Glucose and ketones

[Tinkerisdead]

I'm 14+5 and had antenatal today. My wee had +1 glucose and +1 ketones.
The midwifes straight away asked if I was hungry, been sick a lot or skipped a meal? I said I've been nauseous but eating normally, I told them whilst it's not healthy I'd eaten sausage and chips an hour and a half before. They raised eyebrows like I was lying.

I explained that eating stops my morning sickness but after a meal I feel quite unwell, my heart races I feel quite dizzy and sick and quite breathless. All of these I thought was just pregnancy. I should add that this is dc2 and I feel generally unwell whereas with dd I felt sick. I often go to bed at 8ish as after my evening meal I feel quite poorly.

The midwifes said they'd bring my gt test forward but wrote 'feels unwell' on my notes. Is this indicative of potential gestational diabetes then, for her to bring the test forward although it's not for another 10 weeks. With dd I craved sweets but this time I can't even stand squash as it's too sweet so I'm not stocking up on sweets like last time.

shameless bump...can anyone shed some light on this?

Was it your first morning urine? I had +1 Ketones and +1 protein at my last antenatal check up (was about 16 weeks) Apparently these its very common in FMU, and only really of concern if +3 or more. I had to go do another wee, (was midafternoon) and this time it was ok. The Ketones were due to not eating since dinner (like you) and the protein was due to discharge. I have no idea about the GD testing but would imagine it will be something they keep an eye on with you...

No it was a wee after I'd eaten at lunch time etc. I ate at 1 and was seen at half 2 so I was by no means hungry, sicked it up etc? Hmmm maybe thats why, maybe my lunch hadnt processed and so it was a big gap between breakfast at 8am and lunch at 1pm. I've got an appointment in three weeks to discuss blood screening so maybe I could ask her to do a dip test again to check the state of affairs although she was quite stern that I wouldnt need to bring a sample.

I've had + ketones in a previous pregnancy and was told it was usually an indicator that the body was breaking down body fat for energy as you haven't eaten enough recently.

I've also had + sugar in this pregnancy and been told that it can be a normal feature of pregnancy (IIRC its that larger molecules can cross the membranes in the kidneys so sugar molecules, which would normally not make it into urine, are seen - can't remember whether that was due to differing pressures brought about by increased blood volume other changes to the membranes themselves) but it can also be an indicator of problems handling sugars - which can be a flag for GD.

I doubt its anything to worry about massively or your MWs would have been a lot more proactive, but if you're body is dumping ketones and sugar (even though your most recent meal was reasonably substantial, not that long ago and not sugary) combined with feeling ill then I suspect they just one to keep a slightly closer eye on things and try to make sure nothing too untoward is happening - and that includes doing a GTT to rule out GD.

(Just to caveat - I've no medical training, so the above is my speculation based on what I've picked up over 3 pregnancies and a lot of reading!)

Aw I have no idea, sorry! hopefully someone else will come along shortly..
This pregnancy lark is so bloody complicated sometimes... Surely if they were that concerned about you she'd definitely get you to bring in a sample in 3 weeks??

Try not to worry too much....

Cross post with Tangle who knows much more than me!

lol tangle's caveat. I should add my own that my DH is not a Doctor or I would have asked him!

That is quite logical, thank you. That's why i think they thought I was lying when i said I had a massive lunch. I more embarrassed admitting that I'd eaten total junk but as you say it was substantial meal with no sugar.

Its possible that the raised eyebrows were more "that's unusual - might have to go and check up on that" rather than "hmmm - another one that thinks we won't know she's been stuffing chocolate fudge doughnuts!" From what I know, what you're describing doesn't fit into a neat, expected box - which makes me suspect her reaction was the former rather than the latter. The alternative would be that she puts more faith in her interpretation of the reality (that you're lying) and will ignore what you've said - which would be concerning and highly unprofessional, so I'd go with the first assumption until proven otherwise!

Did you ask her what it all meant? It does seem a bit strange as the usual interpretations seems to be ruled out by the circumstances - either she should be able to either explain what she thinks is going on or she should be prepared to say she hasn't come across this particular situation before and is going to go and do some research. "Why?" is a very useful question when you're pregnant

Yeah I tried to ask why but she just sort of shrugged and said we'll bring your GTT forward. She did have to tick a form and it said diabetes? She said not yet, to herself but aloud. I did laugh as she then said oh sorry that was completely the wrong thing to say. But it all started to point to it being an indicator of GD. Dont get me wrong, that wouldnt worry me as such, moreover that I dont like the idea of potentially having it for 10 weeks before its diagnosed IYSWIM.

Popped over from the GD thread, not sure I can help much but willing to provide support and someone to chat to.
I only got the GTT because I had a random blood glucose come back high, so no experience of urine symtoms I am afraid

Did you get a date for the GTT yet? I think the best thing is for them to do it ASAP so you know whats going on.

PS you are very welcome over there - even for info about teh GTT etc etc

Im 14w +5 and she said she would bring it forward to 24 weeks so its a long time to wait. I thought maybe I'll ask for another dip test when I go back about screening results and then take it from there? I assume they can check blood sugar levels for an idea of whats going on before they do the GTT?

I've had two GTTs, one at 16 weeks and one at 29 as my urine consisitently comes back with +2 for Glucose. As Tickle said the kidneys let bigger molecules through when you're pg and so more is picked up in your tests. My MW seems determined to get me diagnosed with GD but both GTTs came back clear so I'm going to throw the folder at her if she persists!

My source is my mum who is a MW btw :)

The test itself involves starving fasting from the night before, they take a blood sample when you arrive, you drink Lucozade, glucose syrup or something similar depending on your health board, and then two hours later they take more blood to see how well you've processed it compared to your "base" level from the fasted sample.

Also I've had urine tested at every appt so far, including my scans, so if you've got appts I'd say take one in, they're bound to have dipsticks to hand!

whats the point of bringing it forward to 24w....why don't they just do one now?
Firstly I suggest ringing the midwife and asking what it means and what she is doing about it?
I would also be seeing your GP and start asking some questions. Oh and take a sample with you when you go - so they can check it then and there. The GP is likely then to refer you to the maternity assessment clinic at your hospital.
TBH I'am little baffled by the ....'well we found something maybe but we'll wait 10 weeks to see' attitude and I can understand why you are confused and asking questions here.

Best of luck

I had an indendant midwife before so Im not really sure what's what with community midwifes. I dont want to appear bolshy or pushy, as my indie midwife would have left me with dipsticks telling me to text her the results and then testing me for the world I had wanted/needed it. I got given a urine bottle and told I have to rinse and reuse it each timetoo so its all a bit new compared to the private care I received before. They didnt feel bump/fundus height/or listen for heart beat either but I assume its too early for that?

I think I will ask them to do a further test or at least ask what happens if future dip tests show similar results rather than waiting for the GTT.

Have you thought of giving your IM a call and asking her opinion? I've been fortunate enough to have the same one involved in my care for all 3 pregnancies, but I've also called her about DD1's earache and assorted other things over the years - she's always been more than happy to have a catch-up and offer as much advice as she can.

IIRC current guidelines suggest not feeling/listening till your near/in the 3rd trimester. I think it was never recommended to try and listen to the heartbeat until about 18 weeks as there's so much space for a baby to hide it's not at all unusual to fail to find the HB for a perfectly healthy baby at that stage. (Re. trying to pee into those silly sample pots, I got one of [[http://www.accessdiagnostics.co.uk/acatalog/copy_of_copy_of_Urine_Collection_Cups.html these] and decanted if required - made life sooo much easier!)

If you want to be pro-active on the testing, it is possible to buy dipsticks here - I'm just always cautious as I think its possible to freak yourself out over seemingly anomalous results (I know I manage to do it over ridiculous things , especially as these are the sticks that test for all sorts of things, whereas they're now advised to only test for a couple of things).

Wow third trimester to hear a heart beat?! I don't think my little dd will put up with that she wants to hear 'the seed baby'. I text my indie midwife and she said input out glucose a lot last time but usually after sweets.

I checked my old notes and it states Glucose +2 but Drswife and I have just eaten a packet of biscuits lol. I wish I could afford her again.

The mw first tried to listen to this baby's heartbeat at 16 weeks and said if she couldn't find it I would be sent for a scan. But I do understand that some don't until later.

I am on the GD thread so wanted to offer support but don't really know the answer! I never had glucose in my urine, my GD was picked up with GTT. I did have ketones in my urine the first week of my 'GD' diet as I don't think I was eating enough.

MY first suggestion would just be to have it re-checked in a week? And you can have the GTT done at any time so if she seriously suspects GD then surely you should be checked sooner?

Anyway keep us posted and hope you get some answers soon.

Also from GD thread. Not sure I can add much to this except that I did have some sugars in my urine in second trimester but mw wrote it off to high sugar breakfast (cheerios, juice, banana, prunes) and I didn't get GTT results back til week 30 with confirmed GDD (numbers were borderline but anything outside the narrow parameters they set is classed as GDD).
A little traumatising to get the diagnosis but I do wonder if I had it earlier as I was craving sweet things and wish I had started regulating my diet earlier. I didn't have any ketones though.
Good luck with everything and I would agree that it's best to take the GTT test earlier if possible.

I had glucose and ketones in my urine several times and it was GD. I also felt unwell as you have described. They didn't diagnose it until very late and I was induced with a 10lb 6oz baby at 40 weeks. If I was in your position I'd be asking for a GTT now.