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Question:

From Monroe, Georgia, USA:

I am 29 weeks pregnant and recently diagnosed with gestational diabetes, at 28 weeks. I saw a perinatologist this past week who started me on daily monitoring of blood glucose levels, along with insulin injections both in the morning and evening. I was not told to check my urine for ketones, but because I am a registered nurse, I thought to do so myself. The first day I tested was three days ago and found my urine to have a large amount of ketones consistently throughout the day. I notified my obstetrician who sent me to the outpatient Labor and Delivery Department of the local hospital for I.V. fluids and laboratory work.

I was discharged after a bolus of fluid with a small amount of ketones still present in my urine and instructions to drink plenty of fluid (water) per day. And, even despite drinking copious amounts of fluid, I still continue to have times during the day when my urine shows moderate to large amounts of ketones. I know I am not dehydrated because I am taking in almost four liters per day of water alone. While I have changed my diet related to the diabetes, I am still eating three meals per day, with snacks in between, and following a 2500 calorie ADA diet.

I am concerned that the ketones are harming my baby, as I am finding information that states that ketosis can cause neurological/brain damage and mental retardation in the fetus. I am doing everything I am supposed to do, and I don't understand why the ketones are still present. What does this mean for me, and has this possibly caused damage to my unborn baby?

Answer:

All pregnant women will occasionally spill ketones in their urine. This is more common before a meal and reflects that you have not eaten in a while. It usually has no implications for problems. In this context, it is not necessarily an indicator of significant ketones in the blood. With gestational diabetes, ketones in the urine can occur as well and are not cause for alarm. It is not the same as in a woman who has type 1 diabetes and does not make any insulin when it may be an early sign of ketoacidosis. I usually do not even check the urine of women with gestational diabetes for ketones.

As long as you are making your target glucose values, as I stated in the above paragraph, the presence of ketonuria is not a concern. One thought may be to either increase your caloric intake or throw in some snacks between meals.

OWJ

DTQ-20070325101114
Original posting 3 Apr 2007
Posted to Gestational Diabetes

  
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Last Updated: Tuesday April 06, 2010 15:10:12
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