Diabetes metabolism. In order to maintain normoglycemia insulin should

Diabetes
mellitus in definition is a disease of carbohydrate metabolism. In order to maintain normoglycemia insulin
should be secreted in appropriate amount in response to any change of glucose
level in the blood. This normal range of blood glucose is maintained only if
?-cell of the pancreas function is maintained at a level that can compensate
for insulin resistance if present. In patients with diabetes, the function of
?-cell decreases with time leading to progressively worsening blood glucose
control. In type 2 diabetes, a greater demand on pancreatic cells to secrete
more insulin is caused by insulin resistance leading to an increase in ?-cell
apoptosis that will contribute with the time to a loss of the entire ?-cell
mass and function. Therefore, a diet or therapy that reduces the workload of
pancreatic ?-cells might be predicted to have a beneficial effect for
maintaining and maybe preserving their capacity to respond to increases in
blood glucose. Reducing dietary carbohydrate by following a Ketogenic diet
reduces in post-meal glucose excursions and the need for insulin secretion. Ketogenic diet is a diet very low in
carbohydrate but high in fat that induces ketosis at carbohydrate intakes below
50 g/day. Based on the restriction of carbohydrate we differ many type of ketogenic
diets. Ketogenic diets contain the Atkins-style diets: very low in carbohydrate
less than 20 g/day and high in protein and fat, and other diets like the Zone
diet that promote a moderate carbohydrate restriction with high protein and
lower fat intakes. The Very low carbohydrate, ketogenic diet appears to have
more effects than other less restricted carbohydrate.(1)

Carbohydrates
are the primary source of glucose for metabolism, and restricting carbohydrate
intake can reduce insulin levels, reduce postprandial hyperglycemia, and
improve insulin sensitivity. This strong relationship between postprandial
serum glucose and dietary carbohydrate led to the use of ketogenic diet as a
treatment for type 2 diabetes. Despite
evidence, low carbohydrate diets remain an area of controversy and this report
aims to explore the role of low carbohydrate diets for people with type 2 diabetes. (2)

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In the
following study we will verify the ability of ketogenic diet to improve
glycemic control and treat patients with type 2 diabetes.

Methods: participants recruited by news-paper
advertisements were divided to two treatment groups one for whom BMI is greater
than 32 kg/m2 and the other for less BMI. Same nutritional
supplements were given to both groups. Some participants follow ketogenic diet by
restricting carbohydrate intake to less than 20 grams per day, without
restricting caloric intake. While other participants, decrease calorie diet
with 55% of daily intake from carbohydrate following a low-glycemic index.
Hemoglobin A1C the primary outcome was measured at baseline, in the
week 12, and week 24.

Results: From the starting of the study and to the week
24, the reduction of mean HbA1c was greater for the ketogenic diet
group than for the low-glycemic index group. The mean change was -1.5% for the
ketogenic diet and -0.5% for the low glycemic diet. Improvement was notice in
both fasting blood glucose and insulin for both groups over the 24 weeks. In
addition group following ketogenic diet 20 participants had a reduction in
medication and 5 who were taking 20 units of insulin were no longer taking
insulin at the end of the study.

Conclusion: in general reducing carbohydrate intake led to
improvement in glycemic control and elimination or reduction of the medication
in individuals with type 2 diabetes. The ketogenic diet which is low in
carbohydrate had a more effect on improving glycemic control than in those
following the low glycemic diet. We can conclude that lifestyle modification
based on low-carbohydrate diet interventions improve type 2 diabetes.

Limitations: participants in this study were volunteers from
the community, and mainly women, which limit the generalization of these
findings to other populations mainly men. Another possible limitation is the imbalance
in the primary outcome HgA1 test which despite random allocation has
occurred. (3)

 

Ketogenic diet remains
a controversy topic where a lot of studies were done to demonstrate that it
does not have effect on diabetes type 2. One of the studies is discussed in the
following.

Method: this study was realized on mice that were
fasted overnight and re-fed their respective diets to assess insulin and
glucose levels. Body weight and blood glucose measurements were carried out
prior to the removal of food and repeated the next day, following an overnight
fast (16 h). After 7–8 weeks, oral glucose tolerance test (OGTT) was performed
and intravenous glucose tolerance test was performed after 9 weeks.

Results: fasting insulin levels tended to be higher but
insulin secretory function in ketogenic diet-fed mice was not improved nor was
?-cell mass. Fed plasma insulin levels in the ketogenic diet mice were also
significantly higher, which is suggestive of exacerbated
insulin resistance and consistent with the increased weight gain and adiposity
observed in this group. During an OGTT, blood glucose levels increased similarly
in both ketogenic diet and chow-fed mice but remained significantly higher
throughout the remainder of the test in the ketogenic diet-fed.

Conclusion: we found that such a diet in prediabetic mice was associated with
reduced glycemic excursion after a meal but caused increased weight gain and
adipose tissue mass. Increased weight gain requires am over secretion of
insulin and a greater response to a glucose challenge, but with ketogenic diet,
there was no improvement in ?-cell function or mass in mice. Overall, this diet
resulted in greater impairment in glucose tolerance. Our results do not support
the recommendation of a ketogenic diet for use in diabetes.

Limitations: In this study potential positive and negative
effects when considering a ketogenic diet in patients with diabetes were not
taking into consideration which may limit the results. (4)

 

Recommendations:

For future
research, studies should examine the relation between ketogenic diet and the
management of type 2 diabetes on a more diverse and large population.
Psychological support for patients is necessary to improve adherence to the
diet and to maintain the positive effect over a long time. (5) It is important to identify an eating pattern
that is based on each individual lifestyle for a more efficient and long term
improvements.(6) Carbohydrate management is the key strategy so
we must address the type and the amount of carbohydrate by focusing on
unprocessed carbohydrate from whole grains. Although the ketogenic diet appears
to be safe and effective in people with type 2 diabetes, there are more
sustainable alternatives available and this should be explained to all those
with type 2 diabetes. Encourage the dietary pattern that is associated with
better overall health outcomes. This diet is rich in vegetables, fruit, whole
grains, seafood, legumes, and nuts, contains moderate amounts of dairy
products, and is lower in red and processed meat, sugar, and refined grains. (7)