Reducing preference for sugary foods
Weight loss as a result of a ketogenic diet can help lower leptin levels which can improve leptin sensitivity and benefit satiety as a result.
Ketogenic diets can be good at reducing thrush and yeast infections as they lower blood sugar, which reduces glucose being passed out in the urine.
It is glucose in the urine that bacteria feed off that leads to a fertile breeding ground for yeast and bacterial infections.
In addition to that, a higher intake of a saturated fatty acid called lauric acid – found in coconut oil, a staple keto food – has been shown to have anti-microbial properties. It can kill off candida albican and help with yeast infections.