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Ketones are only going to be present if you are exceptionally bad (very high carb diet) or exceptionally good (very low carb diet) at managing your blood sugar.

by umvi 22d ago

Ketones are only going to be present if you are exceptionally bad (very high carb diet) or exceptionally good (very low carb diet) at managing your blood sugar. It's not going to be terribly useful for your average diabetic who has fairly good control over their blood sugars.

dotBen 22d ago
Which makes me think the market for these is diet-focused folk. Get the FDA to clear it on medical grounds for a specific usecase then sell it more broadly. This already happens with CGMs. The bulk of the sales is with people who want them for lifestyle monitoring even though they're only medically cleared for diabetes use.
- hn_throwaway_99 22d ago
  It would be beyond stupid for a healthy "diet focused" person to want to use this. They're not at risk for ketoacidosis, and there is zero evidence that continually measuring ketones would be useful in any sense. That's different from the purported use of CGMs, which is to monitor for glucose spikes in response to specific foods (and even then, the evidence that monitoring glucose spikes in healthy people has any benefits is really thin). If someone really wanted to measure their ketone levels there are simple urine tests that do it - there is no need to measure it continuously for healthy people. And if they want to see if they're in ketosis it's pretty easy to determine - if they're on an ultra low carb diet and their breath smells like shit, it's a good sign they're in ketosis.
als0 22d ago
> your average diabetic who has fairly good control over their blood sugars I think it's huge for diabetics. It's a mental toll for them. They hate having to constantly prick themselves to take readings. It's awkward, inconvenient and you have to do it multiple times to be sure you got a good reading. And worse of all, it's possible to forget to take a reading when you need to.
- hn_throwaway_99 22d ago
  I don't understand. All of the diabetics I know personally (one type 1 and two type 2 diabetics) use continuous glucose monitors and have for some time, so they rarely need to prick their fingers anymore. Ketone levels can be checked with a urine test.
  - scheme271 22d ago
    There's some difference in the readings of a CGM due to sampling different things (blood with finger sticks vs intercelluar fluid for a CGM) and taking a bunch of vitamin C (pills or in food) can throw the readings off. But I think one or two sticks a day to calibrate the CGM and in situations where readings seem off should be sufficient.
- umvi 22d ago
  Well I'm a T1D and I'm not generally worried about DKA because I wear a CGM and keep my blood glucose below 140 mg/dL
ggm 22d ago
A measure which acts as a high and a low pass filter on a band of less risk which can be monitored by other means, or subject to improvements on measurements and narrow the central zone? Sounds bloody useful to me.
marcod 22d ago
Parents of T1D children will certainly be happy about this.
brohee 22d ago
I've fairly good control over not running my car out of the road, yet I have airbags...
sjhatfield 22d ago
This is not correct. When someone with type 1 has an illness they can develop ketones while their glucose appears stable within range. This is can lead to death. About once a year, when my son is sick, we need to monitor his ketones with finger pokes. When he has a stomach bug and can't eat, we have had to go to the hospital for a drip to allow us to give insulin and lower his ketone level. Having ketones on the CGM with glucose would have been very helpful.
- umvi 21d ago
  That seems like an extremely rare condition (source: I'm also a T1D and never encountered that when sick). I presume you are referring to https://www.ncbi.nlm.nih.gov/books/NBK554570/ https://www.ncbi.nlm.nih.gov/books/NBK554570/
  - sjhatfield 20d ago
    When a young child with type 1 is sick and not eating or is vomiting, they are getting almost no insulin. My son's basal can be as low as 0.1U an hour. It's in these cases, where he has developed high ketones with glucose level around 90 mgdl.
Trasmatta 21d ago
I am a type 1 diabetic and this is not true, and an incredible oversimplification. And categorizing "very low carb" as "good" and "very high carb" as "bad" is bizarre and untrue. You can go into DKA on a low carb diet. And low carb vs high carb for T1D is NOT a "good vs bad" equation to start with.
- umvi 21d ago
  Im also a T1D and in my own experience high carb diets are extremely difficult to control BG with. You are chronically elevated/high or roller coastering, while with low carb diet its much easier to stabilize BG and keep sugar levels normal. With low carb diet I have achieved an a1c of 5.6 which would be impossible/dangerous with high carb diet. Dr. Bernstein's "Law of small numbers" and all. But yes, you are correct, it was a simplification.

by umvi 22d ago

dotBen 22d ago

Which makes me think the market for these is diet-focused folk. Get the FDA to clear it on medical grounds for a specific usecase then sell it more broadly. This already happens with CGMs. The bulk of the sales is with people who want them for lifestyle monitoring even though they're only medically cleared for diabetes use.

hn_throwaway_99 22d ago
It would be beyond stupid for a healthy "diet focused" person to want to use this. They're not at risk for ketoacidosis, and there is zero evidence that continually measuring ketones would be useful in any sense. That's different from the purported use of CGMs, which is to monitor for glucose spikes in response to specific foods (and even then, the evidence that monitoring glucose spikes in healthy people has any benefits is really thin). If someone really wanted to measure their ketone levels there are simple urine tests that do it - there is no need to measure it continuously for healthy people. And if they want to see if they're in ketosis it's pretty easy to determine - if they're on an ultra low carb diet and their breath smells like shit, it's a good sign they're in ketosis.

als0 22d ago

> your average diabetic who has fairly good control over their blood sugars I think it's huge for diabetics. It's a mental toll for them. They hate having to constantly prick themselves to take readings. It's awkward, inconvenient and you have to do it multiple times to be sure you got a good reading. And worse of all, it's possible to forget to take a reading when you need to.

hn_throwaway_99 22d ago
I don't understand. All of the diabetics I know personally (one type 1 and two type 2 diabetics) use continuous glucose monitors and have for some time, so they rarely need to prick their fingers anymore. Ketone levels can be checked with a urine test.
- scheme271 22d ago
  There's some difference in the readings of a CGM due to sampling different things (blood with finger sticks vs intercelluar fluid for a CGM) and taking a bunch of vitamin C (pills or in food) can throw the readings off. But I think one or two sticks a day to calibrate the CGM and in situations where readings seem off should be sufficient.
umvi 22d ago
Well I'm a T1D and I'm not generally worried about DKA because I wear a CGM and keep my blood glucose below 140 mg/dL

ggm 22d ago

A measure which acts as a high and a low pass filter on a band of less risk which can be monitored by other means, or subject to improvements on measurements and narrow the central zone? Sounds bloody useful to me.

marcod 22d ago

Parents of T1D children will certainly be happy about this.

brohee 22d ago

I've fairly good control over not running my car out of the road, yet I have airbags...

sjhatfield 22d ago

This is not correct. When someone with type 1 has an illness they can develop ketones while their glucose appears stable within range. This is can lead to death. About once a year, when my son is sick, we need to monitor his ketones with finger pokes. When he has a stomach bug and can't eat, we have had to go to the hospital for a drip to allow us to give insulin and lower his ketone level. Having ketones on the CGM with glucose would have been very helpful.

umvi 21d ago
That seems like an extremely rare condition (source: I'm also a T1D and never encountered that when sick). I presume you are referring to https://www.ncbi.nlm.nih.gov/books/NBK554570/ https://www.ncbi.nlm.nih.gov/books/NBK554570/
- sjhatfield 20d ago
  When a young child with type 1 is sick and not eating or is vomiting, they are getting almost no insulin. My son's basal can be as low as 0.1U an hour. It's in these cases, where he has developed high ketones with glucose level around 90 mgdl.

Trasmatta 21d ago

I am a type 1 diabetic and this is not true, and an incredible oversimplification. And categorizing "very low carb" as "good" and "very high carb" as "bad" is bizarre and untrue. You can go into DKA on a low carb diet. And low carb vs high carb for T1D is NOT a "good vs bad" equation to start with.

umvi 21d ago
Im also a T1D and in my own experience high carb diets are extremely difficult to control BG with. You are chronically elevated/high or roller coastering, while with low carb diet its much easier to stabilize BG and keep sugar levels normal. With low carb diet I have achieved an a1c of 5.6 which would be impossible/dangerous with high carb diet. Dr. Bernstein's "Law of small numbers" and all. But yes, you are correct, it was a simplification.