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Close collaboration between endocrinology and rheumatology or immunology specialists is advisable when managing patients with complex autoimmune conditions requiring metabolic intervention

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These include: Blood glucose readings above your target range, especially if over 300 mg/dL Increased thirst and urination Unexplained fatigue or weakness Fruity-smelling breath Nausea or vomiting (which may indicate hyperglycemia rather than medication side effects) Seek urgent care if your blood glucose is above 300 mg/dL or above 250 mg/dL with moderate to large ketones, if you have persistent vomiting, inability to keep fluids down, confusion, or signs of dehydration