Contributor: Sia Christine, PharmD Candidate, Class of 2028, PCOM Georgia School of Pharmacy
Marcus is a 19-year-old college freshman living with type 1 diabetes since age 8. He recently transitioned from his parents’ care to managing everything on his own, from his insulin pump to his continuous glucose monitor and his sick-day plan. Last October, during finals week, he skipped a few pump site changes, his glucose looked “okay,” and he pushed through feeling tired and nauseous, assuming it was just stress. By the time his roommate called 911, Marcus was in the ER with diabetic ketoacidosis (DKA). His glucose had never spiked high enough to trigger an alarm. But his ketones had been climbing for hours. Marcus’s story is not unusual. Many people living with type 1 diabetes, and even some with type 2, have experienced DKA that seemed to come out of nowhere, even with glucose levels that looked fine. That’s because glucose and ketones tell two different stories, and until now, most devices have been able to read only one.
That’s about to change.
What are ketones, and why do they matter?
When the body doesn’t have enough insulin to use glucose for energy, it starts breaking down fat as an alternative fuel source. That process produces ketones. A small amount is normal, but when ketones build up faster than the body can clear them—due to missed insulin doses, illness, pump failures, or certain medications—the blood becomes dangerously acidic. That’s DKA, and it’s a medical emergency.
DKA can be tricky to detect; it doesn’t always announce itself through high blood sugar. People on SGLT2 inhibitors, a class of diabetes medications that lower glucose by flushing it through the kidneys, can develop what’s called euglycemic DKA, meaning ketones reach dangerous levels while glucose still appears completely normal. Even in classic type 1 DKA, symptoms like fatigue, nausea, and increased thirst can be easy to write off, especially in a busy college student like Marcus, who assumed he was just stressed. Blood ketone meters exist, but most people only reach for them when something already feels wrong. By then, they may already be hours into a crisis. Urine strips are even less reliable because they only detect ketones after significant buildup, and they tell you nothing about which direction things are heading.
What just got FDA authorized?
On August 25, 2026, the FDA authorized the Abbott Libre Duo 10 Day which is the first wearable device in the world to continuously monitor both glucose and ketones at the same time, every minute, around the clock. The sensor works similarly to the FreeStyle Libre, which, as many people may already know, sits on the skin and reads the fluid just beneath the surface. The difference is that this novel sensor has two detection channels instead of one. It tracks glucose and ketones simultaneously, sends readings to a compatible smartphone every minute, and automatically alerts the user when ketone levels rise above a set threshold. For Marcus, this would have meant a ketone alert hours before he felt sick enough to act. For his parents watching from home, it would have meant seeing the data as it was happening and calling him before things escalated.
The device is approved for people with diabetes from ages 2 and older. It integrates with automated insulin delivery systems and allows data sharing with caregivers and healthcare providers. Abbott plans to make it available in the U.S. later in 2026.
How is this different from what we already have?
It helps to think of existing ketone testing like a photograph. It shows you exactly where things stand at one moment in time, but nothing about which direction they’re moving or what happened while you were sleeping. The Libre Duo is more like a live video feed. Because it reads continuously every minute, you and your care team can see the whole trend, rather than just one number. Are ketones stable? Rising slowly? Climbing quickly? Context can change everything about how and when someone intervenes. New international guidelines published in January 2026 specifically recommend continuous ketone monitoring for people at risk of DKA, noting that earlier detection could significantly reduce hospitalizations and serious outcomes. The Libre Duo is the first device to make that recommendation clinically actionable.
What this means if you or someone you care for has diabetes:
If you have type 1 diabetes, this device is most directly relevant, particularly if you’ve had a prior DKA episode, use an insulin pump, or manage diabetes independently. The overnight alert function alone addresses one of the most dangerous gaps in current monitoring. If you have type 2 diabetes and take an SGLT2 inhibitor (like empagliflozin, dapagliflozin, or canagliflozin), this is also worth asking your provider about. Euglycemic DKA is rare but serious, and continuous ketone monitoring provides a layer of protection that currently doesn’t exist for this group.
A few more things worth knowing as this becomes available:
- Like all CGM technology, the Libre Duo reads interstitial fluid rather than blood directly, so there is a small lag time compared to a fingerstick. Trend arrows and alerts are where the real value lives, not just the number in isolation.
- This is a monitoring tool and not a replacement for having a clear sick-day action plan with your care team. Knowing your ketone threshold for calling your provider, taking a correction dose, going to urgent care, or calling 911 is still essential. The device gives you earlier information; what you do with it depends on a plan you’ve made in advance.
- Insurance coverage details are not yet confirmed. As this becomes available later in 2026, it’s worth asking your care team and contacting your insurance directly.
Marcus was discharged from the hospital after three days. He’s doing well now with a new pump site routine, better sick-day habits, and a care plan he follows. But he told his endocrinologist afterward that he wished something had caught it before he felt that bad.
That device now exists. And for the next Marcus out there, that could make all the difference.
References:
- U.S. Food and Drug Administration. (2026, August 25). FDA authorizes first wearable device that continuously monitors both ketone levels and blood sugar. FDA Newsroom. https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-wearable-device-continuously-monitors-both-ketone-levels-and-blood-sugar
- Abbott. (2026, August 25). Abbott receives FDA authorization for world’s first dual glucose-ketone sensing technology for people with diabetes. Abbott Newsroom. https://abbott.mediaroom.com/2026-08-25-Abbott-receives-FDA-authorization-for-worlds-first-dual-glucose-ketone-sensing-technology-for-people-with-diabetes
- Levy, A. (2026, September 1). Libre Duo, first dual glucose-ketone monitor authorized in U.S. diaTribe Learn. https://diatribe.org/diabetes-technology/libre-duo-first-dual-glucose-ketone-monitor-authorized-in-us
- Dhatariya, K., Bergenstal, R. M., Al-Sofiani, M., et al. (2026). Continuous ketone monitoring for people with diabetes: international expert recommendations on the application of a new technology. The Lancet Diabetes & Endocrinology, 14(1), 82–92. https://doi.org/10.1016/S2213-8587(25)00331-6
- Centers for Disease Control and Prevention. (2026, January 21). National diabetes statistics report. https://www.cdc.gov/diabetes/php/data-research/index.html