Numerous studies in a variety of settings show dramatic improvements in blood glucose control and blood lipids in type 2 diabetics consuming a low-carb diet (1-5).

When these studies included a low-fat, high-carb comparison group, the low-carb diet consistently showed superior effects on blood glucose control, medication reduction, blood lipids and weight loss. Weight loss is particularly important because treatment goals for patients with type 2 diabetes always emphasize weight loss if the individual is overweight, yet the drugs used to treat diabetics can increase the risk of weight gain. Unlike medications, a low-carb dietary approach to type 2 diabetes can deliver improved blood sugar control and weight loss.

Weight Gain as a Side Effect

On its surface, the management of type 2 diabetes seems pretty easy: just get your blood glucose back down into the normal range. But insulin resistance characterizes type 2 diabetes; put simply, the glucose level “doesn’t want” to go down. This means that the body is less responsive to the most powerful drug used to treat it: insulin. So the dose of insulin that most type 2 diabetics are prescribed is sometimes very high. Moreover, because insulin not only drives glucose into muscle cells but also accelerates fat synthesis and storage, weight gain is usually one side effect of aggressive insulin therapy.(6) Other pills and injected medications have been developed to reduce this effect, but on average, the harder one tries to control blood glucose, the greater the tendency to weight gain.(7) 

Hypoglycemia as a Side Effect

The other major side effect of attempting to gain tight control of blood sugar with medication is driving it too low, resulting in hypoglycemia, which causes weakness, shakiness and confusion. If these symptoms appear, the advice is to immediately eat a lot of sugar, which jump-starts the blood sugar roller coaster all over again. Interestingly, once type 2 diabetics work with their doctors to adjust medications, follow the program correctly and complete the first few weeks of the Atkins program, they rarely experience hypoglycemia. 

Why Not Just Cut Calories?

So why isn’t it good enough just to cut back on one’s calories without cutting back on carbs? It’s true that going on a diet and losing weight typically improve diabetes control. However, weight loss is usually not enough to significantly reduce medication dosage when carbohydrate intake is still high. Since diabetic drugs produce side effects and appetite stimulation, losing weight on a standard diet is a difficult tightrope for a diabetic to walk.


Once you understand this tightrope of weight loss during drug treatment, it’s easier to appreciate the advantage of using the Atkins Diet to manage type 2 diabetes. When you remove added sugar, significantly reduce carb intake overall and confine your carb consumption primarily to “foundation vegetables,” insulin resistance rapidly improves and blood glucose control improves—usually dramatically. Additionally, most people find that they can stop or substantially reduce their diabetes medications. (This process should always be done in close consultation with a physician.) As a result, the path to meaningful weight loss changes from a tightrope to wide road. As long as you stay within your carb tolerance range, you should be able to navigate your way to heath.



  1. Bistrian, B.R., Blackburn, G.L., Flatt, J.P., Sizer, J., Scrimshaw, N.S., Sherman, M., “Nitrogen Metabolism and Insulin Requirements in Obese Diabetic Adults on a Protein-Sparing Modified Fast,” Diabetes, 25, 1976, pages 494–504.
  2. Boden, G, Sargrad, K., Homko, C., Mozzoli, M., Stein, T.P., “Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes,” Annals of Internal Medicine, 142, 2005, pages 403–411.
  3. Daly, M.E., Paisey, R., Millward, B.A., Eccles, C., Williams, K., et al., “Short-Term Effects of Severe Dietary Carbohydrate-Restriction Advice in Type 2 Diabetes—A Randomized Controlled Trial,” Diabetic Medicine, 23, 2006, pages 15–20.
  4. Westman, E.C., Yancy, W.S., Jr., Mavropoulos, J.C., Marquart, M., McDuffie, J.R.,“The Effect of a Low-Carbohydrate, Ketogenic Diet Versus a Low-Glycemic Index Diet on Glycemic Control in Type 2 Diabetes Mellitus,” Nutrition & Metabolism,5, 2008, page 36.
  5. Dashti, H.M., Al-Zaid, N.S., Mathew, T.C., Al-Mousawi, M., Talib, H., Asfar, S.K., et al., “Long Term Effects of Ketogenic Diet in Obese Subjects with High Cholesterol Level,” Molecular and Cellular Biochemistry, 286, 2006, pages 1–9.
  6. Daly, A., “Use of Insulin and Weight Gain: Optimizing Diabetes Nutrition Therapy,” Journal of the American Dietetic Association, 107, 2007, pages 1386–1393.
  7. Gerstein, H.C., Miller, M.E., Byington, R.P., Goff, Jr., D.C., Bigger, J.T., Buse, J.B., et al., “Effects of Intensive Glucose Lowering in Type 2 Diabetes,” The New England Journal of Medicine, 358, 2008, pages 2545–2559.
Posted by Linda O'Byrne
Atkins Nutritionist