The Ketogenic diet has an interesting history as a last measure treatment for out of control epilepsy in children where it was discovered to carry and fuel the brain with ketones rather than the now unavailable glucose, which results in a strong reduction in epileptic attacks. Over the years it’s been studied further and simultaneously been picked up and developed as a less strict mainstream diet for everything from weight-loss to athletic conditioning. Despite the prevalence of pseudoscience and marketing surrounding the keto diet, studies and tests have revealed many benefits (and a few cons too!) that struck me as particularly useful for diabetics, as well as much of the general population.
I’ve tried and failed to stay on a Keto diet a few times, always because of unpredicted hypos. Hypos, or low blood sugar, becomes less common the more controlled and dedicated you are to your numbers, and any low-carb diet will actually lessen the number of hypos you have because of the law of small numbers- the less corrections you need to make, the less likely you are to go either high or low. However, despite the vast improvements of the keto diet on my blood sugar control I, like any diabetic, still invariably run into unpredictable events and times when the body doesn’t react the way you’d expect. Since the only consistently reliable way to treat low blood sugar is with carbohydrates (yes, stimulants, intense exercise and other things can also raise blood sugar, but as a treatment for hypos these are dangerous and unpredictable solutions) and since any sharp increase in blood sugar tends to knock you out of ketosis, I haven’t yet been able to find a way to treat hypoglycemia without breaking ketosis.
With that said, it’s important to re-iterate that hypos are both less common and easier to treat (less carbs required to raise blood sugar than on a standard diet) while eating keto, and that if time is not an issue (you’re only slightly low and not feeling any symptoms, while also certain that you’re not going to go any lower, for example) I could often treat it with protein, coffee, or something else less likely to break ketosis, so for you truly dedicated and ultra-disciplined diabetics out there, it’s possible for longer periods of time.
It’s also worth noting that my symptoms of hypoglycemia are very different on low carb and keto diets. I suffer all the standard symptoms of anxiety, shaking and feeling light when low on a standard diet followed by sweating and confusion and lessened understanding when even lower. Conversely, when on keto or low carb I don’t get those symptoms or not nearly as prominently, nor do I notice any mental sluggishness or confusion, I simply treat it as normal and it’s pretty much completely insignificant other than a mild worry of being low. Whether having those warning signs earlier is a good or a bad thing is a matter of debate, but for me, so long as I can treat them in time I’d prefer to have them lower as to be more in line with a non diabetic.
Because of those reasons I’ve decided it makes more sense, at least for me, to focus on low carb rather than a strictly ketogenic diet. This still offers the blood sugar benefits and the reduced water weight, inflammation and other clinically studied findings of the keto diet yet it means I don’t have to stress out about eating a glucotab or two on those occasions when my blood sugars are plummeting for some completely unknown reason.