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My mom was a dramatic woman prone to overreacting. When I was a snotty teen, I told her she needed to take several chill pills. Most of the time, I was right. Back in 2004, when she was swearing in Korean and hurtling down the highway in a Honda Odyssey that had no business going 20mph over the speed limit, swerving in and out of traffic as I vomited bile into a plastic baggie, I have to admit that she was right to rush me to the emergency room.
After two days of nonstop vomiting, I thought I just had a gnarly stomach bug. Instead, I watched as doctors furrowed their brows as I failed to keep down tiny sips of water. They asked if I was diabetic. My mom said no; I was just on a ridiculous low-carb diet. Dizzy and disoriented, I was told to try peeing on a strip of paper. It changed colors. After that, things went blurry as they frantically worked to get me into a bed. I don’t remember much else, except waking up several hours and two whole IV drips later to a doctor lecturing my mom about why unsupervised diets in teens can be dangerous.
In an ill-advised attempt to lose some weight, I’d accidentally created a situation where the ketones in my blood had reached toxic levels — the official term: ketoacidosis.
The Libre Duo measures ketone levels, lasts 10 days, and requires a prescription, but is similar to Abbott’s other CGMs. Image: Abbott
This memory was the first thing I thought of when I heard last week that Abbott had obtained FDA authorization for a new continuous glucose monitor (CGM). The Libre Duo is the first 2-in-1 CGM that measures both glucose and ketone levels. As for why diabetics would want to know about ketones, it’s the same reason why I ended up in the ER roughly 22 years ago: ketoacidosis.
Ketoacidosis sucks, but it is somewhat common for diabetics. Diabetic ketoacidosis (DKA) occurs when there’s not enough insulin to turn blood glucose into energy. The liver then turns to burning fat, and ketones are a byproduct of that process. That’s not inherently bad, but too many ketones cause blood to become highly acidic. In diabetics, this can be an alarmingly fast process. It can also be fatal if left untreated. It’s typically a concern in Type 1 diabetics, since they don’t produce enough insulin. However, it can also occur in Type 2 diabetes — which develops over time, often due to lifestyle factors.
“It’s actually the most common hyperglycemic emergency for people living with diabetes. It’s the leading cause of hospitalization, and it’s increased quite rapidly over the last decade,” says Mark Taub, vice president of technical operations for Abbott’s diabetes care business. “The symptoms of rising ketones are easily missed — they’re a lot like a flu or infection.”
According to Taub, the new Abbott sensor measures beta-hydroxybutyrate — a type of ketone — and is intended to function like a “check engine light.” Worn for 10 days at a time, the sensor can not only deliver alerts when a diabetic’s glucose levels are out of range, but it can do the same for ketones. The idea is to not only provide an actionable warning system, but to do so in a way that’s already familiar to diabetics. It uses the same app, works with smartwatches, and allows caregivers to monitor the glucose / ketone levels of loved ones — a potentially huge benefit, as DKA is a significant risk among diabetic children.
“DKA is one of the primary fears or dangers of uncontrolled or unmonitored diabetes,” says Dr. David Ahn, chief of diabetes at the Mary and Dick Allen Diabetes Center for Hoag Hospital. Ahn notes that ketone monitoring is much more common in children as part of a standard diabetes education protocol. “The overwhelming majority of adult clinicians, and even endocrinologists like myself, don’t routinely prescribe ketone strips … in a perfect world, [ketone strips] would be one of the things that we send patients home with. But in practical scenarios, it often just isn’t a top priority.”
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