Should I be worried about low blood sugar on keto or during intermittent fasting?

Not if you are in relatively good health. A healthy body is perfectly capable of keeping blood sugar levels stable even on low-carb diets. If you are diabetic, however, you may be at risk of hypoglycemia if you don't adjust your medication to this diet [1]. If you were not diagnosed with diabetes but develop symptoms of hypoglycemia on keto or when fasting, there's no reason to worry. Studies show that some people develop symptoms like shakiness and irritation during food restriction despite having blood glucose within normal ranges [2].
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A more likely cause of discomfort in the first days of keto or fasting is the keto flu. The keto flu is a result of electrolyte imbalances and includes symptoms like brain fog, fatigue, muscle aches, and headaches [1]. You can reduce the severity of any of these symptoms by limiting your carbs gradually and staying hydrated. We suggest decreasing your carb intake by 20 to 30 grams daily until you reach your target intake. Eating smaller meals throughout the day may help you get into keto more easily.

If you experience severe ketosis symptoms like shakiness or feeling faint, try having a sugary drink like fruit juice. Keep in mind that this will take you out of ketosis and slow down your adaption. Some people find the transition to keto easier than others and if you have insulin resistance or pre-diabetes, you may be more susceptible to developing severe symptoms due to changing blood sugar levels.

On the bright side, once your body adapts to using ketones for fuel instead of glucose, you'll notice these side effects subside. You may also see an improvement in your health if you're diabetic or have pre-diabetes [3].

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