Ketones in urine, normal blood sugars, on steroids for asthma, 30 weeks pregnant

[Cmeredith85]

Hi there
Just after some advice if possible. I’m 30 weeks pregnant, on steroids for bad asthma (35mg) As a consequence have now got diabetes - on 1000mg twice a day, Levemir at night and Novorapid before breakfast and lunch. Suffer with IBS prior to pregnancy and think metformin might have made it worse (having intermittent episodes of loose stool) Over the weekend been having abdo cramps, loose stool and nausea (not vomited). Checked urine dip and 3-4 plus of ketones. Blood glucose have been within normal ranges throughout. Anyone have any ideas on what’s happening here? Or been through similar? Thank you

 

[Lucyr]

Have you been eating and drinking normally over the weekend or not eating many carbs because of feeling ill? Not eating many carbs can cause ketones.

You can get DKA with normal blood sugars, particularly if on the “flozin” type drugs like empagliflozin, and I’ve heard it can happen with Covid too, so if on anything like that, or if any other signs of DKA, or if you can’t keep fluids down, you need to seek medical help.

But to be honest given you’re 30 weeks pregnant I’d be seeking medical advice ASAP anyway.

 

[Cmeredith85]

Yes although I have felt unwell I have made sure that I continue normally… for the baby.

I contacted my diabetes nurse specialist this morning and was due to go in for bloods, but the ketones in my urine before lunch was only 1, so they said to hold off. They recommended to continue monitoring the ketones in my urine and if they spike again then to call them and go for bloods. Ketones at the moment have gone up to 2+. As you can imagine I’m just feeling anxious about it, as I don’t want it to have any negative impact on my baby.

Thank you for getting back to me

 

[Leadinglights]

Yes although I have felt unwell I have made sure that I continue normally… for the baby.

I contacted my diabetes nurse specialist this morning and was due to go in for bloods, but the ketones in my urine before lunch was only 1, so they said to hold off. They recommended to continue monitoring the ketones in my urine and if they spike again then to call them and go for bloods. Ketones at the moment have gone up to 2+. As you can imagine I’m just feeling anxious about it, as I don’t want it to have any negative impact on my baby.

Thank you for getting back to me

Did she give you any indication what level was still Ok or when to call for help. You could always call 111 if you don't have an emergency number for nurse.

 

[Cmeredith85]

Did she give you any indication what level was still Ok or when to call for help. You could always call 111 if you don't have an emergency number for nurse.

No she just said if it spiked again, so I’ve just assumed she means if it goes to the same as it was last night, which was 3/4+ She also advised to increase my Levemir by 2units. So I will do that in the hope it might help.

Yes, my plan is to call labour ward if it happens again, hopefully then they can direct me to the appropriate team until the specialist nurses are back in on the morning. Fingers crossed it will stay low

 

[PattiEvans]

Checked urine dip and 3-4 plus of ketones. Blood glucose have been within normal ranges throughout. Anyone have any ideas on what’s happening here?

It's many years since I used urine dips for ketones, but I wouldn't like to rely on them now. You have to read them at exactly the number of seconds stated on the pack and compare the colour with a guide if I recollect - the colour deepens every second. I would ask for a BG meter which can read blood ketone strips and a supply of the blood ketone strips to go with it. You cannot be too careful with a baby on board. Good luck and let us know how you get on.

 

[Inka]

Over the weekend been having abdo cramps, loose stool and nausea (not vomited). Checked urine dip and 3-4 plus of ketones. Blood glucose have been within normal ranges throughout. Anyone have any ideas on what’s happening here? Or been through similar? Thank you

Could you have a tummy bug or have eaten something that disagreed with you? When you have ketones it’s really important to keep well-hydrated. If you’ve had an upset stomach, you could be a little dehydrated. Make sure you’re drinking enough water.

I had ketones during labour but they were starvation ketones. I ate some carbs and they improved. I was in hospital so was monitored, but in your case, I’d phone for medical advice if they go up to 3 or 4 again, and even if they don’t I’d still give your midwife/diabetes team a call so that they know what’s happening and can call you in if needed or simply reassure you if not.