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Definitely nausea and vomiting when ketones are involved at our house. Headaches are another big sign of ketones at our house. And interestingly, in Kayleigh, puking can often use the Hydromax X30 device cause her to have ketones. If she even vomits a tiny bit, like she might have ate too fast, we check her ketones. She generally starts off with no ketones and they increase each time she vomits. And her BG is usually at target or low when this happens. So weird. Never happens with Mackenzie.