Ketogenic diet

I am considering transitioning from eating low carb way of life to a ketogenic diet. I have been reading about its positive results not only on BG but how ketosis can help so many other areas (weight loss, inflammation, prevention of cancer and Alzheimer’s are a few). Any words of wisdom are appreciated. I have been diagnosed T1D for just over a year as of now. Thanks!!

I may be wrong but I believe it is dangerous for T1 to do ketogenic diet. I would check with your doctor first before attempting.

AFAIK there is no reputable data to support that conclusion. We have members here who have achieved great success doing it.


As @David_dns said, there are many with success on a ketogenic diet. They said, be careful, as you may see big changes in your insulin requirements - even basals - early on in the changeover to such a diet. Don’t get caught by surprise without a good source of fast glucose nearby just in case.


So, educate me on this. I’ve had DKA twice. How is the production of ketones a positive thing? Not trying to argue the point, I honestly don’t understand.

Ketones are always (underscore always) produced when the body burns fat. Ketones are not, in and of themselves, dangerous. They are a normal part of metabolism. Everyone generates them at various times, e.g., during extended exercise or during any extended period of fasting, such as when asleep. It’s normal to have slightly elevated ketones upon awakening in the morning.

The way they can get you in trouble is when both ketones and blood sugar are extremely high together, at the same time. That can produce ketoacidosis, which is indeed dangerous. Unless BG is wildly out of control, it’s just not gonna happen. And one of the principal benefits of a keto diet is—ta-da!—better BG control. :sunglasses:


Thank you!! Now I understand why diets like this don’t send people to ICU. All they ever told me about my DKA was that when insulin is that low you burn fat, which creates ketones that lower the ph of your blood. I never knew there was an “okay” level of ketones.

Just to flesh out the explanation a bit more, it takes ketones and blood sugar together produce ketoacidosis, but as mentioned above, the levels have to be really high for that to happen.

In uncontrolled T1, it can happen pretty easily. As cells lose the ability to absorb glucose, it just keeps building up in the blood stream to higher and higher levels. At the same time, the cells are being starved for energy* so the body tries to get some by burning fat. That elevates ketone levels, and pretty quickly you have a vicious cycle going. Eventually they get so high that you get DKA. That 's the scenario. Keep the BG under control, and the vicious cycle never has a chance to get started.

P.S. People often confuse the terms “ketosis” and “ketoacidosis”, which is bad because they are two different things that unfortunately sound a lot alike. Ketosis is simply the (entirely normal) process of burning fat to produce ketones. Ketoacidosis, on the other hand . . . well, we know what that is. :wink:

*This is why, back in the bad old days before insulin, T1 diabetes was usually characterized by extreme weight loss—the body’s cells couldn’t get the fuel they needed and so all the fat reserves were eventually burned up trying to produce some. In the dark ages, since the condition was accompanied by sugar in the urine, it was thought that the body was literally dissolving into sugar.


My understanding, based on what I’ve read and also what my endo has told me, is that ketones are safe up to levels of about 3.0 mmol/L (in the blood) if blood sugar levels are under control. For people with Type 1, at least for me (ha!), it’s very difficult to keep my blood sugar from ever going high on a daily basis, even with low carbs, pump, CGM, and “sugar surfing” techniques. I’m also very prone to developing high ketones with any illness or brief interruption of insulin delivery.

When I’m eating low carb (which I am now) I always have some ketones in my blood and urine. (For example, I just tested my blood ketones and they are 0.8 mmol/L, which is technically “high” if checking a scale, but my blood sugar is 4.3 mmol/L, which is perfect, if not a bit low considering I have insulin on board.) And, at times (multiple times a week) I have blood sugar that goes above target range and is somewhat difficult to get back down. So, what I do is:

  • if my blood sugar is at 13 mmol/L or above and ketones are high (above 0.5 mmol/L), or
  • if my ketones are high and I’m feeling sick (there’s a particular queasiness that I feel when I have little to no insulin in my system)

I work to get both blood sugar and ketones down. This may mean eating carbs to get rid of the ketones, and giving lots of extra insulin, and dealing with high blood sugar for a bit. When I’m high and have ketones, getting ketones down is more important to me than getting blood sugar down. High blood sugar doesn’t pose an immediate risk to health, but high ketones can pose an immediate risk to health if things progress to DKA. Of course, ultimately the goal is to get both down.

I don’t think that a low carb diet is inherently dangerous, but I do think if someone with Type 1 is doing it and they are on a pump and have no insulin production and are therefore prone to developing ketones quickly with interruptions in insulin delivery, it is important that they stay on top of their diabetes by testing often, using a CGM, and being on high alert for problems at times when blood sugar is high. There may be some people who actually never have blood sugar go above 200 mg/dl while eating a low-carb diet, and for them it may be that they just never worry about ketones at all. But I’m not one of those people, so I do keep a ketone meter on hand and do check them when my blood sugar is high or when I’m feeling unwell.

(Note: I am NOT a doctor. Please talk to your doctor about issues around carbs, ketones, and what to do in the case of high blood sugar or high ketones!)

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It’s my understanding when your BG is under control and you have enough insulin on board then your body burns fat for fuel instead of glucose…producing safe level of ketones in the blood stream

Nutritional ketosis is to diabetic ketoacidosis as a light breeze is to a hurricane-force wind.


Hi Lisa,
There is a distinction between diabetic ketoacidosis (very high blood sugar, lack of insulin, dehydration, acid-base imbalance and very high levels of ketones), and metabolic ketosis.

Metabolic ketosis is entirely normal and adaptive. It is a response to fasting, starvation, or eating a very low carb diet. It is common for people (particularly pregnant women) to have low levels of ketones present in the mornings after an overnight fast.

In metabolic ketosis insulin and glucose levels are normal, there is no dehydration, and ketone levels are quite low.

The brain and heart actually prefer ketones as their source of energy. Thus for a person with diabetes who is in metabolic ketosis, this may be protective to some extent against the symptoms of low blood sugars (because the brain is functioning fine on ketones).


I’m a huge fan of a ketogenic way of eating. It gives me amazing, steady energy over the day, and helps with mental focus. I rarely feel hungry and often only feel like eating twice a day. It also gives me amazing, steady basal basal rates and low bolus requirements. My challenge has often been to stay in ketosis, as for me it requires a combination of high-fat and regular high-intensity exercise. I think because I’ve been low-carb for over 5 years now, my metabolism can easily slip into gluconeogenesis if my fat intake drops or I skip my exercise. Not a bad state either, but it doesn’t give me the same benefits as Ketosis.

Let’s not forget that we’ve only had carbs and starches as a significant part of the human diet for about the last 12,000 years with the advent of agriculture, which is only a blink of an eye in terms of human evolution. We evolved as hunter-gatherers where protein and fat was our primary nutrition. The human metabolism is optimized for and quite comfortable in a Ketogenic state. There’s nothing dangerous about it.


Personally I will never ever do keto again. In 2008-2010 After being pushing into it by my endo at that time and nutritionist (with neither of them now) I was diagnosed with superventricular tachycardia. I had to have two ablations to fix it. 3 years to the day of the first ablation my heart went into bradycardia and now I have a pacemaker. No one could ever tell me what caused either until recently. I had a sit down with my cardiologist, endocrinologist and my nutritionist and we ran over all my records then and how my diet was. They all agreed that the keto diet over a long period of time can cause muscle damage including damage to the heart since the heart is also a muscle. There are other issues it can cause but luckily none of them affected me. It also may be why my peripheral neuropathy was so bad at one point in time in my life. Also ketosis is a mild form of DKA so while yes some Type 1s have had a good experience with it they still run the risk of going into DKA.

what brand of ketone meter do you use?

I use the Precision Xrra and Precision Neo meters for ketone testing.

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It depends on the activity, not what you eat.

Everyone burns fat for fuel for certain levels of activity. And they use muscle glycogen (stored carbs) for other types of activities, and they use ATP–CP (adenosine triphosphate - creatine phosphate) for others.

Fat is the most concentrated source of energy we have. We have over twice as much potential energy with fat as we do with muscle glycogen or protein. But it is not the go-to source for quick energy.

Put another way, you won’t win a mile race using fat for fuel. You would win that with muscle glycogen (the stored form of carbs in the muscles).

And you won’t win a 100 meter sprint using muscle glycogen. You would win that with the ATP–CP system.

So the short answer - what you burn depends on the activity.

I suggest to consult with your nutritionist before making decision. I also read the success of ketogenic diet were amazing but there are risks involved.

This is not scientifically or medically accurate, in any respect. While it is certainly fine to decide that you don’t care for a particular diet or treatment option, it isn’t OK to spread misinformation. And the fact that you had even more than one doctor agree with you doesn’t make it accurate either.

I don’t care for keto diets either (for me), since they lead to uncontrollable weight loss (for me). But it is important to recognize that they do indeed work for many people, Type 1s included. And while muscle damage sounds terribly unfortunate for you, correlation (the fact that you were eating keto) doesn’t equal causation (of your muscle damage). Glad to hear you have found a way to eat that works for you, but many Type 1s eat keto without any fear of going into DKA.


what activities will burn FAT? I have a bunch of it to burn off!!