Preventing Diabetic Ketoacidosis: Clinical Decisions in Action (On-Demand)-DKA_CGM

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This document is an evidence-based clinical reference on how to interpret continuous glucose monitoring (CGM) patterns that may precede diabetic ketoacidosis (DKA) in people with type 1 diabetes. It emphasizes that CGM measures glucose, not ketones, so any concerning glucose pattern should trigger ketone testing rather than being used alone to diagnose or exclude DKA.<br /><br />It highlights four warning patterns:<br />1. Correction-resistant glucose rise over several hours despite repeated corrections, suggesting insulin delivery failure or degraded insulin.<br />2. Silent overnight climb without an alarm, often indicating set failure, missed basal insulin, or early illness.<br />3. Ceiling plateau or “HIGH” reading, which may reflect severe insulin deficiency and requires immediate fingerstick glucose and blood ketone testing.<br />4. Reassuring in-range CGM in a symptomatic patient, which can still represent euglycemic DKA, especially with SGLT2 inhibitor use, pregnancy, fasting, low-carb intake, surgery, or alcohol use.<br /><br />The guide also identifies risk markers to review at each visit: time above range, coefficient of variation, low sensor wear time, and very high HbA1c or a large gap between HbA1c and the glucose management indicator.<br /><br />A key section explains CGM’s limits: it cannot measure ketones, may miss euglycemic DKA entirely, and cannot distinguish whether a glucose rise is due to pump/set failure, insulin problems, or missed doses. Automated insulin systems may also mask early failure.<br /><br />The central clinical message is: glucose trends tell you whether insulin is getting in, while ketones tell you how sick the patient is. Ketone measurement remains the deciding test for DKA risk and management.

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Concept Diabetic Ketoacidosis

Concept Blood Ketone

Concept Ketone Monitoring

Concept Continuous Glucose Monitoring

Concept Euglycemic Diabetic Ketoacidosis

Keywords

continuous glucose monitoring

CGM patterns

diabetic ketoacidosis

type 1 diabetes

ketone testing

insulin delivery failure

euglycemic DKA

blood ketones

glucose management indicator

time above range

Diabetic Ketoacidosis

Blood Ketone

Ketone Monitoring

Continuous Glucose Monitoring

Euglycemic Diabetic Ketoacidosis