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What to do if…
you check ketones and they are high while you feel nauseated or unwell

Short answer

If you feel nauseated or unwell and your ketones are high, act urgently. If blood ketones are over 3.0 mmol/L (or urine ketones over 2+), call 999 or go to A&E now; otherwise call your diabetes care team now or get urgent help from NHS 111, especially if you feel unwell.

Do not do these things

  • Do not “wait and see” if you feel sick (especially nausea/vomiting, tummy pain, deep/fast breathing, drowsiness, confusion) and ketones are raised.
  • Do not stop taking insulin because you’re not eating.
  • Do not exercise to “bring sugars down” when ketones are raised.
  • Do not drive to A&E. Ask someone to take you or call 999 for an ambulance.
  • Do not keep trying repeated home fixes if ketones stay raised, you’re getting worse, or you can’t keep fluids down.

What to do now

  1. Get support in the room if possible. If you’re alone, call or message someone and tell them: “My ketones are high and I feel unwell.” Keep your phone nearby and unlocked.
  2. Re-check and write down: blood glucose, ketones (blood or urine), time of the reading, and whether you’ve vomited. If you can, check your temperature. Keep your meter/strips with you.
  3. Use your ketone result to decide how fast to escalate (blood ketone meter):
    1. 0.6 to 1.5 mmol/L (slightly high): test again in 2 hours, and if you feel unwell with this level, call your diabetes care team now or contact NHS 111 now.
    2. 1.6 to 3.0 mmol/L: you’re at risk of DKA — speak to your diabetes care team for advice now or contact NHS 111 now, even if you do not feel unwell.
    3. Over 3.0 mmol/L: this is high — call 999 or go to A&E now.
    • If you used urine strips: over 2+ is high — call 999 or go to A&E now.
  4. If your insulin “isn’t working” to reduce high glucose (even if ketones are normal): treat that as urgent — call your diabetes care team now or contact NHS 111 now.
  5. If you use an insulin pump: assume insulin delivery might have failed until proven otherwise.
    • Check the infusion site/cannula, tubing, reservoir, and whether insulin could be spoiled (expired/overheated/frozen).
    • Follow your personal sick-day plan if you have one. If you don’t, don’t improvise — use steps 3–4 to escalate urgently.
  6. Sip fluids if you can keep them down. Take frequent small sips of water or an oral rehydration drink. If you’re vomiting or can’t keep fluids down, treat that as a worsening sign and escalate using step 3.
  7. Prepare a quick handover for 111/A&E/ambulance: your readings + times, insulin/pump details, all medicines (especially any SGLT2 inhibitor), when you last took insulin, and what triggered this (infection, missed insulin, pump issue).

What can wait

  • You do not need to work out the exact cause right now.
  • You do not need to decide if it’s “definitely DKA” before seeking urgent help.
  • You do not need to clean up, go to work, or “push through” symptoms before contacting 111/your diabetes team or going to A&E.

Important reassurance

It’s normal to feel alarmed by high ketones — this is a situation where acting early is genuinely protective. Getting urgent advice or emergency care is a sensible safety move, not an overreaction.

Scope note

This guide covers first steps for the next couple of hours. Once you’re safe and assessed, you can review longer-term sick-day rules and prevention with your diabetes team.

Important note

This guide is general information, not a diagnosis or personal medical advice. If you have diabetes and feel unwell with raised ketones, it can become serious quickly; when in doubt, seek urgent help via your diabetes care team, NHS 111, or emergency services.

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