Avoiding DKA With Continuous Ketone Monitoring
Might there be a way to detect and prevent the serious complication of DKA before it happens?
As people with diabetes may know, diabetic ketoacidosis (DKA) is a serious complication of diabetes that can happen when the body does not have enough insulin. When the body does not have enough insulin, the body can break down fats for energy, which produces ketones. The body can handle the breakdown of a small amount of ketones, but not large amounts, which can make the blood acidic. During DKA, high levels of ketones, even for a few hours, can cause serious illness affecting the brain, other organs, and can be potentially life-threatening.
At the 2026 ATTD conference, experts discussed the need for continuous ketone monitoring and agreed that there are a number of important reasons why people with diabetes should use such systems when available.
A large new study of nearly 660,000 people in the U.K. found that over the last 23 years, the rates of DKA have risen sharply among people with diabetes. Though DKA is traditionally seen in people with type 1 diabetes, the study noted nearly a six-fold increase in DKA in people with type 2 diabetes. The data also found a high DKA recurrence rate, with nearly 32% of people with type 1 and 12% of people with type 2 having multiple DKA events.
Ketone tests using fingerpricks are highly effective in preventing DKA, but other new data from France and the U.S. found that blood ketone testing among people with diabetes is infrequently done, and healthcare providers report a lack of knowledge regarding ketone monitoring. Earlier this year, new international guidelines were published with recommendations for continuous ketone monitoring, which could significantly improve outcomes for people at risk of DKA.
How CKM could help
Dr. David O’Neal, director and founder of the Diabetes Technology Research Group at the University of Melbourne, Australia, said in a study of 205 people with diabetes conducted by his group in several Melbourne clinics, more than 30% of people with type 1 did not own a ketone test kit, and many of those who did were not testing regularly or did not know when to do so.
O’Neal said that continuous ketone sensing could be especially useful for people with diabetes:
With recurring DKA
During pregnancy
On very low carb/weight loss diets
With anorexia
During exercise
During an illness
Taking medications like SGLT-2 inhibitors, which can increase DKA risk
O’Neal described ketone monitoring, and ideally, a CKM device, to be like an airbag. “You might never need it, but it could save your life,” he said.
“It should be accurate at low ranges, durable and integrated with other sensors, and should not be an additional cost burden to the user,” he said.
His group has suggested that for the technology to have a widespread effect on people with diabetes, glucose and ketones should be measured by the same sensor. Ketone sensing would run in the background, alerting the user at a level that allows them to seek medical advice, adjust insulin, and possibly prevent a visit to the hospital. Abbott recently submitted a continuous dual glucose-ketone (DGK) monitor to the FDA for clearance – if approved, it could be available in the U.S. later this year.
DKA and SGLT-2 Inhibitors
Glucose-lowering medications called SGLT-2 inhibitors have also been shown to protect against kidney disease and heart failure in people with type 2 diabetes. While many people with type 1 diabetes – who face similar risks for these complications – could potentially benefit from these drugs, studies have shown that SGLT-2 inhibitors increase the risk of DKA – even DKA without high blood sugars.
Some people with type 1 diabetes have been prescribed these drugs off-label by their healthcare providers, but they have not been approved by the FDA for type 1 diabetes because of the risk of DKA. A combined continuous glucose and ketone monitor offers a potential solution to this issue. If a sensor could detect increasing ketone levels in time for people to address it on their own and avoid DKA, more people with type 1 could safely take SGLT-2 inhibitors to protect against kidney disease and heart failure.
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