Stomach virus and ketones... help

Hi All,
I haven’t posted in a long time but I could use some help. I’ve had a stomach virus since this afternoon. I haven’t kept any food down - gotten sick twice. Managed to keep my bg up after my lunch bolus with a Pepsi this afternoon.

My blood sugar is pretty stable around 100 but I just checked ketones and it came back as the lower of the two high values on the chart.

I’m nervous to take a lot of insulin in case I can’t keep food down. I’m feeling a little better so might be able to eat a bit but i just don’t know what to do.

Any suggestions for where you’d start, if you were in this situation?


My old endo always said you can spill ketones in a starvation situation even when blood sugar is in range.

If it were me, I’d just do my best to hydrate for now and add sustenance when able. FWIW, I’ve never been able to manage a 100 bg during a stomach virus. :+1::+1:

I’ll wait for more educated people to weigh in, but I’d be more worried about inducing a low at this point given the nausea.


If you can keep the pepsi or other sugary drinks down, I would conservatively increase the insulin to deal with rising bg from the sugary drinks. That way you aren’t anticipating needing to catch the low but feeding it so you can increase the insulin and deal with the ketones.


I agree with @T1Allison I’d be more worried about a low that you cannot bring up due to nausea. I was in this situation before. I got my glucogon out just in case I would need to take it. I ended up managing to eat part of a banana but did not take any insulin for it. I felt it was safer for the time being to be a bit high rather than chance an uncontrollable low. I hope you are feeling better now.


I am trying to hydrate and the nausea is feeling a little better at the moment. I took a little insulin and ate a little applesauce so we’ll see how that goes.

What do I need to look out for in this scenario? How do I know when the ketone situation is getting away from me? Is it safe to try to get some sleep later, given that Dexcom will alert me to lows or crazy highs?

I’ve never tested ketones before, and honestly it’s a little scary. I so appreciate you all’s responses.


If your summary info is still accurate and you’re still using the Omnipod, the great news is you can always adjust or temporarily turn off your basal if you need to as you deal with your nausea.

My approach in trying to introduce food is to use an extended bolus so if it starts to come back up, I can stop the rest of the bolus. Or I’ll bolus afterward if I think I can keep the food down.


You can get into DKA without running high with a stomach virus. You need to be able to take insulin until the ketones go down, which most likely means drinking fluids with sugar in them and taking insulin once you’ve kept them down (even if you spike a little—better that way than prebolusing and then vomiting it up, keep in mind the issue with DKA is not actually blood sugar values, but lack of insulin). If you cannot intake both fluids and sugar and keep taking enough insulin that your ketone levels start dropping, I would go to the ER. When in any doubt with a stomach virus and high ketones, go to the ER for IV fluids, glucose, and insulin.

I almost died from this exact situation when having salmonella food poisoning years ago, and ended up spending almost a week in the ICU and taking about a month to recover fully. It is not worth messing around with.


How are things going so far, @kpanda01?


So sorry you’re dealing with a virus and fighting off ketones! Do you have any glucagon? I believe that you could use small amounts of glucagon to bring you back up after giving some insulin when sick and unable to keep food down (please confirm @Eric because I’m not entirely sure)


I’ll echo what others have said. You need insulin (and good hydration) to suppress ketones. To take insulin you either need carbs (ginger ale sugar soda is a traditional remedy) or microdoses of glucagon.

If you have an old expired glucagon kit, you could mix it up and give a few units with an insulin syringe (not the whole vial’s worth with the huge rescue syringe). When your BG rises from the glucagon you can give insulin to bring it back down. You can keep using microdoses from the mixed glucagon vial; it will last at least a day.

One reference that gives directions on how to mini-dose glucagon is at

If you can’t control your ketones by yourself, go to the emergency room where they will give you IV glucose with insulin. Don’t ignore the issue because you can get acute kidney failure after a day of really high ketones.


You are correct Larissa, you can fractional-dose glucagon. It will work, but it has limited powers in that it can only release what the liver has stored. So it isn’t an unlimited resource. But it does work.


I feel a little bad for giving somewhat shoddy encouragement higher up in the thread. I’m going back and rereading threads that covered Ketones and Low(er) BG. I think I’m hard-wired to connect ketones and high bg, which is obviously not the only time ketones can present themselves.

Has anyone here gotten some of the DKA symptoms before? I have. When they say fruity breath, boy of boy do they mean it. I was driving myself to the pharmacy to buy Pedialyte to try to get my body hydrated/flush out the ketones…and it smelled in my car like every Bath and Body Works lotion ever made had exploded in my car. It was like the Sweet Pea lotion scent times one million. FWIW.


Thank you all so much :pray: feeling a bit better today… I’m able to keep food down now, so that’s making this easier, although nothing sounds good. Ketones are down to moderate so at least we’re headed in the right direction.

My bg ended up hovering a bit under 200 most of the night, which at least gave me the opportunity to throw insulin at the ketones without having to worry about a low. It’s back to mostly in-range today, and I’m doing my best to rehydrate with Gatorade, popsicles and jello :slight_smile:

You guys are so amazing. Thanks for your guidance and your concern!


Glad you are on the mend!

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Yeah, a micro-dose of glucagon can be great for an emergency. Like if you suddenly get sick after you have already taken your insulin.

But to reemphasize what others have said - if you have an empty store of liver glycogen, a glucagon injection will be much less effective. It may still work, but you might need more. Or it might not raise your BG as much as it would otherwise.

So for example, if you have not eaten for days, you won’t have nearly as much liver glycogen available.


I’m afraid I am guilty of this, too. I actually didn’t realize ketones were associated with lack of insulin.

I’ve never been in DKA but I have certainly have had fruity breath many times. I assumed this was related to poor control, but I didn’t know this was associated with DKA though!

I’m so glad you, @kpanda01, are feeling better! :sunflower:


Glad you are feeling a bit better and the ketones are heading downward! Gatorade is definitely going to be your friend, since running high ketones will also screw with your electrolytes. Hope you continue to improve quickly!


Fruity breath means you are producing ketones (in trace to small amounts, not dangerous; if you can smell them strongly, they are probably getting up there though). People vary in how quickly their bodies produce ketones in absence of being able to use blood glucose for energy, either because they haven’t consumed any glucose or because they don’t have enough insulin to use any of the glucose floating around there. That’s why T1s tend to run ketones when high; however, it really depends on whether the cause of the high is deficiency of insulin. For example, if you eat dinner and forget your bolus, your blood sugar spikes but your body can’t use any of that energy, so it switches to burning fat and thus producing ketones as a byproduct. However, if a T1 ate a normal meal, took plenty of insulin to cover it, then had a sugary drink, they might well spike high but not have any ketones, because their body has plenty of energy (glucose + insulin) from the meal and no need to burn extra energy from fat.

Anyway, if you have ketones/fruity breath, you may not yet be in DKA, which is when the level of ketones is so high that the pH of the blood has become acidic, and typically wouldn’t occur in a non-diabetic or non-starving person. You’re potentially at risk for it though, and it’s a sign to take insulin right away. DKA is extremely dangerous, and can cause permanent organ damage fairly quickly (within a day or two) and then be lethal. It is what sick day rules are all about preventing, and it is why you almost always should be increasing, not decreasing, insulin levels when sick.


Thanks, this really helps me! I try not to get to the point where I have fruity breath now but in the past it was not an unusual experience at all as I had terrible control. I felt lousy but had no idea I was in a risky situation! I think I will order a ketones kit.


Can you explain a bit more when you say “it has limited powers in that it can only release what the liver has stored”? I think I’m missing something here.