Study finds transient ketosis in type 1 diabetes during very-low carbohydrate states
A new study published in the journal of Diabetes Technology & Therapeutics showed that during very-low carbohydrate states in type 1 diabetes patients face transient ketosis very frequently.
People with type 1 diabetes who use sodium-glucose cotransporter-2 (SGLT2) inhibitors may potentially have diabetic ketoacidosis (DKA) in addition to insulin insufficiency. SGLT2 inhibitors have been linked in clinical studies to an increased risk of DKA, including euglycemic DKA when compared to placebo, especially in women, insulin pump users, and people with lower body mass indices.
Continuous ketone monitoring has recently been demonstrated to be viable in people and may help lower DKA risk, although its real-world efficacy and normal ketone fluctuation in type 1 diabetes are unclear. This research used a new continuous ketone sensor to analyze ketosis metrics throughout two ketogenic diets in persons with type 1 diabetes who received automated insulin therapy, giving the first thorough outpatient free-living data on continuous ketone levels in this cohort.
Two 6-day ketogenic diets were administered to adult subjects on automatic insulin administration in a random sequence while they wore SiBio continuous ketone monitors. The two diets were intermittent 12-hour fasts and extremely low carbohydrate intake (<50 g/day). In order to evaluate sensor accuracy, subjects were hospitalized for a 6- to 8-hour insulin suspension experiment between the two diets. The FreeStyle Libre 2 meter was used to compare ketone sensor readings with capillary levels.
870 sensor-meter paired data points were supplied by 16 people who finished the trial (age 36.5 [17.0] years, HbA1c 7.0% [0.6], insulin dosage 0.72 [0.26] units/kg). The relative MADs for ketone levels ≥0.6 and ≥1.0 mmol/L were 24.2% (17.1) and 19.6% (13.3), respectively, whereas the mean absolute difference (MAD) for ketone values <0.6 mmol/L was 0.1 (0.1) mmol/L. There were 81 ketosis episodes (3.7 occurrences/week) ≥0.6 mmol/L lasting more than 15 minutes over the 155-day ketogenic diets, with a median length of 60 (30–105) minutes each event.
With the exception of one, every ketosis incident was asymptomatic. Ketosis occurrences were unrelated to basal insulin administration, glucose levels, or the time of day. Overall, benign, temporary ketosis is widespread in type 1 diabetes under extremely low carbohydrate conditions, according to the SiBio ketone sensor's preliminary accuracy.
Source:
Sabelli, N., Pasqua, M.-R., Perz, N., Majdpour, D., Tsoukas, M., & Haidar, A. (2026). Transient benign ketosis is common in type 1 diabetes during very-low carbohydrate states: Novel data from continuous ketone sensor. Diabetes Technology & Therapeutics, 15209156251412812. https://doi.org/10.1177/15209156251412812
