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Diabetes medications and a low-carbohydrate diet

Do you suffer from diabetes and would like to try a low-carbohydrate diet? Congratulations on your accomplishment. This is probably the healthiest thing you can do. Type 2 diabetes can be reversed, and type 1 diabetes blood sugar control can be greatly improved. However, you must be aware of your surroundings. You’ll need to reduce your insulin doses drastically when starting a low-carbohydrate diet.

By avoiding carbohydrates that raise blood sugar, you can cut down on the amount of medication you need to control it. Taking the same insulin dose as before dieting can result in hypoglycemia (blood sugar levels that are too low). You should monitor your blood sugar levels on a regular basis, especially during the first few weeks of dieting. All changes should be made after consulting with a doctor regularly.

No medication

There is no risk of your blood sugar dropping too low if you have diabetes and are taking no medications or only metformin. You are free to begin your diet.


When following a low-carbohydrate diet, the doses must usually be reduced by 30-50 per cent or more. Unfortunately, predicting how much the dose will need to be reduced in advance is impossible. You’ll need to monitor your blood sugar levels on a regular basis and adjust your insulin dosage accordingly. Dose changes should be consulted with your doctor.

It is generally preferable to start with a low dose and gradually increase it as needed. If you overdose and your blood sugar drops too low, you should eat or drink more carbohydrates, which will, of course, counteract the negative effects of your diet.

Insulin for type 1 diabetes

The same principles as above also apply to type 1 diabetes. Type 1 diabetics can control their blood sugar levels with a high-fat keto diet. It also helps to prevent sugar spikes and hypoglycemia after insulin administration. If you have frequent hypoglycemic episodes, you should think about lowering your insulin dose.

Ketosis is a physiological state that occurs when you eat a low-carbohydrate diet. Ketone levels may rise above 1.5 mmol / l on a strict low-carbohydrate (ketogenic) diet that also restricts protein intake. It is completely safe in healthy people, but it brings you closer to ketoacidosis in people with type 1 diabetes (usually at a level of 10 – 15 mmol / l). Simply forgetting one dose of insulin is enough to necessitate hospitalisation. A moderately low-carbohydrate diet with a carbohydrate intake of about 50 grams per day is the best solution for type 1 diabetes. It will not enter a deeper state of ketosis (> 1.5 mmol/l).

We strongly advise against following a strict low-carbohydrate diet (less than 20 grams of carbohydrate per day) until you have a better understanding of the risks and how to mitigate them. Just in case, if you have type 1 diabetes, it’s a good idea to include one or two fruits per day in your diet.

Drugs that increase insulin secretion

Some medications for type 2 diabetes increase pancreatic insulin secretion. While the risk of hypoglycemia is lower with a low-carbohydrate diet than with IV insulin, it still exists. These are sulfonylurea-derived drugs. On a low-carbohydrate diet, these medications may need to be reduced in dosage or discontinued entirely. This is something you should talk to your doctor about.


Metformin-containing medications can be taken safely while following a low-carbohydrate diet. There is no risk of your blood sugar dropping too low if you only use these medications.

Incretin drugs (GLP-1 analogues) and DPP-4 inhibitors

These medicines should not cause a dangerously low blood sugar level, but it is worth checking it regularly and consulting a doctor if necessary.

SGLT2 inhibitors

They are effective drugs for type 2 diabetes, but they increase the risk of ketoacidosis as a side effect. This phenomenon can also occur with a low-carbohydrate diet, so any changes should be discussed with your doctor.

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