I am in my 32nd week of pregnancy with twins and do not have diabetes according to my glucose tolerance tests, but I continue to have high urine glucose during the day. I believe I eat plenty, drink plenty, and still wake up with moderate to high levels of urine ketones in the morning (and have sometimes before as well). I notice that when my urine sugar is high, my ketones are non-existent, and when ketones are high, sugar is not present.

I did call a nurse who said not to worry about it as well as a doctor I saw previously when I had this question. I have read a lot of things that say ketones can be harmful to the developing nervous system of the fetus. Maybe I just need someone to explain it to me a little better as to why this is not a problem instead of just saying everything is okay.

Are ketones in the urine reflective of ketones in the blood? I have read mixed information on this. I’ve read that urine spills ketones before they build up in the blood, and I’ve read that urine ketones only show up hours after the levels in the blood have risen. Does the answer depend on the reason there are ketones in the first place? Is there a difference in the way ketones from diabetes, starvation ketones, and dehydration ketones affect the fetus?

Ketones occur from the breakdown of fat. The ketones are first in the blood and then cleared out by the kidneys and excreted into the urine. Ketones can be used by the brain as a source of energy. The body prefers to use glucose sugar for energy. The lack of ability to use available glucose for energy then triggers the body to use stored energy (in fat) and to burn fat which leads to the ketones.

There are two common situations whereby the body will be low in available glucose. The first and most common, is during relative “starvation” when your blood sugar is low, and you haven’t eaten in awhile. We all do that at sometime or another (because of flu, schedule conflicts that delay us in eating, etc.).

The other is in the case of diabetes. In diabetes, while there is an abundance of glucose, it is not available for use because of lack of insulin (as in type 1 diabetes) or sometimes in type 2 diabetes (because of lack of the body’s complete responsiveness to insulin). Diabetes has been characterized as “starving in a sea of plenty.”

DS
Additional comments from Dr. Bill Jones:
Glucose can appeas in the urine of pregnant women relatively easily. This may occur following high sugar intake such as a bowl of cereal at breakfast. Urine ketones are also fairly common during pregnancy. This is usually due to what is called “starvation ketosis” and I often see this in women who come to the office first thing in the morning without eating breakfast. With prolonged fasting, such as overnight, your body will produce glucose from its reserves and in the process ketones result. The ketones are cleared through the kidney. By eating or with hydration, the ketones should go away. Ketones resulting from this process are not harmful to the fetus and usually do not reflect significant ketones in the blood. Severe ketone production is usually only a problem with Type 1 diabetes and is extremely rare in gestational diabetes.

OWJ

[Editor’s comment: If you have not been able to get a satisfactory answer from your present health-care team, you ought to demand a referral to either an endocrinologist or obstetrician who has an interest in diabetes in pregnancy, and who is willing to share information with you.

WWQ]