Complicated question: With renal insufficiency, metformin can cause lactic acidosis. So on the surface, there is not a risk of ketoacidosis. But if you eliminate all carbs you may not need metformin, and an extreme ketogenic diet can cause many symptoms and metabolic derangements that i would not want to combine with metformin. Suggestion: moderation. Enough carbs to limit ketosis, and check glu daily. See your md.
Answered 1/6/2020
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