In type 2 diabetes, ketoacidosis is impossible in the overwhelming majority of cases if a person switches to a strict keto diet. This is due to the following fundamental mechanisms:
Type 2 diabetes and ketones — what is important to understand. Unlike type 1 diabetes, where insulin is hardly produced, in type 2 diabetes insulin is present — it just works poorly due to insulin resistance. This means that:
- the body does not effectively utilize glucose;
- blood glucose levels remain high;
- cells experience energy starvation, especially with reduced mitochondrial function.
Why ketoacidosis is theoretically possible in type 2 diabetes, but extremely rare. Even with high glucose and poor insulin sensitivity, a person with type 2 diabetes almost always retains at least a minimal level of insulin, which means:
- excess ketogenesis is suppressed;
- critical levels of ketones are not reached to shift pH towards acidosis;
- mitochondria are still capable of partially using ketones as fuel.
Thus, transitioning to ketosis in the context of type 2 diabetes is not just safe — it restores energy balance, reduces inflammation, and improves insulin sensitivity.
Keto diet: why it is a solution:
- excludes sharp spikes in glucose → high insulin production is not required;
- reduces the load on pancreatic beta cells;
- activates lipolysis and ketogenesis within physiological norms;
- ketones become a full-fledged source of energy without causing acidosis;
- improves metabolic profile: HOMA-IR decreases, triglycerides decrease, HDL increases.
The main point: on a keto diet, a person with type 2 diabetes simply does not create conditions for ketoacidosis, as there is neither severe hyperglycemia, nor complete insulin deficiency, nor mitochondrial collapse.
Conclusion. Ketoacidosis is an emergency condition that arises under the following conditions:
- complete insulin deficiency,
- hyperglycemia,
- energy depletion.
In type 2 diabetes, against the background of a fat-based diet and low glucose, all these conditions are eliminated. Therefore, on a keto diet, ketoacidosis is impossible: the body receives a stable source of energy, ketones are utilized, and blood pH remains normal.
