Over and over again scientist point out that insulin is the problem, and one way to lower it is to eat a low carb diet with moderate protein (the New Atkin’s Diet).  Westman an author of the article and has conducted a trial of 28 morbidly obese diabetics of which 21 completed the trial.  Of the 21, 7 were cured (off medications) and 10 reduced their medications.  Westman is President of the American Society of Bariatric Physicians, a co-editor of a text book on Obesity and treatment, and co-author of The New Atkins for a New You.

FULL PDF https://nutritionandmetabolism.biomedcentral.com/track/pdf/10.1186/1743-7075-2-34?site=nutritionandmetabolism.biomedcentral.com

Summary  https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-2-34

A low-carbohydrate, ketogenic diet to treat type 2 diabetes

• William S YancyJr^{1, 2}Email author, Marjorie Foy¹,  Allison M Chalecki¹,  Mary C Vernon³ and Eric C Westman²

  Methods:  From an outpatient clinic, we recruited 28 overweight participants with type 2 diabetes for a 16-week single-arm pilot diet intervention trial. We provided LCKD [low carb, ketogenic diet] counseling, with an initial goal of <20 g carbohydrate/day, while reducing diabetes medication dosages at diet initiation [calories were not restricted, nor were fats & oils]. Participants returned every other week for measurements, counseling, and further medication adjustment. The primary outcome was hemoglobin A_1ch.  Results:  Twenty-one of the 28 participants who were enrolled completed the study. Twenty participants were men; 13 were White, 8 were African-American. The mean [± SD] age was 56.0 ± 7.9 years and BMI was 42.2 ± 5.8 kg/m² [morbidly obese].  Hemoglobin A_1c decreased by 16% from 7.5 ± 1.4% to 6.3 ± 1.0% (p < 0.001) from baseline to week 16. Diabetes medications were discontinued in 7 participants, reduced in 10 participants, and unchanged in 4 participants. The mean body weight decreased by 6.6% from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg (p < 0.001) [289 to 269 lb]. In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A_1c. Fasting serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001) while other serum lipid measurements did not change significantly.  Conclusion The LCKD [ketogenic diet, under 50 grams a day of carbs] improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication. [Note there was no energy restriction, yet calories dropped 519, lowering it to 40 grams a day would lower insulin, see New Atkins diet.  In a different trial, 539 calorie reduction occurred by skipping breakfast. Combing all three produces even better results; this is what Dr. Jason Fung use in his clinic.]