1989-LB: High Serum Ketone Emergencies and Diabetic Ketoacidosis (DKA) in People with Type 2 Diabetes, Prediabetes, and Obesity on Carbohydrate Restricted Nutrition Therapy (CRNT)

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