Prediabetes is a condition where blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes. It's often considered a warning sign, indicating an increased risk of developing type 2 diabetes, heart disease, and stroke. The good news is that prediabetes can be reversed through lifestyle changes, with diet playing a central role. A low-carbohydrate diet, particularly a ketogenic diet, has shown promise in managing and even reversing prediabetes. This article explores the benefits, risks, and practical steps involved in adopting a pre-diabetic keto diet plan.
Understanding Prediabetes and the Role of Diet
Prediabetes affects a significant portion of the population. It's estimated that a substantial percentage of adults have prediabetes, highlighting the widespread nature of this health concern. Blood that has too much glucose tends to move more slowly through your arteries. That can eventually weaken and damage blood vessels and lead to heart issues, vision problems, kidney disease and nerve problems. When the average of your blood sugar levels (called hemoglobin A1c) reaches between 5.7% to 6.4%, this qualifies as prediabetes and deserves attention.
Dietary changes are often the first line of defense against prediabetes. Modifying eating habits to include more nutritious foods can help bring blood sugar levels back into a healthy range.
Can a Low-Carb Diet Reverse Prediabetes?
Yes, a low-carb diet can be effective in reversing prediabetes. Reducing daily net carbohydrates to roughly 25-30% of total calories lowers insulin demand, allowing the pancreas to recover and improving insulin sensitivity. In clinical studies, more than half of adults reached normoglycaemia within 12 months. Sina Hartung, MMSC-BMI, notes, “The body responds to carb restriction surprisingly quickly-glucose control can begin improving within days.”
Success Rates and Timelines
- 12 Months: A daily limit of 75-100 g net carbs reversed 58% of cases in 12 months. The landmark DIRECT trial found that participants who sustained this carb range lowered HbA1c from 6.0 % to 5.4 % on average.
- 12 Weeks: University of Virginia data show a mean drop of 14 mg/dL over three months, even without significant weight loss, fasting glucose normalised in as little as 12 weeks.
- 10 Days: Continuous glucose monitoring revealed 34% fewer post-meal spikes (>140 mg/dL) after just a week of carb reduction.
- 24 Months: Hallberg’s continuous-care ketogenic intervention saw 53% of adults with prediabetes reach HbA1c < 5.7 % after two years on a diet providing fewer than 30 g of carbohydrates per day.
- 6 Months: An audit of 100 prediabetic adults on a very-low-carb ketogenic diet reported HbA1c normalization in 84 % within six months, alongside a median 5.7-kg weight loss.
The Impact of Weight Loss
Losing 5% body weight doubles the chance of remission. Each 5% loss raises remission odds by 102 % according to pooled analysis of 4,000 adults.
Read also: Vegan Diet for Diabetes Management
Understanding Low-Carb and Keto Diets
A low-carb diet is generally recommended for people who have Type 2 diabetes or who are at risk of developing the disease. The ketogenic diet is an ultra-low-carb, very high-fat diet that involves a drastic reduction in carbohydrate intake.
Defining Low-Carb
“Low carb” means under 130 g per day while keeping at least five portions of fruit and veg. Diabetes UK advises that carbohydrate intakes below 130 g daily can help manage weight and blood sugars, provided meals remain balanced with a minimum of five portions of fruit and vegetables for fibre and micronutrients.
The Ketogenic Diet
The ketogenic diet (or keto diet, for short) is a low carb, high fat diet that offers many health benefits. In fact, many studies show that this type of diet can help you lose weight and improve your health. Ketogenic diets may even have benefits against diabetes, cancer, epilepsy, and Alzheimer’s disease.
The ketogenic diet is a very low carb, high fat diet that shares many similarities with the Atkins and low carb diets. It involves drastically reducing carbohydrate intake and replacing it with fat. This reduction in carbs puts your body into a metabolic state called ketosis.
When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain. Ketogenic diets can cause significant reductions in blood sugar and insulin levels. This, along with the increased ketones, has some health benefits.
Read also: Foods for Pre-Diabetes
Types of Ketogenic Diets
There are several versions of the ketogenic diet, and what you eat depends on the type. They include:
- Standard ketogenic diet (SKD): This is a very low carb, moderate protein and high fat diet. It typically contains 70% fat, 20% protein, and only 10% carbs.
- Cyclical ketogenic diet (CKD): This diet involves periods of higher carb refeeds, such as 5 ketogenic days followed by 2 high carb days.
- Targeted ketogenic diet (TKD): This diet allows you to add carbs around workouts.
- High protein ketogenic diet: This is similar to a standard ketogenic diet, but includes more protein. The ratio is often 60% fat, 35% protein, and 5% carbs.
However, only the standard and high protein ketogenic diets have been studied extensively. Cyclical or targeted ketogenic diets are more advanced methods and primarily used by bodybuilders or athletes.
Ketosis Explained
Ketosis is a metabolic state in which your body uses fat for fuel instead of carbs. It occurs when you significantly reduce your consumption of carbohydrates, limiting your body’s supply of glucose (sugar), which is the main source of energy for the cells.
Following a ketogenic diet is the most effective way to enter ketosis. Generally, this involves limiting carb consumption to around 20 to 50 grams per day and filling up on fats, such as meat, fish, eggs, nuts, and healthy oils.
It’s also important to moderate your protein consumption. This is because protein can be converted into glucose if consumed in high amounts, which may slow your transition into ketosis. Practicing intermittent fasting could also help you enter ketosis faster. There are many different forms of intermittent fasting, but the most common method involves limiting food intake to around 8 hours per day and fasting for the remaining 16 hours.
Read also: Manage Diabetes with This Indian Diet
Blood, urine, and breath tests are available, which can help determine whether you’ve entered ketosis by measuring the amount of ketones produced by your body. Certain symptoms may also indicate that you’ve entered ketosis, including increased thirst, dry mouth, frequent urination, and decreased hunger or appetite.
Planning a Low-Carb Meal
Consistency matters more than perfection. Planning reduces decision fatigue and prevents carb creep. The Eureka Health team notes, “Batch-cooking protein and chopping vegetables on Sunday slashes weekday prep time to under 10 minutes.”
Meal Planning Strategies
- Rotate Meals: Rotate two breakfasts, three lunches and three dinners. A limited template simplifies shopping yet keeps boredom away-e.g., yoghurt parfait or veggie omelette for breakfast.
- Batch-Cook Protein: Grill 1 kg chicken breast or bake a tray of salmon; use in salads, wraps or stir-fries. Batch-cook protein for five meals.
- Quick Snacks: Keep quick-grab snacks at 5 g net carbs. Mozzarella sticks, 10 almonds or celery with 2 tbsp peanut butter prevent impulse carb choices.
- Scheduled Higher-Carb Meal: Plan one higher-carb dinner per week. Scheduling a 40-50 g carb meal helps social flexibility and may improve long-term adherence by 15 %.
- Freeze Portions: Double recipes and freeze portions for friction-free lunches. Diet Doctor’s 14-day low-carb plan advises cooking extra servings at dinner and freezing leftovers so weekday meals only need reheating, eliminating most prep work.
Setting Carb Targets
Daily carb targets of 50-100 g keep most plans in the low-carb zone. Healthline explains that standard low-carb eating stays under 100-150 g carbs, while keto and weight-loss versions often cap intake around 50 g, giving planners a concrete numeric goal.
What to Eat on a Low-Carb Diet
Low-carb does not mean no-carb. Focus on nutrient-dense choices that blunt glucose spikes while providing fibre and micronutrients. “Think of carbs as a seasoning, not the main dish,” says Sina Hartung, MMSC-BMI.
Building Your Plate
- Non-Starchy Vegetables: Fill half the plate with non-starchy vegetables. Aim for 2 heaping cups of leafy greens, cruciferous veg or peppers at lunch and dinner-about 10 g net carbs total.
- Protein: Choose protein at 1.2 g per kg body weight. Fish, poultry, tofu, eggs and Greek yoghurt stabilise glucose and support lean mass.
- Fats: Use fats from olive oil, avocado and nuts for 40 % of calories. A Mediterranean-style fat profile improved insulin sensitivity by 22 % in the Predimed cohort.
- Carb Budget: Limit higher-carb extras to a 15 g “carb budget” per meal. One small apple or half-cup cooked quinoa fits; test your glucose 1 hour after to stay under 140 mg/dL.
Foods to Include
- Meat: Red meat, steak, ham, sausage, bacon, chicken, and turkey.
- Fatty Fish: Salmon, trout, tuna, and mackerel.
- Eggs: Pastured or omega-3 whole eggs.
- Butter and Cream: Grass-fed butter and heavy cream.
- Cheese: Unprocessed cheeses like cheddar, goat, cream, blue, or mozzarella.
- Nuts and Seeds: Almonds, walnuts, flaxseeds, pumpkin seeds, chia seeds, etc.
- Healthy Oils: Extra virgin olive oil, and avocado oil.
- Avocados: Whole avocados or freshly made guacamole.
- Low Carb Veggies: Green veggies, tomatoes, onions, peppers, etc.
- Condiments: Salt, pepper, herbs, and spices.
It’s best to base your diet mostly on whole, single-ingredient foods.
Foods to Limit or Avoid
Sugary foods: soda, fruit juice, smoothies, cake, ice cream, candy, etc.Grains or starches: wheat-based products, rice, pasta, cereal, etc.Fruit: all fruit, except small portions of berries or strawberriesBeans or legumes: peas, kidney beans, lentils, chickpeas, etc.Root vegetables and tubers: potatoes, sweet potatoes, carrots, parsnips, etc.Low fat or diet products: low fat mayonnaise, salad dressings, and condimentsSome condiments or sauces: barbecue sauce, honey mustard, teriyaki sauce, ketchup, etc.Unhealthy fats: processed vegetable oils, mayonnaise, etc.Alcohol: beer, wine, liquor, mixed drinksSugar-free diet foods: sugar-free candies, syrups, puddings, sweeteners, desserts, etc.
Sample Meal Plan
Breakfast: Veggie and egg muffins with tomatoes.
Lunch: Chicken salad with olive oil, feta cheese, olives, and a side salad.
Dinner: Salmon with asparagus cooked in butter.
Breakfast: Egg, tomato, basil, and spinach omelet.
Lunch: Almond milk, peanut butter, spinach, cocoa powder, and stevia milkshake with a side of sliced strawberries.
Dinner: Cheese-shell tacos with salsa.
Breakfast: Nut milk chia pudding topped with coconut and blackberries.
Lunch: Avocado shrimp salad.
Dinner: Pork chops with Parmesan cheese, broccoli, and salad.
Breakfast: Omelet with avocado, salsa, peppers, onion, and spices.
Lunch: A handful of nuts and celery sticks with guacamole and salsa.
Dinner: Chicken stuffed with pesto and cream cheese, and a side of grilled zucchini.
Breakfast: Sugar-free Greek, whole milk yogurt with peanut butter, cocoa powder, and berries.
Lunch: Ground beef lettuce wrap tacos with sliced bell peppers.
Dinner: Loaded cauliflower and mixed veggies.
Breakfast: Cream cheese pancakes with blueberries and a side of grilled mushrooms.
Lunch: Zucchini and beet “noodle” salad.
Dinner: White fish cooked in olive oil with kale and toasted pine nuts.
Breakfast: Fried eggs with and mushrooms.
Lunch: Low carb sesame chicken and broccoli.
Dinner: Spaghetti squash Bolognese.
Always try to rotate the vegetables and meat over the long term, as each type provides different nutrients and health benefits.
Monitoring Progress and Seeking Medical Support
Monitoring shows whether the plan is working and flags emerging problems. “Numbers guide us; they’re not a judgment,” emphasises Sina Hartung, MMSC-BMI.
Recommended Lab Tests
- HbA1c: Every 3 months until below 5.7 %. A 0.3 % drop corresponds to about 10 mg/dL lower average glucose.
- Fasting Insulin and HOMA-IR: Twice a year. Falling insulin indicates improved sensitivity even before HbA1c changes.
- Lipid Panel and ALT: Every 6 months. Low-carb diets often raise HDL by 5-7 mg/dL but can transiently raise LDL; liver enzymes track fatty-liver regression.
Medication Considerations
Metformin may be added if fasting glucose stays above 110 mg/dL. Guidelines allow starting 500 mg nightly; dose and need should be reviewed with a clinician.
Prediabetes Thresholds
Diagnostic cut-points of fasting plasma glucose 100-125 mg/dL or HbA1c 5.7-6.4 % mark prediabetes; falling below them signals remission of the condition.
The Role of AI in Managing Prediabetes
Eureka’s AI doctor analyses food logs, glucose readings and labs to spot patterns humans miss. The team at Eureka Health explains, “Our algorithm flags rising post-meal spikes days before HbA1c drifts upward.”
Features of AI Support
- Real-time feedback on meal photos: Users receive a carb estimate within seconds, cutting guesswork.
- Automated reminders for fasting labs: Completion rates for HbA1c testing improved from 64 % to 87 % among active users.
- Safe escalation to human clinicians: If three readings exceed 180 mg/dL in 24 hours, the app prompts a review by a licensed provider.
- Integration with popular CGMs: Glucose curves sync automatically, letting the AI correlate specific foods with spikes.
Potential Risks and Side Effects
A keto diet could cause unpleasant effects, including bad breath, dizziness, nausea, headache, fatigue, confusion, excessive thirst and hunger, fast heartbeat, fever, and chills. Also, the Frontiers in Nutrition review revealed potential elevations in LDL cholesterol when following a low-carbohydrate diet, as well as a possible increased risk of cardiovascular disease, cancer, and Alzheimer’s disease. And pregnant women in the review were more likely to have a child with a neural tube defect when following a keto diet.
A 2021 review found that the ketogenic diet does not increase the risk of hypoglycemia, unless glucose-lowering medications are unchanged. Because low-carbohydrate diets can reduce glucose levels so effectively, it may quickly become necessary to adjust the dosage of medications such as insulin and metformin; one more reason to keep in close contact with your doctor when beginning a ketogenic diet.
Overall, study findings on the potential benefits - and risks - of the keto diet for diabetes are mixed. More studies are needed before scientists understand the long-term implications of the eating plan for this group.
Who Should Be Cautious?
The American Diabetes Association (ADA) recommends against very low-carbohydrate eating patterns for people with chronic kidney disease. Also, be careful with the keto diet if you have type 1 diabetes. Ketones, which are produced by the body during ketosis, are a risk factor for diabetic ketoacidosis (DKA), which is more common in people with type 1 diabetes than people with type 2 diabetes, according to the ADA.