Ketones can rise without warning, sometimes even when blood sugar looks normal.
For decades, people living with diabetes have managed a silent asymmetry: their devices watched blood sugar while ketones — the harbingers of a far more acute danger — rose unseen. Abbott's CE-marked Libre Duo sensors, approved for use across Europe, close that gap for the first time, offering continuous, simultaneous monitoring of both glucose and ketone bodies in a single wearable. The approval arrives as diabetic ketoacidosis has quietly become one of the leading causes of death in younger adults and children with type 1 diabetes, a crisis that hospitalizes four times more patients than low blood sugar yet has long resisted early detection. In granting this technology a path to market, regulators are acknowledging what clinicians have long known: that seeing only half the picture has always carried a cost.
- Ketone levels can surge to life-threatening heights even when blood sugar appears normal, leaving patients with no warning until symptoms mimic a common flu — by which point a coma may be hours away.
- DKA hospitalizations have climbed 55 percent in a decade, and a UK study spanning 23 years found cases tripling in type 1 and sextupling in type 2 diabetes, exposing a monitoring gap that existing technology has failed to close.
- Nearly a third of people with type 1 diabetes have no means of measuring ketones at home, relying on separate blood tests or urine strips that most never use routinely — a structural failure the Libre Duo is designed to dismantle.
- Abbott's dual sensor feeds real-time glucose and ketone data every minute to a smartphone, with versions designed for adults and for children as young as two, and integration planned with insulin pump systems for a more complete automated response.
- CE marking clears the path for a European launch before the end of 2026, though the device remains unauthorized in the United States, leaving a significant patient population still without access to continuous ketone visibility.
Abbott has received CE marking in Europe for the Libre Duo and Libre Duo 10 Day — wearable sensors that do something no continuous glucose monitor has managed before: they track both blood sugar and ketone bodies simultaneously, every minute, feeding the data directly to a smartphone or reader.
The clinical problem they address is both old and underappreciated. Ketones are the dangerous byproduct produced when the body, starved of insulin, begins burning fat for fuel. When they accumulate, the result is diabetic ketoacidosis — a condition that can progress to coma or death within hours. What makes it particularly treacherous is that ketones and glucose don't move in lockstep; blood sugar can appear normal while ketones climb to crisis levels. Early symptoms — nausea, fatigue, a vague flu-like feeling — are easy to dismiss, and by the time the picture clarifies, the emergency is already advanced.
The scale of the problem has grown. DKA hospitalizations have risen roughly 55 percent over the past decade. A UK analysis of nearly 660,000 patients found that over 23 years, DKA cases tripled among adults with type 1 diabetes and increased sixfold in type 2. In the United States, the CDC identifies DKA as a leading cause of death in children and adults under 58 with type 1 diabetes — responsible for approximately four times more hospitalizations than hypoglycemia. Yet in a survey of nearly 3,000 people with type 1 diabetes, only 18 percent owned a blood ketone meter, and close to a third had no way to measure ketones at all.
The Libre Duo's 15-day version is approved for adults 18 and older; the 10-day version is designed for children as young as two, built to withstand the demands of younger, more active patients. Both will connect to Abbott's digital health ecosystem, enabling data sharing with caregivers and clinicians. Abbott is also working to integrate the sensors with automated insulin delivery systems — a step toward closed-loop diabetes management that responds to both glucose and ketone signals at once.
The approval is supported by a recent international consensus from Breakthrough T1D endorsing continuous ketone monitoring as a safe and effective component of diabetes care. Abbott plans to launch in select European markets before the end of 2026. The devices are not yet authorized in the United States — meaning the gap between what is now technically possible and what most patients can access remains, for now, wide.
Abbott has won regulatory approval in Europe for a device that does something no continuous glucose monitor has done before: it watches not just blood sugar, but also ketone bodies—the dangerous byproduct that can signal a medical emergency unfolding in real time.
The Libre Duo and Libre Duo 10 Day are wearable sensors that measure glucose and ketones every minute, feeding real-time data to a smartphone or reader. For people with diabetes, this matters because ketones can spike without warning, sometimes even when blood sugar looks normal. When ketone levels climb too high, the condition is called diabetic ketoacidosis, or DKA—a state where the body, starved of insulin, begins breaking down fat for energy, flooding the bloodstream with acids that can trigger coma or death within hours if untreated.
The problem Abbott is trying to solve is old and persistent: people with diabetes have no easy way to know when their ketones are rising. Traditional glucose monitors track blood sugar, which is essential for daily management. But ketones? Those require separate blood tests or urine strips, and most people don't check them routinely. The American Diabetes Association recommends ketone monitoring during illness or high blood sugar episodes, yet early detection remains elusive. In a survey of nearly 3,000 people with type 1 diabetes, only 18 percent said they owned a blood ketone meter at home. Almost a third had no way to measure ketones at all.
The stakes have grown sharper. Hospital admissions for DKA have climbed roughly 55 percent over the past decade. A recent analysis of nearly 660,000 people in the United Kingdom revealed something more alarming: over 23 years, DKA cases in adults with type 1 diabetes tripled, and in type 2 diabetes they increased sixfold. The U.S. Centers for Disease Control lists DKA as one of the leading causes of death among children and adults under 58 with type 1 diabetes. It causes roughly four times more hospitalizations than low blood sugar—making it the primary driver of acute diabetes-related hospital use in America.
What makes early detection tricky is that ketones and glucose don't always move together. A person's blood sugar can sit at a normal level while ketones climb dangerously. The early warning signs—nausea, fatigue, flu-like symptoms—are easy to mistake for a common infection, which delays treatment and lets the crisis deepen.
The Libre Duo addresses this gap by offering continuous ketone monitoring alongside glucose. The 15-day version is approved for adults 18 and older. The 10-day version, designed for active children as young as 2, aims to help younger patients complete the full sensor life. Both will integrate with Abbott's digital health ecosystem, allowing users to share data with caregivers and doctors. Abbott is also working with insulin pump manufacturers to connect automated insulin delivery systems to these sensors—a step toward fully closed-loop diabetes management that responds to both glucose and ketone signals.
The approval aligns with a recent international consensus statement from Breakthrough T1D, a research and advocacy organization focused on type 1 diabetes, which endorsed continuous ketone monitoring as a safe and effective part of diabetes care. Abbott plans to launch the Libre Duo in select European countries by the end of 2026. The devices are not yet authorized in the United States. For people living with the constant calculation of insulin and glucose, the ability to see ketones coming could mean the difference between catching a crisis early and ending up in an ambulance.
Citações Notáveis
Ketone bodies can increase independently and, in some cases, even when glucose is at normal levels, which can delay detection of DKA risk.— International consensus statement cited in Abbott announcement
Early signs of rising ketone levels—nausea, fatigue, flu-like symptoms—are frequently confused with common infections, delaying detection and treatment.— Source analysis of DKA detection challenges
A Conversa do Hearth Outra perspectiva sobre a história
Why does it matter that ketones can rise independently of glucose? Doesn't watching blood sugar already tell you when something's wrong?
No—that's the trap. You can have a normal blood sugar reading and still be in real danger. Your body is breaking down fat for fuel, flooding your system with acids, but the glucose number looks fine. By the time you realize something's wrong, you might only have hours.
And people don't check ketones now because it's inconvenient?
Partly that. But also because there's no routine. Doctors recommend checking during illness or high blood sugar, but most people don't have a ketone meter at home. You'd need to go to a lab or use strips. It's reactive, not preventive.
The numbers you mentioned—DKA cases tripling in type 1 diabetes over 23 years—that's a huge jump. Why is it happening?
The research doesn't say exactly why, but we know DKA is being missed more often, and when it is caught, it's late. The early symptoms feel like the flu. People treat it as a cold, and by then the metabolic crisis is advanced.
So this device is really about giving people a chance to act before it becomes an emergency.
Exactly. If you can see ketones rising in real time, you can call your doctor, adjust your insulin, get help. You're not waiting for symptoms to become obvious. You're watching the actual chemistry.
And Abbott is planning to connect this to insulin pumps?
Yes. Eventually, the pump could respond automatically to ketone signals, not just glucose. That's the real future—a system that understands the whole metabolic picture.