You require at least a low level of insulin to keep metabolic systems in balance. Whether they eat carbs or not, T1 diabetic patients need insulin or they will go into diabetic ketoacidosis and die. Because insulin necessarily lowers glucose in addition to suppressing ketoacidosis, T1 patients need carbs.

T2 patients are on a spectrum with some having enough insulin production and sensitivity left that they can do okay with no/very low carb intake and may even get better as they lose weight. Some T2 patients get a kind of burned out pancreas and severe insulin resistance which requires exogenous insulin to treat and behaves more like T1 but with the caveat that due to reduce insulin sensitivity, they usually need much higher doses in insulin than T1 patients.

T1 and T2 are completely different diseases. T2 should not be called diabetes. It should be called insulin resistance or chronic carbohydrate overdose.

I was diagnosed as pre-diabetic/T2. I started wearing a cgm and watching how various foods affected my blood sugar. I eliminated foods that caused spikes, and started cooking my own meals so I could control what went into them. I wound up with a very low carb diet of meat and vegetables, and a very stable blood sugar with NO spikes ever. According to my blood work and checkups I cured my NAFLD, cured my hypertension (including getting off drugs for that), and "cured" my pre-diabetes. I lost a lot of weight, but still have a lot more to lose.

I put cured in quotes because I don't think this diet can cure you once you're bad enough to need treatment. I think it can only put your disease into remission so that you don't suffer any health effects from it. Some of us just can't overeat carbs or we develop this disease, and the only effective treatment is to stop eating the carbs.

There are some people with T2D—a minority of them—who are not overweight. I think T2D with overweight or obesity should be called something else.

It's metabolic dysfunction at its core.

Optimizing the electron transport chain via supplements like CoQ10 (Ubiquinol more bioavailable), Benfotiamine (b1 form), Nicotinamide Riboside (b3 form) are extremely helpful.

That's the reason why metformin works so well for diabetes, and has longevity extension effects, because of how it stimulates the AMPK pathway, which is also anti-inflammatory (thus lowering oxidative stress).

We can reframe a TON of chronic conditions under the umbrella of mitochondrial dysfunction, whether it's ME/CFS, T2 diabetes, anxiety, depression, and addressing the mitochondrial dysfunction tends to be extremely helpful, if not able to bring the conditions into remission.

The problem though is that addressing mitochondrial dysfunction requires a multi-pronged approach with a lot of disruptive lifestyle interventions, which makes the activation cost for such things a hump that the average person will not be able to get over unless they have enough privilege to do so.

Please share more. This is the first time I heard of mitochondrial dysfunction. The more I read and research, the more I see this type of pattern: A host of similar diseases claimed to be caused by a very fundamental process in the body, which is only malfunctioning due to the modern lifestyle. Many of those stuff are backed by research.

I'm a T2 diabetic who went all carnivore 34 months ago. No sugar or carb foods anymore at all. My diabetes is in remission with an A1C under prediabetic. Symptoms like brain fog are gone. I'm off the medications (but wasn't on insulin). My Libre says this works lots better than the Metformin and Glyburide.

Survive, check. Living comfortably, more so than before.

My diet is more monotonous than before, mostly beef and butter. But I'm enjoying and looking forward to meals at least as much as ever. I question if I'd have survived this long without taking the leap.

It's actually a quite complex question that does not have a clear cut answer. In case of T2D you can 'go into remission' meaning you can get your blood glucose levels to 'normal levels' with little or even no medication (T2Ds are not necessarily using insulin, they can also use medication that increases insulin sensitivity such as metformin). Generally weight loss, exercise and a healthy diet are what allows them to accomplish that and a keto / low carb diet can definitely help there.

For T1Ds I'm afraid even a keto diet still contains too much carbs to live healthily without insulin. Unfortunately if your body has fully stopped producing insulin and you don't take any artificial insulin your life expectancy is not looking good regardless of how you live.

I'm not a medical expert, but as far as I'm aware even a 100% ketogenic diet would still have fluctuations in glucose levels which would require insulin to manage. But, it's entirely dependent on how much insulin a T1 or T2 diabetic's body is still capable of producing which would determine if they would still need exogenous insulin. (Because the quantity required _would_ be much lower than on a higher carb diet)

I've lived low-carb as a T1 and my blood sugar was very stable. I would still take sugar to stabilize levels when dipping low. A completely ketogenic diet would be very hard for a T1 and not a sensible goal. Insulin management was simpler, but still required. On many days I would just do the one injection of long-lasting insulin.

While the scantly researched health risks associated with a ketogenic diet remain, the diet is very effective to keep blood sugar stable. A low-carb diet protects most people from T2, and people with T1 profit from simplified insulin management.

For a T2, eating ketogenic could be healthier than eating carbohydrates. Depending on progression, they would recover quickly and not be a T2 anymore.

This may be a terminology thing but as a T2 I will always carry that diagnosis. However, mine is in remission because I manage it through medication/diet.

My doctor and I have talked about trying to see if I can drop the medications and still stay in remission but I'll still be a T2 patient.

Also, not all T2s can manage just through a ketogenic diet.

Thanks for your perspective, and congrats on the lookout to not even take meds anymore. Yea didn't want to imply that the ketogenic diet would work for everybody with T2. And I can see how you'd say you'll always be T2 as you will want to keep watching your diet even if you didn't take medication anymore.

It's worth while reading the literature on pre-insulin treatments, but for type 1 diabetics, the answer is: you might be able to live, if just, for a while (a decade or so), but lifespans are greatly shortened. Probably depends exactly on the particular characteristics of the disease for a patient.

I thought this was a neat discussion: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062586/

A transcript of a speech Joslin gave https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1827782/pdf/can...

It would probably a very good idea if you can keep to it.

Doing so with mild T2 diabetes could lead to complete remission (as long as the diet is kept).

In more advanced T2 diabetes it could lead to significant improvement, and reduction of required medication.

People with T1 diabetes simply don't produce enough insulin. External insulin is required.

Management of T1 diabetes is also way more complicated and mistakes are immediately life threatening.

Are you familiar with Dr. Richard K. Bernstein's approach? It is a very low carb diet (he doesn't call it Keto as Ketosis is not the aim) combined with a lifetime of experience managing it.

See his book The Diabetes Solution, his Youtube channel, and the Type1Grit facebook group. There are a lot of type 1s running <5% HbA1C on his program.

He's definitely very contreversial, but I always found his reasoning extremley presvasive. Not to mention that he's a 90 year old with T1 from childhood, still practicing medicine and seeing patients (or at least he's been practicing up to a few months ago).

https://www.diabetes-book.com/

https://www.youtube.com/@DrRichardKBernstein/videos

https://www.facebook.com/Type1Grit/

There's also the great Gary Tabues and his books, especially Rethinking Diabets

https://garytaubes.com/rethinking-diabetes/

A ketogenic diet can do some pretty wild things to medication. I'm bipolar and I am unable to do a ketogenic diet without serious side effects, like loss of motor control. If done for a prolonged time, it is possible those side effects become permanent.

I can reduce sugar but not carbohydrates as a whole.

T1 needs insulin, some T2 are ok without it.

Insulin is cheap to make, now, it is expensive because of commercial considerations like monopolization or investment. In reality any national system worth its salt could produce enough insulin at a very low cost for all diabetics in the world. But, this won't happen because of trade rules and so on.

Some people are trying to build the infrastructure for local/homebrew insulin production, but it's proving to be challenging. See this site for more: https://openinsulin.org/2023-recap/