Sick w/ sustained ketones question

How long do you fight ketones while sick?

I’ve had that undefined, non-covid respiratory virus that is like the worst cold ever with ear pressure, sore throat, and you are exhausted. I first felt bad about 10 days ago.

So on Friday, I called for a video visit and the doc prescribed augmentin & cough meds. On Sunday my bgl got very high (daughters confirmation and getting ready was stressful, a bite of cake at reception) & I had moderate ketones. I got it back under control. The bgl landed at 120 w/ trace ketones.

Monday and today bgl is running higher than it should and ketones are fluctuating between small and moderate. I called the advice nurse. She said they usually don’t advise er unless ketones are high, but she didn’t know about ongoing issues. She couldn’t get me in to see my endo for a couple of days online or in person. She left a message for them to call to advise me. But they never did.

Ketones for several days, bgl from 170-220 when it isn’t specifically corrected. Feeling breathy and back, muscles hurt. Drinking tons of water. When should I just go to urgent care/ER?

Sorry that was a book.


I honestly don’t really know. Can you contact the endo’s office directly? I would try that.

ADA guidelines

Mayo guidlines

Here is UK’s guidelines. It seems informative.

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How high are the ketones?

Are you eating low carb, or reduced your carbs due to feeling sick? This can contribute to low level of ketones.

Or could be bad insulin, so could try a new vial/pen. Or if on pump, a bad infusion set or dislodged set.

But if all that is ok, there may be internal infection or other problem causing stress and insulin resistance, resulting in high bg and ketones. Then trip to dr or urgent care could do tests to confirm.


They fluctuate between moderate and small. That’s 25-40 ml/dl or 3.4-6.88 mmol.

It’s not scary, but definitely uncomfortable.

Ketones are a sign you are burning fat. Therefore either you are not eating enough, or you are not eating enough carb. Or you are not taking enough insulin.
Those three are the only reason.
I am eating less and doing intermittent fasting. My ketones go from moderate to trace. I’m not worried because I am still taking my basal insulin even when I am fasting. That prevents acidosis.


@Timothy You can still go into DKA when taking insulin. Not enough insulin or the ability to utilize insulin to manage high blood sugar can cause the process to happen. Once the process starts it becomes harder to control.

We all know how fast our blood sugar can go up with a pump failure, and if your insulin is bad it can happen too. But also some illnesses can start the process as it can block your ability to utilize insulin properly.

Just being sick can be one of the triggers. While Covid has been known to set it off, who knows what other viruses could cause an issue. There is a particularly nasty respiratory virus going around right now. She has said she has been sick with a respiratory virus.

Under ketone triggers


The back pain could be kidney pain. Drink lots of hydrating fluids and keep on top of your BG. You can go into DKA even in the low 200’s if not getting enough insulin. If you suddenly start throwing up get to the hospital as even if it’s not DKA related that can tip you into DKA. Fluids, fluids, fluids and if you can eat you should to bring down the ketones.

I don’t think you are currently in danger but better safe than sorry.


I recently went to ER for reaction to a pain Med I took for dental infection. I was on antibiotics and waiting for a root canal. My BG had fluctuated, but wasn’t high. When I went to ER my average BG according to my CGM was 150. Anyway, they said I had ketones! Early DKA! The ER doctor said glad you caught it early and that you can get DKA without high numbers! Idk, They gave me fluids and I left in a couple of hours. I followed up with my Endo. I met with my pump trainer the following week and she was satisfied with my uploaded CGM info.

Since then, I randomly check for ketones, no matter how I feel. I’m type I and take only novolog.

Many years ago, I had full blown DKA after getting food poisoning, I didn’t realize what it was at first, though I was talking to my primary office by phone everyday. I was very sick. (No pump or CGM then) Extreme nausea, stomach pain, limb pain, headache, etc. When I said I had labored breathing, they said GO TO ER NOW! I did and it was intense. ICU and 5 day hospital stay, but full recovery.
When I have concerning highs now, I change my entire set of infusion and reservoir several times, moving to various sites. I recently switched to a new vial of insulin, though it had recently been opened.

I also consider if I have a UTI or other illness that’s driving it up.

Hopefully, your doctor can give you specific instructions. I know it can be very stressful.


The ony time I check for ketones is when I’m high for a sustained period of time. For me that’s above 180 for more than 2 hours.

When I’m sick I make a special effort to eat the minimum that I know I need when I’m healthy regardless of how hungry I feel. I know that I need more nutrition when I’m sick than when I’m healthy and my BG is harder to control.

My understanding is that measurable ketones above the trace amount that’s normal, is due to the body having more need for energy than is being provided easily from diet. This can happen if you’re starving OR if your body thinks it is because it’s not able to metabolize the glucose in your bloodstream.

Metabolizing fat or protein creates ketones as a byproduct. That’s what produces fruity or fingernail polish scented breath and sour BO. You can reduce the level of the ketones by drinking much more water and letting your kidneys flush it out but if you keep doing whatever is producing those ketones the problem will continue.

Anyway elevated ketones is a symptom and unless extremely high for sustained amount of time (days ) is not an immediate problem. What is, is whatever is.causing them. Address the cause and the symptom will decline.

I suggest that you do what I do when I’m sick , switch to eating more smaller meals- not snacks but balanced mini-meals .

Here’s my thinking: when Im sick Im ess active- more likely to be lying down than walking around. That means that food is more likely to sit in my stomach longer and become more digested before it passes into. the intestine. And that’s most likely to happen when I get up to go to the bathroom. When I do. that produces a surge of carbs
The smaller those surges the easier it is to correct for them.

If you make a special point between these mini meals to drink a cup of water and take a bathroom break whether you feel like it or not, I believe you will be able to get a better handle on your BG and ketones

Elevated higher ketone levels for even a few hours can be extremely serious and dangerous. DKA can happen very fast in some.


Elevated per se is not a problem High is a problem. 40mg/dL is moderate.

It’s normal for there to be a trace of ketones in your blood. It’s a byproduct of what the liver does in recycling cholesterol. When you’re under stress or ill it’s not unusual for the level that’s detectable to be higher than that “elevated”. It’s only when it gets to be above 40 mg per deciliter for a sustained amount of time (days) that it starts to becomes a concern. If it’s off the scale more than 160 mg per deciliter then you should probably seek medical help.

Regardless it’s a symptom and what needs to be done is to address the cause which is most likely uncompensated blood sugar spikes.

Hi, i really hope you are feeling better now. These are the “rules” i was taught a few years ago here in the UK. Have helped me out numerous times.
HG.01-003-v3-Sick-day-rules-Pump.pdf (210.0 KB)

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