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DIABETES MANAGEMENT
Your go-to hub for tips, tricks, and real talk on living boldly with diabetes
Beyond Blood Sugar: Are Continuous Ketone Meters the Next Big Thing?
CGMs changed how we see glucose. Now, diabetes tech is starting to track another important number. For years, continuous glucose monitors have given people with diabetes something that once seemed impossible: a nearly constant view of what their blood sugar is doing. Now, the next evolution of continuous sensing is starting to take shape. In May 2026, Abbott received CE Mark for Libre Duo, the world's first sensor designed to continuously monitor both glucose and ketones. Instead of reaching for a blood ketone meter or urine strip when something feels off, this new generation of technology could eventually make ketone information available alongside glucose data throughout the day. For people at risk of diabetic ketoacidosis (DKA), especially those who rely on insulin, that extra information could offer an earlier look at a problem that can escalate quickly. Why Ketones Matter Ketones aren't inherently bad. Your body produces them when it burns fat for energy instead of glucose. The concern for people with diabetes is when ketone levels rise because there isn't enough insulin available. Without sufficient insulin, ketones can accumulate in the blood and potentially progress to DKA, a serious and life-threatening complication. For people with type 1 diabetes, checking ketones has traditionally been something you do in response to a specific situation. You might reach for a blood ketone meter or urine strips when you're sick, experiencing symptoms of DKA, dealing with unexplained high blood sugar, or wondering whether a pump or infusion site is actually delivering insulin. The ADA currently recommends that people at risk for DKA have access to ketone testing and check when symptoms or circumstances suggest an increased risk, particularly during illness, missed insulin doses, or elevated glucose. Continuous ketone monitoring could change that relationship entirely. Think CGM, But for Ketones The concept will sound familiar to anyone who remembers diabetes before CGMs became commonplace. A blood glucose meter tells you what your glucose is when you decide to check it. A CGM gives you a much fuller picture by collecting readings continuously, including during the stretches of time when you aren't actively thinking about diabetes. Ketone monitoring today still largely operates like the first scenario. You have to recognize that there may be a problem and decide to test. A continuous ketone monitor could add visibility between those individual checks, showing when ketones begin to rise and how they're changing over time. That distinction matters because DKA doesn't always arrive with an obvious glucose warning. The ADA notes that approximately 10% of people experiencing DKA present with glucose below 200 mg/dL, a condition known as euglycemic DKA. In other words, glucose can tell us a lot, but it can't tell us everything. Meet Libre Duo Abbott's Libre Duo is the first major product bringing continuous glucose and ketone sensing together in a single wearable sensor. The system measures both glucose and beta-hydroxybutyrate (BHB), the primary ketone measured in blood when assessing for ketosis and DKA. According to Abbott, both measurements are taken every minute, allowing users to see glucose and ketone information together rather than relying on separate testing methods. Abbott has announced two versions: Libre Duo, designed for up to 15 days of wear, and Libre Duo 10 Day, designed for up to 10 days. The systems integrate with Abbott's Libre digital ecosystem, allow data sharing with caregivers and healthcare professionals, and are being designed for compatibility with automated insulin delivery systems. Libre Duo received CE Mark in Europe in May 2026. Abbott has also submitted the system to the FDA for review, though it has not yet received clearance and is not currently available in the United States. Why Pump Users Could Especially Benefit Anyone who relies on insulin can develop DKA, but pump therapy introduces a particular vulnerability. People using insulin pumps generally receive rapid-acting insulin continuously rather than having a separate dose of long-acting insulin working in the background. If insulin delivery is interrupted because of an occlusion, dislodged infusion set, leaking pod, or other device problem, ketones can begin developing relatively quickly. The ADA specifically notes that infusion-set dislodgement and occlusion can put pump users at risk for ketosis and DKA and need to be recognized early. A continuous ketone sensor could potentially add another layer of information in these situations. Imagine seeing your glucose climbing after a site change. Right now, you might troubleshoot the site, give insulin, wait to see what happens, and eventually check ketones if the high persists. Continuous ketone information could help show whether that stubborn high is simply a stubborn high or whether ketones are beginning to rise alongside it. It wouldn't replace knowing how to troubleshoot a pump failure or following your diabetes care team's sick-day plan. But it could provide another piece of information when you're trying to figure out what's happening. It Could Also Change Sick Days Sick days are another time when ketone testing suddenly becomes much more important. Illness can increase the risk of both high and low glucose, and the ADA recommends more frequent glucose monitoring during illness along with blood or urine ketone monitoring for people prone to ketosis. The problem is that checking ketones requires you to remember to do it. When you're already dealing with nausea, fever, dehydration, unpredictable blood sugar, and the general misery of being sick, adding another manual diabetes task isn't exactly ideal. Continuous monitoring could make it easier to spot rising ketones sooner and follow their direction over time. More Information Isn't Always Better Of course, people with diabetes know better than most that more data isn't automatically more helpful. CGMs have transformed diabetes care, but they've also introduced more alarms, more numbers, and more opportunities to watch every small fluctuation. Adding another continuous metric raises reasonable questions about how alerts should work, when a ketone change actually requires action, and how to provide useful information without creating another number people feel obligated to watch all day. Continuous ketone monitoring will need more than accurate sensors. It will need thoughtful thresholds, clear guidance, and systems that help people understand when the information matters. After all, the value isn't simply knowing your ketone level every minute. It's being able to recognize a meaningful change early enough to do something about it. Could Continuous Ketone Monitoring Help Prevent DKA? This is where the technology becomes especially interesting. Rather than discovering elevated ketones after symptoms develop or a high blood sugar refuses to budge, continuous monitoring could potentially identify a rising trend earlier. The ADA's 2026 Standards of Care specifically point to the anticipated availability of continuous ketone monitors as a potential future approach to DKA prevention. Research is still needed to determine exactly how these devices should be used and whether continuous monitoring translates into fewer DKA events in everyday life. That distinction is important. Libre Duo represents an exciting new monitoring capability, but continuous ketone sensing hasn't yet made DKA a thing of the past. For now, people at risk should still follow their established ketone-testing and sick-day guidance. What's Next? Libre Duo's European clearance marks an important milestone, but this category of diabetes technology is still at the beginning. The bigger story may be what happens when continuous ketone data begins interacting with the rest of the diabetes tech ecosystem. Abbott says Libre Duo is designed to be compatible with leading automated insulin delivery systems. In the future, having both glucose and ketone information available could potentially give diabetes algorithms another signal for recognizing interrupted insulin delivery or other situations that increase DKA risk. Exactly how that information will be incorporated into automated systems remains to be seen. But we've watched this progression before. Fingersticks gave us individual glucose readings. CGMs gave us trends. Automated insulin delivery systems learned to use those trends to adjust insulin. Continuous ketone monitoring adds another piece of information that diabetes technology has never had access to in real time. Final Thoughts CGMs changed diabetes care by making glucose visible between fingersticks. Continuous ketone monitors could bring that same shift to another important part of diabetes management. For now, blood ketone meters and urine strips remain important tools, and anyone at risk for DKA should continue following the ketone-testing guidance provided by their healthcare team. Libre Duo isn't yet available in the United States, and there's still plenty to learn about how continuous ketone information will fit into everyday diabetes care. Still, the arrival of the first dual glucose-ketone sensor offers a glimpse at where diabetes technology may be headed next.
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Why Your CGM May Be Making You More Anxious (And What You Can Do About It)
Continuous glucose monitors (CGMs) have transformed the way we live with type 1 diabetes. They give us access to real-time glucose data, trend arrows, alerts, and insights that were unimaginable just a few years ago. But there's a side of CGM use that doesn't get talked about enough. For some people, this constant stream of diabetes data doesn't create peace of mind. It creates anxiety. I've worked with hundreds of adults living with type 1 diabetes, and there's a pattern I see again and again. Instead of feeling more confident after starting a CGM, they find themselves looking at their phone every few minutes, reacting to every blood sugar fluctuation, and feeling like diabetes is taking up more mental space, not less. The problem isn't the technology. The problem is that more information doesn't automatically create more confidence. Without the psychological skills to respond to uncertainty, more information often leads to more anxiety. The Anxiety Feedback Loop Imagine you're sitting at your desk working. You glance at your phone and see your blood sugar has drifted from 118 mg/dL to 132 mg/dL. Ten minutes later, you check again. Now you're 146 mg/dL with a diagonal arrow up. Your mind immediately starts racing. Should I correct? Should I wait? Did I miscount lunch? Did I not take enough insulin? A few minutes later, you check again. Before you know it, you've spent the last 30 minutes thinking about your blood sugar, even though it's been in range the entire time. This is how people become trapped in an anxiety feedback loop. You feel anxious about your blood sugar, so you check your CGM. Looking at the number gives you a brief sense of relief. That relief teaches your brain that checking reduces anxiety. So the next time you feel anxious, you check again. Over time, this becomes automatic. You're no longer looking at your CGM because you need information. You're looking because you've trained your brain to use checking as a way to manage anxiety. The problem is that the relief only lasts for a moment. Before long, the uncertainty returns, and so does the urge to check. The cycle repeats itself all day long. The Answer Isn't Less Data. It's Better Boundaries. The way to break this cycle isn't to stop using your CGM. It's to create healthier boundaries with it. Boundaries are the key to any healthy relationship, including your relationship with your CGM. That may sound strange at first. After all, isn't the whole point of having a CGM to look at it? Yes, but there's a difference between using your CGM as a tool and allowing it to become the center of your attention all day long. Five Boundaries That Can Reduce CGM Anxiety 1. Check your CGM with intention, not out of habit. Before you look at your phone, ask yourself one simple question: Why am I checking right now? If the answer is because you're about to eat, exercise, drive, or respond to an alert, that's intentional. If the answer is, "I just want to make sure everything is okay," you're probably looking for reassurance rather than information. 2. Remember that not every number requires action. Blood sugars naturally fluctuate. Many people start treating every small rise or fall as a problem that needs to be fixed immediately. Learning to tolerate normal glucose fluctuations is one of the most important psychological skills you can develop. 3. Make your alerts work for you, not against you. Alerts are one of the greatest safety features of CGMs. They can also keep your nervous system in a constant state of vigilance if they're set too aggressively. Work with your healthcare team to make sure your alerts support your goals instead of constantly pulling your attention back to diabetes. 4. Give yourself permission not to look. If your CGM isn't alerting you and you're not making a diabetes decision, you don't need to know your glucose every five minutes. Choosing not to check becomes an opportunity to build trust, both in your CGM and in yourself. 5. Don't let your CGM decide how you live your life. This is the most important boundary. I've seen people cancel walks because of a trend arrow, say no to dinner invitations because their blood sugar was running a little high, and avoid playing with their kids because they were worried about what might happen. Your CGM should inform your decisions. It should never make them for you. Psychological Diabetes Care Can Help CGMs have transformed the way we manage type 1 diabetes. But they haven't solved the psychological challenges of living with diabetes. A CGM can tell you what your blood sugar is and can even predict where it's going. It can't teach you how to tolerate uncertainty, resist the urge to seek reassurance, or stop fear from driving your decisions. Those are psychological skills. The problem is that diabetes education teaches you how to manage your blood sugar. It doesn’t teach you how to manage the stress of living with diabetes. That's the gap Psychological Diabetes Care is designed to fill. Psychological Diabetes Care is the missing half of diabetes care. It teaches psychological skills, such as boundaries, that you need to respond effectively to fear, uncertainty, frustration so those emotions no longer dictate your behavior or consume your life. That's why I wrote LiveFree with T1D - a free, digital resource designed to fill that gap. The book introduces the principles of Psychological Diabetes Care and gives you practical, evidence-based tools to respond to the stress of T1D so you can live life on your own terms.
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Beyond Your CGM: Diabetes Apps Worth Exploring
If you live with diabetes, your phone is probably already doing a lot of heavy lifting. Your CGM sends alerts. Your pump has an app. Maybe you use your manufacturer's platform to review reports before an endocrinology appointment. But some of the most helpful apps aren't the ones that came with your diabetes devices. Some help you better understand your glucose patterns. Others make diabetes feel a little less overwhelming. A few simply help you build habits that make day-to-day life easier. Here are a few apps worth exploring, whether you're looking for better insights, less mental load, or a little extra support along the way. Sugarmate Sugarmate has become a favorite among Dexcom users for good reason. While it displays your glucose readings, its real strength is making that information more accessible throughout your day. The app offers customizable alerts, Apple Watch integration, desktop widgets, calendar integration, and even the ability to receive urgent phone calls during severe overnight lows. For many users, those extra features make it an invaluable companion to the Dexcom app. Best for: Dexcom users looking for more customizable alerts and easier access to glucose data. Happy Bob Managing diabetes doesn't always have to feel so serious. Happy Bob adds a little personality to your CGM data with encouraging messages, humor, and playful notifications. Instead of another stream of clinical numbers, the app offers a lighter approach that many people in the diabetes community have come to love. Sometimes a little encouragement goes a long way. Best for: Anyone who appreciates a more positive, lighthearted diabetes experience. Nightscout Originally created by parents who wanted remote access to their children's CGM data, Nightscout has grown into one of the most influential open-source projects in diabetes. It allows users to visualize, customize, and share glucose data in ways that go well beyond many standard manufacturer apps. While it does require a bit more technical setup, Nightscout offers incredible flexibility for people who enjoy tailoring their diabetes technology. Best for: Tech-savvy users who want maximum customization. Tidepool If you use multiple diabetes devices, keeping everything in one place can make a huge difference. Tidepool brings together data from compatible insulin pumps, CGMs, and blood glucose meters into a single dashboard, making it easier to identify patterns and share reports with your healthcare team. Instead of bouncing between multiple apps, you can see the bigger picture. Best for: People who want to review diabetes data across multiple devices. Glucose Guide Food is one of the biggest variables in diabetes, and learning how different meals affect your blood sugar takes time. Glucose Guide is designed to help connect the dots by pairing meal tracking with glucose insights, making it easier to recognize patterns over time. Rather than simply logging what you ate, the app helps you better understand how different foods affect your body so you can make future decisions with more confidence. Best for: People looking to better understand how food impacts their glucose. Calm When people think of diabetes apps, mindfulness usually isn't the first thing that comes to mind. But managing diabetes also means managing stress, sleep, and the mental load that comes with making countless health decisions every day. That's why Omnipod recently partnered with Calm to create the Mind in Range Collection, a series of guided meditations, breathing exercises, and sleep content created specifically for people living with diabetes. Whether you're decompressing after a challenging day or winding down before bed, it's a reminder that caring for your mental health is part of caring for your diabetes. Best for: Supporting stress management, sleep, and emotional well-being. Finch Finch is a self-care app designed to make healthy habits feel a little more rewarding. Each day, you complete small goals to care for a virtual pet, turning everyday habits into something a little more rewarding. It's become especially popular among people living with chronic illnesses because it encourages consistency without adding pressure. Whether your goal is drinking more water, taking a walk, or simply getting out of bed on a difficult day, Finch celebrates progress instead of perfection. Best for: Building healthy routines and making self-care feel more approachable. Waterllama Hydration can play an important role in how you feel day to day, and it's especially easy to fall behind during hot weather, long workouts, or travel. Waterllama turns water tracking into something surprisingly fun, using playful visuals and gentle reminders to help you stay on top of your hydration goals. It may not be a diabetes app, but it's one that many people find themselves opening every day. Best for: Creating consistent hydration habits. Final Thoughts No app can take diabetes off your plate, but the right one might make that plate feel a little lighter. Whether it's giving you better insight into your glucose trends, helping you understand how meals affect your body, encouraging sustainable habits, or simply reminding you to take a deep breath, technology has evolved far beyond blood sugar graphs. You don't need to download every app on this list. But finding one that fits your routine could make managing diabetes just a little easier.
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