Diabetic ketoacidosis is a major diabetes-related complication and one that people with type 1 diabetes (T1D) dread the most. Many people get their T1D diagnosis following a ketoacidosis episode.
Persistent high blood sugar levels (over 14 mmol/L) combined with a lack of insulin can cause ketoacidosis. When this happens, the body can no longer use sugar as a source of energy and uses stored fat instead.
Ketone bodies (ketones) then cumulate in the bloodstream and make it acidic, which leads to ketoacidosis. This causes symptoms of “poisoning,” such as nausea, vomiting, abdominal pain and fruity breath.
Ketoacidosis is an emergency situation that could lead to a potentially fatal coma if not quickly treated.
It is therefore recommended for people with T1D to check their ketone levels whenever their blood sugar levels remain high, even if they take their insulin and keep hydrated.
Are ketones always bad?
Ketones categorized as “fasting ketones” can develop in other situations (e.g., low-carb or keto diet, fast, gastroenteritis), but they don’t represent any risk as long as there is a sufficient amount of insulin in the body.
New upcoming technology
The current device for measuring blood ketone levels works the same as capillary blood sugar meters. It requires a droplet of blood from the tip of a finger and a specific meter along with test strips.
A study recently showed positive results for a new continuous monitoring device for blood ketones. The study was done with 12 people who followed a low-carb diet, including one person with T1D.
The technology is similar to the one used in continuous glucose monitoring systems. A sensor is worn on the arm for 14 days and requires only one calibration with a capillary blood test.
The researchers concluded that this device could help detect ketones quickly and minimize risks of ketoacidosis for people with T1D, and especially those who are frequently hospitalized with ketoacidosis.
Those who follow a very low-carb diet could also use it to check how their diet impacts their ketone levels.
The researchers listed other situations where this system could be useful for people with T1D:
- Managing sick days or hospitalizations;
- Monitoring ketones in people who take SGLT2 inhibitors (more commonly used as a treatment for type 2 diabetes, but sometimes used in T1D patients, although not authorized by Health Canada), which can cause ketoacidosis even in the absence of hyperglycemia.
Other studies will need to be completed before the system is made available on the market. The researchers believe that the challenge will be to collect data on people who have varying levels of blood sugar and ketones and who have an “immediate” risk of ketoacidosis.
Do you know what to do in case of hyperglycemia? Do you know how and when to check your blood ketone level? Members of the BETTER registry have access to all the resources of our SUPPORT self-training program. Find out more»
If you or your child are living with type 1 diabetes in Quebec, sign up for the BETTER registry!
By doing so, you will help us to be a better voice for type 1 diabetes and help to advance research and improve access to treatments and new technology.
We will soon launch a series of webinars that will be available exclusively to members of the registry. They will cover topics such as:
- New insulin pumps
- The financial aspect of type 1 diabetes
- The psychological aspect of type 1 diabetes
- Low-carb diet and type 1 diabetes
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- Alva, S., Castorino, K., Cho, H., & Ou, J. (2021). Feasibility of Continuous Ketone Monitoring in Subcutaneous Tissue using a Ketone Sensor. Journal of Diabetes Science and Technology. https://doi.org/10.1177/19322968211008185
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