UPDATED BY FRANZISKA SPRITZLER, RD, CDCES
The current treatment model for type 2 diabetes is broken. Patients aren’t getting better; they’re getting worse. Meanwhile, rates of this metabolic disorder continue to rise. But recent research suggests a path forward: the ketogenic diet.
In the sections that follow, we’ll explain how the ketogenic diet helps manage type 2 diabetes. But first, let’s take a brief look at the scope of the problem.
The Problem of Type 2 Diabetes
Type 2 diabetes is a condition defined by chronically high blood glucose and insulin levels, often accompanied by elevated blood pressure, high triglycerides, and excess body weight – all of which are major risk factors for chronic disease. Over time, type 2 diabetes significantly increases the risk of heart disease, cancer, Alzheimer’s, and early death.
Globally, more than 800 million people have diabetes, and more than 90% have type 2 diabetes. In the US, rates of type 2 diabetes rose by nearly 20% between 2012 and 2022. What’s changed? Primarily, our food and lifestyle. We’re consuming more sugar and processed carbohydrates while moving far less than previous generations. These shifts have played a significant role in fueling the diabetes epidemic.
Unlike type 1 diabetes, which results from an autoimmune attack on the pancreas, type 2 diabetes is largely driven by diet and lifestyle. Diets high in refined carbohydrates and added sugars, combined with low physical activity, cause repeated spikes in blood glucose and insulin levels. Over time, chronically elevated insulin – known as hyperinsulinemia – leads to insulin resistance, where the body’s cells become less responsive to insulin’s effects. As this resistance progresses, the pancreas produces even more insulin to compensate, creating a cycle that promotes weight gain, rising blood sugar, and eventually, type 2 diabetes.
How the Ketogenic Diet Helps with Diabetes
The ketogenic diet is a high-fat, moderate-protein, very low-carbohydrate eating plan. Although calorie needs vary based on individual factors like age, weight, and activity level, the typical macronutrient breakdown is about:
- 70–75% fat
- 20–25% protein
- 5–10% carbohydrates
This macronutrient ratio helps lower both blood glucose and insulin levels. When carbohydrate intake is restricted, the body’s supply of glucose – the body’s primary fuel source under typical dietary conditions – begins to decline. In response, the liver starts converting fat into ketones, which serve as an alternative energy source for the brain and other organs and tissues. This metabolic shift, known as nutritional ketosis, typically occurs within a few days of starting the diet and is marked by a measurable rise in blood ketone levels.
Ketosis can be especially beneficial for people with type 2 diabetes. By lowering insulin levels and promoting fat burning, it addresses key drivers of the condition, such as insulin resistance and excess body weight.
Addressing the Root Causes of Type 2 Diabetes
The ketogenic diet helps manage type 2 diabetes by targeting its core drivers: excess weight, high carbohydrate intake, and insulin resistance.
Weight Loss. Sustainable weight loss is a key goal in type 2 diabetes management, but traditional calorie-restricted diets often lower metabolic rate, making long-term success difficult. By contrast, ketogenic diets have been shown to promote more effective fat loss than low-calorie, low-fat diets in multiple randomized clinical trials. This may be partly due to the diet’s impact on appetite-regulating hormones: “hunger” hormones like ghrelin tend to decrease, while “satiety” hormones like GLP-1, CCK, and PYY tend to increase, making it easier to naturally eat less and maintain weight loss.
Carbohydrate Reduction. Since carbohydrates raise blood sugar more than any other macronutrient, reducing carb intake is a direct and effective way to lower glucose levels. High-carb diets can worsen hyperglycemia, while ketogenic diets have consistently been shown to reduce both fasting glucose and HbA1c in people with type 2 diabetes – in some cases, even leading to reversal or remission of the condition.
Improved Insulin Sensitivity. Insulin therapy is often necessary in advanced diabetes, but it doesn’t correct insulin resistance. By lowering carbohydrate intake and stabilizing blood glucose levels, ketogenic diets reduce the body’s need for insulin. Indeed, many clinical trials have shown that exogenous insulin can be decreased or even eliminated with a well-formulated ketogenic diet with close medical monitoring.
A New Model for Diabetes Treatment
A growing number of clinics now offer programs aimed at reversing type 2 diabetes through a ketogenic approach. One of the most recognized is Virta Health, a US-based program that provides patients with continuous support from remote medical providers and health coaches to help them achieve and maintain nutritional ketosis.
Virta has also contributed some of the most widely cited long-term research in this area. In their first published study, led by Dr. Sarah Hallberg, adults with type 2 diabetes who followed a ketogenic intervention showed significant improvements in glycemic control, including a 55% reduction in insulin resistance. Impressively, 94% of insulin users were able to reduce or discontinue insulin without adverse effects reported.
A follow-up study led by Dr. Shaminie Athinarayanan reported two-year outcomes. Among those who remained in the program, 55% met criteria for diabetes reversal, defined as achieving an HbA1c below 6.5% without any diabetes-specific medications aside from metformin. Participants also lost an average of 26 pounds and significantly reduced their need for medications, including insulin.
In a five-year extension of the same study, Dr. Amy McKenzie and colleagues found that 20% of long-term participants achieved diabetes remission, defined as maintaining an HbA1c below 6.5% for at least three months without any diabetes medications. These individuals also sustained a 6% average weight loss, along with reductions in triglycerides and markers of inflammation.
Practitioners outside of the US are reporting similar results. One example is Dr. David Unwin, a general practitioner in the UK who has been using a very-low-carb approach in his practice since 2013. His results have been similarly impressive: 51% of patients with type 2 diabetes achieved remission, with marked improvements in weight, HbA1c, lipids, and blood pressure. His clinic has also reported significant savings on diabetes medication costs.
The Final Word
Type 2 diabetes continues to rise, driven largely by high-sugar diets and sedentary lifestyles. But there’s a more effective approach.
The ketogenic diet targets the root causes by lowering blood sugar, improving insulin sensitivity, and supporting sustainable weight loss. Rather than just managing the disease, it offers a path to lasting improvement – and in many cases, diabetes reversal or remission.
