CRNT including nutritional ketosis is increasingly used by people with Type 2 diabetes (PWT2D), prediabetes (PWPreD), and obesity (PWO) for weight loss and glycemic control. The characteristics of high ketone emergencies in people on CRNT are not known. DKA is a known complication of diabetes; triggers include very low carbohydrate diet and SGLT2-inhibitors (SGLT2i). We reviewed all in-person medical assessments for high fingerstick beta hydroxybutyrate (BHB) readings self-reported by patients at a telemedicine clinic. From 2017 to 2023, 85 PWT2D (1.7/1k person-years) sought medical care for high BHB. Mean age was 55 years (SD 9), 35 (42%) were female, mean diabetes duration was 16 years (SD 9), 38 (45%) were on SGLT2i, and 32 (38%) were on insulin. The incidence of severe high ketone emergencies was extremely low (0.8/1k person-years). Home glucose and home BHB levels did not distinguish severe from mild conditions. Higher laboratory glucose (p<0.001), lower pH and bicarbonate (p<0.001), and greater anion gap (p<0.001) were seen more often in more severe disease. Moderately abnormal values were common in both severe and moderate disease. These findings underscore CRNT’s potential as a remarkably safe and effective tool for metabolic disease management in the setting of remote biomarker monitoring.
C.G.P. Roberts: Other Relationship; Virta Health Corp. S.J. Athinarayanan: Employee; Virta Health Corp. R.E. Ratner: Stock/Shareholder; Abbott, AbbVie Inc. Other Relationship; American Diabetes Association, Juvenile Diabetes Research Foundation (JDRF). Advisory Panel; National Committee for Quality Assurance, National Institute of Diabetes and Digestive and Kidney Diseases, Virta Health Corp.
