North Texas GME Research Forum 2024



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North Texas


Medical City Fort Worth


Family Medicine

Document Type


Publication Date



type II diabetes, ketogenic diet


Family Medicine | Medicine and Health Sciences | Nutritional and Metabolic Diseases


The management of patients with high cardiac risk profiles who require insulin therapy for diabetes can be challenging due to the potential adverse effects of insulin on cardiovascular health. In order to achieve remission of type 2 diabetes mellitus (T2DM) and discontinue the need for insulin, weight loss has long been recognized as a valuable approach. The goal for this case was to implement dietary and lifestyle changes in a safe and efficient manner to induce remission of T2DM, without increasing the sympathetic load often associated with fully dosed ketogenic and other fasting strategies. This case report highlights the successful management of a 40-year-old male patient with high cardiac risk factors and a history of untreated T2DM who required insulin therapy. After experiencing a ST elevation myocardial infarction (STEMI) and subsequent three vessel coronary artery bypass graft (CABG), the patient was found to have an A1C of 11.6% and a BMI of 31.5 kg/m2. A comprehensive treatment approach was employed, which included carb restriction, intermittent fasting (IF), a ketogenic diet (KD), and non-insulin medications to gradually wean the patient off insulin therapy. With regular follow-ups with his primary care physician (PCP) and strict adherence to the treatment plan, the patient achieved remarkable results. After three months of treatment, the patient's A1C dropped to 5% and BMI decreased to 27.3 kg/m2, enabling discontinuation of insulin use. The patient remained in remission throughout repeated follow-ups over the next 6 months while maintaining dietary and exercise habits, as well as continuing his other medications, including Metformin. This case underscores the potential effectiveness of a low-calorie ketogenic diet with exercise as a valuable tool for acquiring and maintaining remission of T2DM in patients with obesity and high cardiac risk factors.

Original Publisher

HCA Healthcare Graduate Medical Education

Type II Diabetes and Keto Diet in Family Medicine Clinic: A Case Report



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