Individuals with Type 1 diabetes attempting to achieve nutritional ketosis face unique risks, including diabetic ketoacidosis (DKA) at higher ketone levels due to the absence of insulin production.

“well I think that there are some interesting intersections in between hardcore I'm not talking about generic low carb or low carb high protein all of the Bernstein method but let's talk about the people who were trying to get into nutritional ketosis with a beta hydroxy butyrate that hovers around one to two well those people have a couple of unique problems and and one is diabetic ketoacidosis as you mention again for the folks to understand why that's the case in you or me even when I'm fasting you know and I fast for a week at a time my beta hydroxy butyrate level will reach six or seven millimolar right but it's not gonna reach 10 millimolar it's certainly not gonna reach 12 or 14 which is where we start to see the acidotic changes because eventually that ketone is going to get elicit some response from insulin right in the person who has no beta cell reserve that”