Wicked Good Cardiometabolic Chat: Ketone Monitoring in Pharmacy Practice

In this month’s episode of Wicked Good Cardiometabolic Chat, Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, and Hailey Choi, PharmD, BCACP, CDCES, discuss the practical role of ketone monitoring in diabetes care and the emerging use of continuous dual glucose-ketone sensing.

Goldman leads the discussion with a fictional pharmacy case involving a patient with type 2 diabetes (T2D) who takes empagliflozin and insulin and develops nausea and poor intake during an illness. Although her glucose is only 168 mg/dL, her symptoms warrant further assessment.

The case illustrates why pharmacists should consider ketones and medication-related risks rather than rely on glucose alone.

Goldman and Choi review urine and blood ketone testing before introducing the Libre Duo 10-Day System, which combines glucose and ketone monitoring in one wearable sensor. They discuss potential candidates, including people with previous diabetic ketoacidosis, insulin pump users, and selected patients with additional risk factors. They also distinguish the potential value of earlier warning from evidence demonstrating prevention of diabetic ketoacidosis.

READ MORE: FDA Authorizes First Ketone, Blood Sugar Monitor for Diabetes

The episode emphasizes what pharmacists should teach patients: how to interpret ketone readings alongside glucose and symptoms, respond to alerts, follow individualized sick-day instructions, maintain back-up testing supplies, and recognize when urgent medical care is needed. Practical considerations include device compatibility, access, caregiver involvement, and confirming understanding through teach-back methods.

Throughout the conversation, Goldman and Choi reinforce that additional monitoring information must be paired with a clear action plan. Pharmacists can help patients understand what to watch for, what to do next, and when to seek help.

Regulatory Authorization and Market Access Expectations

The regulatory authorization of dual monitoring technology marks a significant milestone in diabetes care. The FDA authorized the Libre Duo 10-Day continuous dual glucose-ketone monitoring system in August 2026 for patients aged 2 years and older living with diabetes.¹

Operating as a Breakthrough Device under the De Novo pathway, the sensor continuously measures both glucose and ketone levels in interstitial fluid every minute.

Abbott announced plans to launch the device in the US in December 2026 following its international debut. Significant commercial payer formulary coverage is expected to take effect in January 2027 for people with type 1 diabetes, although reimbursement coverage for non-insulin users with T2D remains further out.²

Clinical Guidance and Pharmacist Education in Dual Monitoring

To support safe adoption, expert recommendations endorsed by the International Society for Pediatric and Adolescent Diabetes emphasize establishing clear action thresholds to prevent severe complications while avoiding alarm fatigue. Early detection is particularly crucial because conditions like euglycemic diabetic ketoacidosis can develop during illness or SGLT2 inhibitor therapy, even when blood glucose levels remain below traditional diagnostic thresholds.^3,4

Pharmacists play a vital role in educating patients on interpreting ketone measurements alongside symptoms, recognizing that levels under 0.6 mmol/L are normal, levels between 0.6 and 1.5 mmol/L require monitoring, and levels above 1.5 mmol/L demand clinical intervention.

The American Diabetes Association (ADA) recommends ketone testing during illness or whenever glucose remains at or above 250 mg/dL for 2 consecutive hours. Patients must understand that continuous biowearables supplement rather than replace comprehensive care plans.⁴

Pharmacists should reinforce individualized sick-day protocols, advising patients to maintain adequate hydration, never discontinue prescribed insulin without clinical guidance, and keep unexpired blood ketone testing strips as essential back-up supplies.

“Glucose does not tell us everything. When someone with diabetes feels sick, we need to ask about the symptoms, their insulin, their medications, and their ketones,” concluded Goldman. “As dual monitoring really becomes available, we need to help patients understand both readings and what to do next.”

In Wicked Good Cardiometabolic Chat, a podcast offering from Drug Topics, Goldman and Choi aim to empower pharmacists with evidence-based insights into various cardiometabolic topics. All new episodes of Wicked Good Cardiometabolic Chat will be available in a video format via DrugTopics.com on the second Wednesday of each month. Check out our most recent episode: Incretin Therapies in Pediatric Obesity, T2D.

REFERENCES

1. FDA authorizes first wearable device that continuously monitors both ketone levels and blood sugar. FDA. News Release. August 25, 2026. Accessed November 10, 2026. https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-wearable-device-continuously-monitors-both-ketone-levels-and-blood-sugar

2. Hale C. Abbott sets Libre Duo glucose-ketone sensor US launch for December. Drug Delivery Business News. October 21, 2026. Accessed November 10, 2026. https://www.drugdeliverybusiness.com/abbott-sets-libre-duo-glucose-ketone-sensor-us-launch-for-december/

3. Dhatariya K, Bergenstal RM, Al-Sofiani M, et al. Continuous ketone monitoring for people with diabetes: international expert recommendations on the application of a new technology. Lancet Diabetes Endocrinol. 2025;14(1):82-92. doi:10.1016/s2213-8587(25)00331-6

4. Managing ketones with diabetes. American Diabetes Association. Accessed November 10, 2026. https://diabetes.org/living-with-diabetes/managing-ketones