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Comment by village-idiot | Hacker News Reader

Generally agreed, but with a caveat: diabetics are at risk of ketoacidosis on low carb diets. They would need to measure their blood ketones and moderate carbohydrate intake to keep their levels down below dangerous thresholds.

Personally when I went low carb, I got blood (not urine) ketone levels up into the range that would kill a diabetic quickly, think in the 7.0 range. Even as someone well adapted I regularly hit the 3.0s when fasting.

Obligatory: I am not a doctor.

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Type 1 diabetics may be at risk for ketoacidosis if they screw up their insulin, but T2 diabetics are not at any risk from just a low-carb diet. The problem is having high blood sugar and high ketones simultaneously, not just having high ketones. And the nice thing about a low-carb diet is that you're not eating carbs, so your blood sugar does not become elevated. If your pancreas can still create insulin at all, you are highly unlikely to go into ketoacidosis.

Keto is a really good diet for both weight loss and correcting insulin resistance for a T2 diabetic.

(Source, I am a T2 diabetic that eats a ketogenic diet. I am losing weight and my A1c is dropping. My doctor is pleased with my diet choices.)

Usually type 1 diabetics (autoimmune, are more at risk for DKA. Type 2 diabetics can definitely be at risk for DKA, especially if insulin-dependent. However, they are at higher risk for hyperosmolar hyperglycemic coma, which is equally frightening.

It's definitely a risk, but not as much if your body is still making insulin to help provide your cells with at least some energy.

You dont get keto acidosis by eating low carb, that is misinformation.

Source? From my read it looks like you absolutely can.

https://www.nejm.org/doi/full/10.1056/nejmc052709

That's a case study of a single patient. Main takeaway:

>Benign dietary ketosis resulting from restricting carbohydrates could, theoretically, cause ketoacidosis in persons with a predisposition to the condition.

That sounds very much like what they were saying. “Theoretically” is closer to “can” than it is to “cannot”.

Also, I said that it’s a risk to be managed. People are acting like I said that it’s a certainty and that not eating sugar constantly as a diabetic will kill you instantly or something.

I made it very clear that it’s high ketones while diabetic that causes it. If you’d like to correct that in a more constructive way, that would be helpful.

Type 1, maybe. Type 2, not at all. In fact, a ketogenic diet will reduce or eliminate the symptoms of T2.

> ketone levels up into the range that would kill a diabetic quickly

That's not how it works. DKA happens because your body is burning fat because it's starving from a lack of insulin. Ketones from healthy weight loss are not dangerous.

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