Grateful we're moving forward on so many fronts in the world.
(don't have a problem with that, but it's predictable)
too bad it's not "wearable" like a watch but that might be coming eventually too since Garmin has a patent on it
* https://the5krunner.com/2026/02/06/garmin-non-invasive-blood...
(btw Fenix 9 launched today but it's same hardware as Fenix 8 and no glucose feature)
Ketones are rare. They can kill you, but before that happens, your blood sugar usually rises enough for you to realise you may have ketones and start using test strips to measure them. Instead of this marketing gimmick, Abbott should have focused on improving the quality of their glucose sensors which is far more important.
Maybe this is more for Type 2 or other diabetes, or for people prone to DKA. Or it is for people with a working pancreas who think looking at their blood sugars (and now keytones) tells them something like soothsayers reading tea leaves
https://www.nytimes.com/2021/04/27/technology/daniel-kaminsk...
This is not verified info, but I would assume these are either A) the exact same device, just with different marketing B) "binned" production runs that did not meet the accuracy threshold for clinical/prescribed use, but are otherwise "good enough" for someone looking to healthmaxx.
We came up with the idea of having a place where nerds could come together to hang out and learn from each other and we decided to call the concept "Hacker Dojo". I had a sign laser engraved in 2002 at a state fair to memorialize the idea but we didn't actually get to open a Hacker Dojo until 2009.
There's a conference room in it called Kaminsky.
Dan was not a very good roommate but man, his brain worked in weird and wonderful ways, and it was inspiring how he could just rabbit-hole on stuff other people didn't find interesting until he MADE it interesting and found things nobody else had.
I miss him too. What a gift he was to the world.
What areas do you have in mind outside of diabetes management?
All this device adds is a simultaneous ketone check, which is really only relevant to diabetics and not as much of a benefit because ketone levels are often checked with a urine test.
As an example: I was on a study that gave T1D patients Dapagliflozin (Farxiga). During the study, while on a long hike, I was hovering at low sugar and consequently insulin supply was mostly cut off for an extended period. As I started to to feel unwell, I measured ketones. I was briefed as preparation for the study to measure ketones when something seems wrong. Otherwise I wouldn't have thought of measuring ketones. Might not even have carried the kit.
On that occasion, the ketones were way above 1 mmol/l: a very high value. Protocol would have required me to call the study doctor due to the high level. Since it was a Sunday, I spared her, shot some insulin, ate a sandwich, and continued my hike. I could do that because I was not alone on that hike. I knew that if my situation deteriorated, somebody would be around to call rescue.
At the study debriefing I mentioned the incident and they said that adding to the effect of the Dapa, I was probably dehydrated, which led to the rare situation of both low sugar and high ketones.
All in all I think that if the sensor makers exhaust possible improvements for the glucose, it can make sense to add the ketone measurement as a safeguard. Having high sugar can have many reasons, and it often takes me a while to get to measuring ketones. Getting the signal of rising ketones, I would react faster a few times a year in situations where my insulin supply is broken.
How? Like, what is the mechanism where this is useful?
Sounds bloody useful to me.
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.
Was analogs in the 2010s, Obama had to pass the analog act low… now it’s back with peptides and glp 1 which aren’t scheduled but..
Yeah I guess make enough money and then lobby for the benefit of your audience base or for future proscuation
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.
For anyone who doesn't get it: glucose is checked every five minutes because it changes very often, jumping or falling dangerously. It's a nightmare. Checking glucose is 1000 times more important than ketones which are almost never a problem. If you get accurate glucose readings you are highly unlikely to ever experience ketoacidosis in the first place. Before ketones become a problem, glucose has to stay high for hours. Abbott is pulling this marketing trick instead of improving the quality of their sensors. Libre 2 is absolute crap. Libre 3 is somewhat okay and sometimes even mediocre - which is still a pretty bad situation. Bad glucose sensor is a nightmare and it can kill a person or a child much likely than ketoacidosis. It will actually lead to ketoacidosis by showing incorrect glucose readings. Now I wonder whether they added a ketone sensor as a failsafe for their low quality glucose sensors.
No one asked them to add a ketone sensor as an add-on to their glucose sensor, except maybe their marketing department. People want higher quality glucose sensors that fail less often and are more accurate. Glucose sensors, not ketones!
[0] https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.htm...
The problems for these non-invasive options so far is they either too easily fail to work, are bulky/expensive, give very ballpark accuracies, or some combination thereof.
Before buying one, just know that fit cyclists will appear glucose intolerant on a CGM. See Fig. 1 at https://pmc.ncbi.nlm.nih.gov/articles/PMC10933193/
Glucose and ketone monitoring seems a natural, more precise extension of that strategy. Isn't the point of carb-cramming to get more glucose into your blood stream, where your muscles can convert that into forward motion?
She figured it out because she recognized the symptoms of ketoacidosis. That sent her to the hospital, which has thankfully allowed her to outlive her pancreas.
He is one of two friends to have passed from DKA. Miss you, Zach. RIP.
Miss pwning with you.
https://www.fda.gov/news-events/press-announcements/fda-clea...
The continuous monitor should help until you get the hang of the diet, it's a bit hard to maintain, but if it works, worth it.
Early diagnosis would save a lot of pain and suffering... and money.
I worked with an older T1 and apparently a bit less than half of kids diagnosed with T1 are diagnosed unconscious during a DKA event in the ER. "Treatment" cost, or at least requested revenue LOL, is at least $30K for an ER visit like that, and it also costs at least some months (years?) off their expected lifespan.
Figure about 0.5% of the population in the USA is T1, you read stuff like "about two million T1 diabetics" in the USA. So early T1 diagnosis would save the country overall about $30B just in DKA treatment alone at time of initial diagnosis.
If you could screen an entire population for less than $30B total lifetime cost, it would be financially rational to prescreen for T1 rather than waiting for ambulances to present incredibly sick kids. And potentially profitable.
Prescreening the entire population for metabolic disorders is quite plausible as a "tech startup idea" as the alternative is waiting for them to arrive in an ambulance while extremely sick/nearly dead. Lets say it could be done for $10B, leaving $10B for startup profit (charge insurance companies $20B which is not bad....) and $10B in lowered health care costs for the country in general, not to mention less suffering in the population. A win-win scenario.
IF blood sugar related disorders could be pre-screened for less than $10B total cost. A solid "maybe"? Plausibly a startup doing blood sugar prescreening would be a "multibillion dollar company" although not a trillion dollar unicorn. Still a good idea.
It would be interesting to see this technology branch out into monitoring hormones, minerals, vitamins, etc. For all of human history, the closest we've had to realtime monitoring is just our mood. It would be life changing for anyone to have this feedback.
Normally it should never happen. It happens at ketones like ~10+ mmol, and it's ~impossible to go more than ~6 for a healthy human even eating 100% fat and fasting for a week+ and doing marathons or whatever all at the same time.
The keto diet, can actually help in T1D, by keeping blood sugar more stable overall, but you still need insulin, just less.
The "real" device gives you what it measures as your real highs and lows while the OTC devices won't report high highs or low lows.
I have a Stelo (I was curious and diabetes runs in my family) while my wife has the Dexcom.
Maintaining consistent glucose levels improves mental health, weight management, sleep quality, muscle recovery, systemic inflammation, cardiovascular health, and may even slow aging. There isn't much clinical data at the moment on how to use blood glucose measurements to control glucose levels outside of people with diabetes (there are lots of things that impact it besides just sugar intake), but there are definitely major theoretical benefits if it can be worked out.
Also, just reducing the incidence of diabetes would be no small accomplishment. About 3.5% of global disability adjusted life-years (DALYs) are due to diabetes. As of 2021 it was the 7th largest contributor of global DALYs.
More on metabolic flexibility: https://www.levels.com/blog/what-is-metabolic-flexibility-an...
For example, about 20% of that number is because someone is finding out for the first time they have T1D [1].
Insulin costs and monitoring costs are also going to be a pretty big contributing factor. CGMs and finger sticks aren't cheap.
IDK how often it happens that ketoacidosis happens when glucose appears to be fine, I assume it's pretty rare.
[1] https://www.sciencedirect.com/science/article/pii/S016882272...
FDA News Release
New device can help people with diabetes detect warning signs of a dangerous complication before it becomes a medical emergency
For Immediate Release:
August 25, 2026
The U.S. Food and Drug Administration today authorized the Libre Duo 10 Day Continuous Dual Glucose Ketone Monitoring System for people aged 2 years and older living with diabetes. The Libre Duo 10 Day is the first wearable device in the U.S. that continuously monitors ketone levels, and the first in the world to continuously monitor both ketones and blood sugar (glucose) together in a single device.
“Today’s authorization is a breakthrough for the safety of children and adults living with diabetes,” said Michelle Tarver, M.D., Ph.D., Director of the FDA’s Center for Devices and Radiological Health. “Knowing that ketone levels are rising, and having that information in real time, around the clock, can be the difference between early intervention and a life-threatening emergency."
According to the Centers for Disease Control and Prevention, an estimated 40.1 million Americans are living with diabetes, a condition that requires careful monitoring of blood sugar levels. For the estimated 2.1 million Americans with type 1 diabetes, blood sugar is only part of the picture. When the body produces too much ketone, which is made by the body when it is using fat instead of glucose for energy, it can lead to diabetic ketoacidosis, or DKA — a serious complication that can develop quickly and become life-threatening if left untreated.
Early detection of rising ketone levels is critical. Until now, people who needed to monitor ketones had to do so separately, using tests that could only provide a single measurement at one point in time which could not tell users if ketones were rising or falling. The Libre Duo 10 Day addresses that gap by continuously measuring both ketone and glucose levels in the fluid just beneath the skin, every minute, day and night. Readings are sent wirelessly to a compatible smartphone, where users can see their current ketone and glucose levels and whether they are trending up or down. The device can send automatic alerts if ketone levels reach a concerning threshold, which may help patients and caregivers recognize rising ketones before DKA becomes a medical emergency. Ketone information should always be interpreted in the context of glucose readings and symptoms.
The FDA’s authorization is based on a comprehensive review of clinical and performance data submitted by the device sponsor. The clinical program included data from six clinical studies that together enrolled more than 600 participants aged 2 years and older to evaluate the accuracy of the device’s ketone and glucose monitoring functionality across a range of ketone and glucose levels. The results demonstrated that the device accurately tracked clinically meaningful differences in ketone levels across its 10-day wear period, including identifying elevated ketone levels before the onset of diabetic ketoacidosis.
This authorization is also aligned with the FDA’s Home as a Health Care Hub Initiative, which focuses on advancing the development of innovative, patient-centered devices that fit more seamlessly into people’s daily lives at home.
Prior to authorization, the FDA granted Breakthrough Device designation for the Libre Duo 10 Day Continuous Dual Glucose Ketone Monitoring System. A breakthrough designation is meant to expedite the development and review of devices that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions.
The FDA granted marketing authorization to Abbott Diabetes Care for the Libre Duo 10 Day through the De Novo premarket review pathway, a regulatory pathway for low- to moderate-risk devices of a new type. Along with this De Novo authorization, the FDA is establishing special controls that define requirements including those related to labeling and performance testing. When met, the special controls, in combination with general controls, provide a reasonable assurance of safety and effectiveness.
Consumer:
888-INFO-FDA
Boilerplate
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, radiation-emitting electronic products, and for regulating tobacco products.
Talking to ultramarathoners and cyclists, I think lactate is a biomarker that is tracked (POC blood samples) and would be more immediately useful for training/performance. AID might be construed as a form of doping, IMO.
Diabetics would snap up a smart watch which does accurate glucose monitoring in a heartbeat.
In T1D with no insulin, muscle break down from gluconesis will increase blood sugar in the blood even more. The absence of insulin also makes ketone production unrestricted, so you end up in ketoacidosis.
Muscle is used when you don't have fat, or when you eat completely nothing (burn both fat & muscle).
Like I've gained ~10KG of muscle while on keto diet. Blood sugar at 70-100 depending on scenario. Usually on the lower end.
It also probably gives the companies really valuable data.
Also there wasn't really a relationship of the keto diet to the rest of my post, just using it to contextualize a technical term with one that might be more familiar.
The presence or absence of ketones in your blood can tell you whether or not (say) that coffee you just drank took you out of the fasted state (that you were in for not eating overnight).
Whether or not you are in a fasted state matters not just for weight loss, but also for things like longevity (when you are in a fasted state your body cleans up dead cells that contribute to things like cancer, whereas in a non-fasted state it leaves them lying around).
AGC will find its main application in surgical and inpatient uses, eg in cardiac, neuro, burn, ICU, and people with diabetes in any hospital setting.
Paying more attention to your blood sugar and acting reasonably to keep it in check isn't giving anyone heart attacks.
From the AI
> The concern was not that lower glucose is inherently bad. Rather, pushing blood sugar down rapidly and very tightly—especially with insulin and multiple glucose-lowering drugs—caused more episodes of hypoglycemia, weight gain, and treatment complexity. Severe low blood sugar can trigger abnormal heart rhythms and other cardiovascular stress. The intensive-treatment arm was stopped early after about 3.5 years because it had a higher death rate, although the exact mechanism was not definitively established.
I had really high carb tolerance but doing keto for many years has plummeted it and I'm very sensitive now (can still train it). Another example doing keto for many years you also have lower alcohol tolerance.
Yes, but you have to work really hard for many years to achieve this!
While on T1D it happens by default if you don't inject insulin.
> while the new system also measures ketones, of keto diet fame, which are leading indicators of a really dangerous situation called diabetic ketoacidosis
It was being said like ketones are bad, because they are known for this scenario, but should be noted that it only happens in these few scenarios, like in uncontrolled diabetes or organ failure or smth.
In most other cases they should be good. But won't happen randomly unless you're explicitly doing keto.
if sugar gives you a headache, this may be related to a gastrointestinal issue (e.g. gluten sensitivity, dietary histamine sensitivity, small intestinal bacterial overgrowth possibly causing its own sensitivities...) The specifics of the cause in your case are between you and your doctor, but i'd like more people to know, especially since these sorts of problems disproportionately affect people with autism and ADHD, long a core Hacker News demographic, and most of us have trouble paying attention to everything our body is feeling in exquisite detail.
other signs of digestive problems in this area may include:
- a pattern of early-afternoon fatigue and brain fog (this is mediated by histamine, which in turn can be caused by a food allergy, a non-allergy food sensitivity, bacteria in the stomach that don't belong there, or the like)
- feeling generally flushed and hot after eating food (more histamine!)
- waking up in the middle of the night, ~4am, especially if you're feeling too hot (also a sign of excess histamine)
- often having an upset stomach, and lots of stomach acid
- increased sensitivity to heat or exercise (mast cell degranulation because your body is already on edge)
- generalized hard-to-place fatigue, brain fog, depression (the whole histamine-response pathway is shot through with various neurotransmitters)
- serious nasal congestion contributing to sleep apnea, and extreme fatigue
now, this is going to be different from person to person, but your doctor's not going to know anything's wrong if you don't tell them!
(and if something like this is the case, it's also the sort of condition that might sometimes has an instant miracle cure, because if you stop releasing the feel-bad neurotransmitters every time you eat, then you suddenly stop feeling terrible!! go figure.)
A cup of coffee has zero carbohydrates, trace lipids, and about half a gram of protein. That's not going to pull anyone out of a fasting state.
Now, if you're talking about a cup of flavoured milk, that's a different question...
That device helped a lot to switch diet habits.
Already banned:
Is it a secret? Why not name them?
No disagreement about AGC in the hospital -- there is a lot of lab/titration work in current clinical workflows for monitoring patient glucose levels.
My anecdotal experience from doctor colleagues giving CGM to patients is that it does 3/5ths of fuck all to everyone except those with actual insulin dependent diabetes (T1 or T2) because when you get down to it the insights aren’t that great and most people actually aren’t that invested in shifting the dial on their health that much. But I’m fascinated by examples to the contrary
They exist, a simple search will turn up a variety (how well they work is a different question). But see my sibling comment, they're banned from cycling competition.
Even if it doesn’t increase steps on average, it will absolutely still work with someone who’s self-motivated and not just looking for a quick fix.
I bought CGM myself, without any doctor's input. Didn't know they exist before reading some selfhelp book which my wife found.
Echoing another poster, it's eye opening how some of the foods you'd never think of, are spiking glucose levels.
Overall, after both me and my wife adjusted diet, much better energy through the day, no crashes.
Hat tip to you and sibling comment about continouous lactate sensors (seem like they are microneedle/patch based?). Quick review shows minimal clinical evidence, but maybe that's sufficient for the consumer wearable market.