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Comment by jablongo | Hacker News Reader

I am a founder and researcher at https://replica.health and co-creator of https://metabo-net.org. This is super exciting and cant wait to see what we can learn once large datasets of overlapping ketones + glucose + insulin data become available.

One point I discussed with other researchers at ADA this year: in theory automated insulin delivery does not stand to benefit much from ketone sensors, since diabetic ketoacidosis will almost always be preceded by high blood glucose, which we already measure using the cgm. It will be interesting to see what this ketone data is actually used for.

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Ketoacidosis can also happen with stable blood sugars if you don't get enough insulin. There were people rationing insulin due to cost and some of them died of DKA even if their blood glucose was perfectly stable. Another possibility of DKA with good blood sugars is when you are sick. I think this data would be helpful.

Yea I'm all about finding the uses for this after the fact. However, it seems unlikely that people who are struggling to afford (or get insurance to cover) insulin would be able to afford a cgm or cgm/ckm in this scenario. Also not sure how it's possible to ration insulin and keep your bg stable, but I wouldn't put it past the most skilled T1s out there. In the sick w/ flu case, thats true, but then whats the treatment action? I still think euglycemia + DKA is an edge case.

To ration insulin you limit eating carbs. If you don't eat, you need less insulin.

Treatment for DKA as far as I kmow is to give glucose insulin and potassium.

For example if you have a stomach bug and can't keep down anything you are at risk of developing DKA even if your BG is normal.

The thing is how do we know we are starving the body of fuel. Most diabetics (me included) are told not to exercise if bg is higher than 250mg/dl, but that is it. We hit over 250 mg/dl frequently and sometimes stay there for multiple hours (infusion set problems, fatty food etc.).

T1D athletes report that they eat a lot and take a lot insulin before/after training and they say they get tired very easily if they don't. They thought this as restoring the glucogen reserves in muscles but maybe it is about fueling the body.

I sometimes feel uneasy even my bg is okay and it had led me to panic attacks. Now when I think it could be raised ketones, or just anxiety.

Knowing the ketones would be helpful.

https://journals.sagepub.com/doi/10.1177/11795514261431390

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