January 14, 2003
Family Planning
Question from Provo, Utah, USA:
I am 27 years old, have had type 1 diabetes for 16 years, and I am about 26 weeks pregnant with my third child. My blood sugar control is excellent (about 6.0% hemoglobin A1c), I had no complications with the previous pregnancies and am showing no complications again. I have also not seen any complications related to retinopathy, nephropathy, or neuropathy yet.
However, I periodically check for ketones in my morning urine,with my last pregnancy I started showing ketones (moderate to large) at about this time, and I am showing them again now. Since my blood sugars were in such good control, we determined the ketones were due to starvation ketosis and solved the problem by my eating a small snack in the middle of the night. If the ketones are due to starvation ketosis, how dangerous is this (isn’t this a normal side-effect to the break-down of fat)? What are the possible side effects to me and to the fetus? Is it necessary to get up for a “midnight” snack to avoid the ketones?
Answer:
As long as your blood sugar is in good control, the ketones in your urine should not be a problem and will not have an adverse effect on the fetus. This is a fairly common finding in pregnancy, but obviously of concern in the presence of diabetes.
I frequently recommend a bedtime snack for pregnant women taking insulin more to prevent early morning hypoglycemia. In your case, it may prevent the starvation ketosis.
OWJ
