Hello, and welcome to Healthcare Magic! With your medical history, the symptoms you are describing are very concerning for diabetic ketoacidosis, or DKA. This can happen as a result of anything that puts stress on your body (such as infection) but can also happen from not taking insulin properly. As a Type 1 diabetic you are much more prone to DKA than if you had Type 2 because your body is completely unable to make insulin. Typical symptoms of DKA include the following: polyuria (increased urination), polydipsia (increased thirst), dehydration, confusion, fruity odor to the breath, diffuse abdominal pain. The ketones in your urine are the most concerning part of what you have said. The body s normal source of energy is sugar. If there is not enough insulin available, the body of a diabetic can t move the sugar from the bloodstream into the cells (this is why blood sugar is high). The body interprets this as there being no available source of energy (because sugar must be in the cells to be useful as energy). As an alternative, the body begins to make ketones to use for energy. These ketones show up in the urine as well. I understand that you do not wish to go the ER. However, untreated DKA is most certainly a life-threatening condition. It is possible to go into respiratory failure, meaning your body is not able to breathe on its own. In this situation patients are placed on a breathing machine (called a ventilator) and admitted to the Intensive Care Unit of the hospital. I recommend that you go immediately to your primary care physician to be evaluated. If for any reason this is not possible, you must go to the emergency room now. I hope I have provided you with helpful information, and I wish you the best of health. Sincerely, Dr. Kinney