If you’re diabetic, you probably already know that In both T1 and T2 diabetes, patients have abnormal insulin signaling. In T1, the pancreas doesn’t make enough insulin, and in T2, the body’s tissues are resistant to insulin. Insulin helps transport glucose from the blood into the cells where it can be used for energy. In severely uncontrolled diabetes (typically someone not being treated for their condition and who have let it go completely out of hand), insulin signaling is wildly impaired, and an acute and life-threatening condition called ketoacidosis can occur. If a person is eating a standard diet wherein carbohydrate is a major portion of their macronutrient intake, their tissues are mostly burning glucose for fuel. Therefore, if insulin signaling is incredibly impaired, this will cause glucose to build up in the blood because it can’t get into the cells. Thus, the cells are basically starving even though there’s plenty of glucose in the blood. (This is sometimes referred to as “starvation in the land of plenty.”) This causes the liver to begin making ketones from stored fats, just as it would if you were starving from not eating anything. Insulin also plays a role in regulating ketone production, and normally it inhibits ketone production if it’s too high to keep ketones at a proper level in the blood.
So, if the patient’s diabetes is too severely uncontrolled, it is possible that a situation called “runaway ketogenesis” occurs. The liver makes lots and lots of ketones in a short amount of time. Ketones are acids, and when at extremely high levels (typically >20mM), they can cause blood pH to drop, which can be very dangerous and/or fatal. This is diabetic ketoacidosis.
That being said, exogenous ketone supplements are not recommended for type 1 diabetics. Exogenous ketone supplements and a ketogenic diet have been found to help control and in some cases reverse type 2 diabetes. As with any medical condition, we highly recommend that you speak with your health care professional before starting a new diet and/or using any dietary supplements.