New guidance from NHS England (2026) sets out a three-tier approach to blood ketone testing, helping diabetes professionals prioritise patients who need urgent assessment while ensuring test shortages do not delay treatment. These priority categories are intended as short-term clinical guidance during the supply disruption of NOVA point-of-care ketone test strips.
In response to the MHRA Device Safety Incident (MHRA, 2026).
Priority 1: Test when an immediate clinical decision is needed
Prioritise available blood ketone testing for patients with suspected diabetic ketoacidosis (DKA), including euglycaemic DKA, and those with confirmed DKA who require monitoring to guide treatment or escalation.
This includes acutely unwell adults and children, pregnant patients, people taking SGLT2 inhibitors with suspected DKA, and insulin-pump users who are unwell or hyperglycaemic following suspected interruption of insulin delivery.
Priority 2: Test when results will change urgent management
Once priority 1 needs are met, test patients whose results could influence urgent investigation, treatment or escalation. These include people with insulin-treated diabetes who develop an acute illness, those with previous DKA or other recognised risk factors, and patients with unexplained hyperglycaemia, vomiting, dehydration or suspected metabolic acidosis.
Priority 3: Defer non-urgent testing
Where patients are clinically stable and results will not affect immediate or urgent management, consider deferring testing or use a validated alternative. Examples include routine screening of asymptomatic, low-risk patients, unnecessary repeated measurements, teaching and audit activities.
What diabetes services should do
Diabetes service leads should review available test strip stocks, communicate the priority framework to diabetes nurses and other relevant staff, and establish clear local procedures for accessing laboratory testing or other validated alternatives.
All diabetes professionals should follow local protocols and approved clinical pathways, seek advice when DKA cannot safely be excluded, and ensure patients are escalated promptly for appropriate assessment and treatment.
