Glucose transporter type 1 deficiency syndrome (GLUT1 DS) is a rare epilepsy, but some resist the ketogenic diet’s benefits. This comprehensive review investigates why, even with proper ketosis, certain patients see limited seizure improvement. A high-fat, low-carb keto diet is key, yet resistance persists. Learn why keto might not work for all, understand the challenges, and explore potential solutions for better epilepsy management with this critical appraisal!