Urine Ketone help requested

Am T1 and have been for five years. I take Novorapid and Levemir.
Had awful food poisoning last night and couldnt keep anything down (even water) between 6 and 12. Have just done my ketones (urine cant find blood monitor or get one) and they are 3+. This is nearly 9 hours after I have last vomited. Bloods high, around 15. Have just eaten toast and lots of water
When should I go to hospital?
Thanks for help

What really matters is two things:

  1. What is your blood sugar, > 250 mg/dl and high ketones raises concern about DKA
  2. Are you dehydrated? If you become dehydrated you can have DKA or HHS and that is a concern.

Having a blood sugar of 15 mmol/L (270 mg/dl) is a concern. If you can correct to bring that down you should be fine. But if you lose control of your blood sugar then you need to seek help promptly.

ps. Note that if you have been fasting it is perfect natural to have ketones as your body burns fat to provide energy.

pps. Drink water is exactly right, but make sure you take in electrolytes as well.


Thank you Brian.

I have just done blood again and it is 14.8

Have rested ketones and still 3+

Am scared of DKA - am nursing a newborn too :confounded:

It is perfectly understandable to be concerned about DKA. And having a young nursing child means that even more you don’t want to be in the ER with DKA. For the most part you should be able to take action to avoid DKA and that dreaded trip to the ER. Remember that once you are sick and have high blood sugars you are likely insulin resistant (both from being sick and from high blood sugars). You may need to correct more aggressively than usual. I also have to be honest. When I correct, I use intramuscular (IM) injections. They work faster. I inject in my quads and then walk around. Some people inject into their deltoids. Below is a video from Dr. Bernstein on how to do a IM injection.


I am type1 and was once dangerously close to DKA and what @Brian_BSC says is correct - you’ll need to take more insulin than usual and keep drinking plenty of water

Hope you have a doctor to call — please call if you do


Brian is right on all counts. Watch out for dehydration and electrolyte loss and attack the high aggressively. Like him, I use IM injections when I need to attack an extreme or stubborn high. In fact, I just did one a little while ago to compensate for an exceptionally stupid lunch. I use my deltoids, but however you do it, find out what works and do that.

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@David_dns can one do an IM with any size syringe, or a pen if that’s all you have?

I’ve also done IM injections when high to speed up a correction, For me biceps and calf muscles are conveniently accessible. And yes, as @Brian_BSC said, when your BG is higher, it’ll take more than the usual amount of insulin to bring it down. And drink plenty of water!!

Normally you need a longer needle to make sure to hit the muscle. That’s one reason for using places with very little subcutaneous fat, like the deltoids or quads. I use a ½" needle for IMs. It’s a very individual thing. 8mm can work if you pick the right spot and make sure to achieve full penetration. The key thing is to make sure to inject into muscle, like a tetanus shot, for instance. The advantage, as mentioned, is faster absorption. Also as Brian said, it helps to work the muscle a little afterward.

I’ve started to try IM injections with my 8 mm pen needles. I’m not sure I’m correctly hitting muscle, because after most IM injections my muscle stays sore for a day or two, but after the ones I attempt I feel nothing unusual. I think if they still made 12.7 mm needles, those would work much better, but I haven’t been able to find them (and pharmacists think I’m crazy that I’m not using the new 4 mm needles, I had to convince them that I really did want 8 mm!).

@a_e_kennedy1982 let us know how you’re doing :smile_cat:


All this advice is perfect:
Stay hydrated is a key not just for this illness but especially for breastfeeding

Normal liquid intake for breastfeeding should be 2-6 oz per hour ( I needed much more than that: 6-8 oz per hour)

Our family is JUST recovering from a very virulent and violent tummy bug, just as you are describing

Active emetic stage (throwing up) was about six hours

During that time, each of us was able to keep a few ounces of water down. After this phase, it was easier to keep 4-8 oz down per hour.

If you cannot get out to get electrolytes, a short term solution is 1/8 tsp salt to 4-6 oz water, sip as needed, along with the 4-8 oz of regular water.

Remember to take extra precautions for washing hands,your face, your breasts, etc. to not transmit virus to baby.

Spraying your clothes with Lysol will help. Even spraying cribs and sheets if you cannot wash them right away.

Using listerine or some xylitol based mouthwash will help.

If baby gets sick, take baby to urgent care immediately. Small little ones can be too young to ward off a bad virus, and it can go from vomiting to dehydration to infection in a snap. They will need intervention SOONER than adults. Personal experience.

Plus if your breastfeeding is compromised, it can throw baby’s system off as well.

Do you have pumped milk in freezer?
If the throwing up is over for you, and you are hydrated again, breastfeeding will help little one.

But if you are still actively throwing up, I would feed with reheated pumped milk, pumping your current milk and throwing it out, until I was hydrated and able to nurse again.

Very best of outcomes for you, and I’m sorry if this advice is not relevant for you as I am posting late.

Let us know.

They do still make them, and they do work well. I have about 10 boxes of them sitting here, and have never had any difficulty getting the pharmacy to stock them. Perhaps Canada has some sort of trade barrier that is keeping them out??

as always, if in doubt, seek medical assistance from a Dr.
but the advice you have been given may let you home treat still. Hydration is the concern and may need a drip, if the anti vomit meds don’t work…

this may help with the insulin and ketones in future
Sick day rules

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Thanks Brian - have never heard of IM injections but is really useful to know and to have video too. Thanks for prompt help and reassurance :blush:

Thanks Marie - no Dr but kept fluids down and ketones returned to normal after another few hours. Blood was 5.2 this morning. Phew! Thanks very much for help and concern :purple_heart:

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Thanks David

Thanks Jack, ended up avoiding hospital hurray! Sick day rules will come in useful thank you

Thank you Lada lady.
I think it was food poisoning as my dad had the same thing at the same time. We had been out for lunch together the day before.
My baby wont take a bottle so i was terrified last night about feeding him. Thankfully supply seemed okay and am drinking lots of water today and eating oaty biscuits!
Thanks so much for being a great help xx

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So glad you are better!

Thank you for letting us all know!