Urine testing for ketones and glucose

Hi everyone,

I'm 20 weeks along, and recently when I went to my OB, there was glucose in my urine (+3), despite a good fasting bg that morning. So she now has me testing my urine every morning for ketones and glucose. I've only done it a few times now, but a couple of times I've had small ketones, and this morning I had some glucose (bg was 190 overnight). My OB said not to worry about small ketones, since I am eating an evening snack and gaining appropriate weight, but I guess I'm a little worried anyway... I was hoping others might share their experiences with this and what their doctors have told them about positive urine ketones and glucose.

Thanks!

Elizabeth

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Replies to This Discussion

Permalink Reply by Sharon Fung on June 26, 2011 at 10:04am

I had trace ketones in the first trimester. I just started eating more carbs during the day and it totally cleared up. My endo told me that ketones are usually a sign that you're not eating enough carbs for you and the baby. Always double check with your endo before doing anything new though. And try to talk to an endo, they're more knowledgeable in this area. I never talk to my ob about diabetes related stuff-I always double check with my endo even my my diabetes nurse tells me something.

Permalink Reply by lizzistardust on June 26, 2011 at 10:18am

ketones are usually a sign that you're not eating enough carbs for you and the baby

Hmmm, it's probably important to point out for the non-D veterans (such as people with gestational rather than 1 or 2) that this would only apply if your blood sugar isn't high!!! If it's high and you have ketones, more carbs are not the answer. :)

Permalink Reply by Sharon Fung on June 26, 2011 at 10:22am

right-this is usually when there are lows. If my BG levels are high (above 200) I will usually check as well -in my case I rarely have them when they're high, actually I rarely have ketones at all so for me it was the food thing and that did go along with low BG levels.

Permalink Reply by lizzistardust on June 26, 2011 at 10:29am

It's interesting about it coming along with the lows. It must be tied to why people who go super-low-carb (like Akin's) get ketones, but go into "ketosis" instead of "ketoacidosis."

Permalink Reply by Kristin on June 26, 2011 at 10:20am

I almost always have trace ketones in the morning, even before pregnancy. So I rarely tested during pregnancy. At my monthly blood work and urine test a couple times, I tested positive for glucose in the urine. The night before I had always had a reading above 140. My endo said that was enough to cause glucose to spill into the urine during pregnancy. So we did not worry about it.

As Sharon said, ketones are a sign that you are not eating enough, but some of us are more like to spill ketones than others. I ate a 10pm snack and had breakfast at 7am. The only option would have been to add a middle of the night snack, but my endo decided that it wasn't necessary. I never had more than trace ketones and they didn't show up in the lab work.

Permalink Reply by E. Louise on June 26, 2011 at 11:36am

Hmm, thanks for the input... I am not eating a low carb diet (I eat at least 180g/day), so I don't think that's it. And I don't think I could possibly eat more before I go to bed; I'm always full then. I'm wondering if maybe I'm having hidden highs at night. I just put in a new CGM sensor today to see if I can find out what's happening overnight.

I almost never have ketones, and when I ever have had them, it's always trace. So it worries me to see the "small" result coming up.

And as for the OB vs endo thing, I know what you mean, Sharon. In my case though my OB specializes in diabetic pregnancies, and the OB practice has an agreement with the Joslin center that I usually go to that during pregnancy, my diabetes will be managed solely by the OB. It is a little weird, though... maybe I will email my diabetes NP and educator and see what they think.

Permalink Reply by lizzistardust on June 26, 2011 at 11:54am

That's interesting that she specializes in diabetic pregnancies! Mine doesn't. She's had plenty of patients with D and she knows enough that she sometimes makes insulin adjustment suggestions that make good sense, but I definitely don't feel like she's much of an authority on D. If she recommends something, I consider that a "suggestion" and *I* make the decision (or I ask my endo). She doesn't see the patterns that someone who specializes in D would. Like, it didn't seem to register with her that having a low can result in a rebound high. She wanted to start increasing my dinner I:C and I was like, "No no, I really think those highs are because I've been low at the start of dinner, which I'm trying to correct by fixing my afternoon basal." Her expression was almost blank. When I talked to my endo, what did she do? Decreased my afternoon basal rates even more than I already had and utterly did away with those post-dinner highs without an I:C change.

I like my OB though, and actually like that she doesn't specialize in pregnancies with D or "high risk" in general. I see a perinatalist for my ultrasounds and he's clearly more into routine induction and c-sections, whereas my OB's stance has been, "We'll keep a very close eye on things and do it if and when it's necessary."

Permalink Reply by Sharon Fung on June 26, 2011 at 12:04pm

ya, my ob is pretty much the same as yours lizzie. Most of her patients are diabetic patients and she has worked with my endo for years and has great faith in him. She actually doesn't even reccommend any changes with me. She just monitors the pregnancy and asks me every now and then how my control is. Maybe she'll become more involved late in my pregnancy, but so far, no and I kind of prefer that. I prefer to have one person making decisions on basal and bolus settings (other than myself) Things are less complicated that way :)

Permalink Reply by E. Louise on June 26, 2011 at 12:15pm

Yeah, it does seem like I have sort of an unusual set up, but I'm okay with it so far. My OB is really knowledgeable about diabetes management. I almost always agree with her suggestions, and when I don't, she is very open to what I think should be done. Often she tells me just to make adjustments and let her know what I've done. It's also kind of nice just to have one MD to see instead of 2--there are enough appointments as it is! She's really responsive to email--I send her my bgs 1-2 times/week, and she always responds right away. We'll see how things go later on, but so far she is open to my working with a midwife for delivery, as long as everything is okay. The only issue I have with her is that because she sees so many diabetic women, mostly with poorly controlled type 2, she sometimes is a little more forgiving than I want her to be when I have higher numbers. But overall, so far so good. Last A1c was 5.5.

Permalink Reply by Marps on June 28, 2011 at 1:25pm

My OB specializes in diabetic pregnancies too. Plus, if I have any questions, she has direct contact with a doctor who is fully engaged in decision-making regarding insulin usage. For example, I asked my OB if Levemir would be okay to use once through the first trimester, even though it hadn't been "officially" approved until pending results due 2012. She contacted her "direct link" and found that there have been NO bad side effects using Levemir in pregnancy that the FDA has found. So, hopefully that's accurate and keeps going that way because I switched back to Levemir at 15 weeks.

My Endo is realy knowledgeable, but I only fax him my glucose numbers on a weekly basis. I havent seen him in months. I see my OB twice a week now. I'm at 36 weeks.

I'm in the Northeast USA too. Wonder if it's a regional thing to have OBs specialize in diabetes management. My OB FULLY recognizes the complexities of Type 1 diabetes management and has not yet made the mistake of mixing up my diagnosis with Gestational- two very different beasts.

Permalink Reply by Heather Nielsen Clute on June 28, 2011 at 12:25pm

Good for you for taking such careful efforts with your diabetes!! That's the best news - you are checking and trying and changing and monitoring. My endo during pregnancy #1 suggested I not check ketones, bc if I am checking my BG and correcting/adjusting, as well as eating regularly, the ketones are irrelevant. That was 9 yrs ago, but I'm not sure there is compelling evidence to warrant fear or different action other than 1) treat your highs and try to keep BG as "normal" as possible, 2) stay hydrated, and 3) stay nourished.
Good luck!!!! It is worth all the work!!! :)

Permalink Reply by LiL MaMa on June 28, 2011 at 3:23pm

I have continued my low carb way of life while pregnant, currently 14 weeks along. My doctor just makes me check for ketones every morning and says it's okay to have small ketones just not moderate +.