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Seek urgent medical attention (call 999 or go to A&E) if you experience: Fruity-smelling breath, confusion, extreme thirst, or rapid breathing (which may indicate diabetic ketoacidosis, a medical emergency) [10] Severe, persistent abdominal pain radiating to your back, with or without vomiting (possible pancreatitis) — stop taking Rybelsus in this case Symptoms suggesting urinary tract problems: Pain or burning sensation when urinating Urgent need to urinate with little urine produced Blood in the urine or cloudy, foul-smelling urine Lower abdominal or back pain Fever accompanying urinary symptoms (seek same-day assessment as this may indicate kidney infection) These may indicate a urinary tract infection or other urological condition requiring investigation and treatment separate from your diabetes management