I have been pondering over why the instructions for Ozempic list ketones as being common. Some recent research has discovered thst alpha cells in the pancreas have another previously unknown pathway to control metabolism. They discovered that the alpha cells have an emergency response to the condition of high glucose with high insulin, and this triggers the pathway to the beta cells to force more insulin out of them. It is actually the pathway that activates fat burning, which is why this med is used for weight loss and why you get ketones. So your dose of Ozempic will stimulate ketosis without requiring carb restriction.
I can understand how keto diets work with low glucose levels since that comes from evolution. But forcing it when there is lots of glucose sloshing around seems to be a bit dodgy.
If the clearance of ketones is impaired, then this will lead to DKA. The presence of high levels of glucose may well be forcing your kidneys to work overtime removing excess, and they may not be so efficient at clearing ketones, which is why ketones come out in the breath and sweat instead. This is similar to what csn happen in the T1D form of DKA except that in that case insulin is not available, so it is just glucose and ketones fighting for the same exits.
