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

Short answer

High ketones plus feeling nauseated or unwell can be a medical emergency. If ketones are high, go to the emergency room right away or call 911, especially if you’re vomiting, getting worse, or feel drowsy/confused or short of breath.

Do not do these things

  • Do not ignore high ketones when you feel sick — don’t “sleep it off.”
  • Do not stop insulin because you’re not eating.
  • Do not exercise to try to bring glucose down when ketones are present.
  • Do not drive yourself if you feel weak, dizzy, drowsy, or are vomiting.
  • Do not keep trying repeated home corrections if ketones stay high, you can’t keep liquids down, or symptoms are worsening.

What to do now

  1. Get support immediately. If you’re alone, call/text someone and tell them: “My ketones are high and I feel sick.” Keep your phone nearby and unlocked.
  2. Re-check and record: ketones, blood glucose, time of the reading, and whether you’ve vomited. Keep your meter/strips with you for the trip or phone call.
  3. Choose emergency care early:
    • Go to the ER right away if ketones are high and you feel unwell (including nausea, vomiting, stomach pain, unusual tiredness).
    • Call 911 now if you have trouble breathing, feel confused/drowsy, have repeated vomiting, are getting worse quickly, or you cannot safely get to the ER.
  4. Use these practical “don’t wait” triggers while deciding (sick-day red flags):
    • You can’t keep liquids down (for example, ongoing vomiting) rather than being able to sip and keep fluids down.
    • You have vomiting and/or severe diarrhea that keeps going and you’re becoming dehydrated or weaker.
    • You have trouble breathing or worsening mental fog/confusion.
  5. If you take an SGLT2 inhibitor (a diabetes pill often ending in “-flozin”): treat ketones + feeling unwell as urgent even if your glucose is not very high — choose ER/911.
  6. If you use an insulin pump: assume insulin delivery might have failed until proven otherwise.
    • Check the infusion site, tubing, reservoir, and whether insulin could be spoiled (expired/overheated/frozen).
    • Follow your clinician’s sick-day plan if you have one. If you don’t, don’t improvise — go to the ER.
  7. Prepare a fast ER handover to reduce delays: tell triage “high ketones” and bring/recite your readings + times, insulin and med list (including SGLT2 inhibitor), allergies, when you last took insulin, and pump details.

What can wait

  • You do not need to confirm whether this is “definitely DKA” before seeking care.
  • You do not need to troubleshoot every possible cause at home.
  • You do not need to make long-term medication decisions today — the priority is urgent assessment and stabilization.

Important reassurance

Feeling alarmed by high ketones is a normal reaction — and it’s useful here. Choosing ER/911 for high ketones with feeling unwell is a safety-first decision, not an overreaction.

Scope note

This is first-step guidance for the next couple of hours. After urgent care (or once stabilized), follow up with your diabetes clinician to make a clear sick-day action plan.

Important note

This guide is general information, not medical advice. High ketones with feeling unwell can become life-threatening and needs urgent evaluation. If you’re unsure, choose emergency care (ER/911).

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