Preventing Diabetic Ketoacidosis with Continuous Ketone Monitoring: Insights from a Clinical Research Case

Delayed identification of impending diabetic ketoacidosis (DKA) often results in hospitalizations. We describe a case where continuous ketone monitor (CKM) use facilitated prompt identification and intervention for impending DKA, avoiding hospitalization. A 55-year-old male (total daily insulin dose of 0.5 units/kg/day; HbA1c 6.9% [51.9 mmol/mol]) with type 1 diabetes using automated insulin delivery (AID) wore a CKM (Abbott) and was educated in responses to ketone information as part of a clinical trial (ACTRN12624000448549). Insulin pump cannula dislodgement resulted in a rapid rise in ketone levels. Initial CKM alarm notification for elevated ketones >1.0 mmol/L prompted initiation of management, including cannula replacement and additional insulin administration. Ketosis resolved following a rise to >3.1 mmol/L without need for hospitalization. He remained asymptomatic throughout. This case highlights the potential for CKM to act as an early warning system to facilitate timely intervention for ketonemia and reduce the risk of DKA and associated hospitalizations.