I've always been told that if your sugars go above 14 you should test for keytones in the urine. If they're present, you should take double your correction dose (your normal correction dose won't work effectively if have keytones) and then re-test an hour later (time dependent on diff circumstances). If still present, keep doing the same until your test is clear. So, even if you do get keytones occasionally, as long as you know how to treat them, then it's OK and all part and parcel of having this delightful condition! I think if you're continually having high sugars and/or keytones in urine, or you feel ill with them, you would need to speak to the doctor/nurse or go to A&E, but sounds like you're well controlled. Just test if you're above 14, otherwise I wouldn't worry. Perhaps you could ask your DSN about this to confirm.