Ketones in urine-what are they and how do i get rid?

[nobodysfool]

Hello,
I'm nearly 32 weeks and i have lots of complications-high risk beacuse of a previous emercency c section with ds1,low lying placenta,and now gestational diabetes.
Saw the MW today and she found ketones in my urine sample.
She asked if i was eating properly-i am albeit on a very strict diabetic diet-then she didnt mention it anymore.
I have come home and started worrying.
I'm not sure if the diabetes lack of food has caused the ketones or is it something else.
Any ideas will be great.
Many thanks

ketones arise in urine when you ahvent eaten ina while

they are a result of the body breaking down fatty acids for energy

Going from A Level biology (I'm really not an expert!):

Ketones come from breaking down fatty acids. Diabetics have their urine monitored for ketones as it can indicate that the diabetes is being poorly managed & the body is beginning to struggle.

If I were you, until a medical professional says anything differently, I'd just make sure that I wasn't going hungry & that I stuck to the diabetic diet to the letter. If you're feeling okay within yourself (no nausea or tummy pain) & your midwife hasn't said anything specific, I wouldn't worry too much.

Is she sending the urine off to microbiology to be checked or anything like that?

I had the same when I was pregnant and was told to eat little and often to keep blood sugar up. I used to have lots of high carb snacks.
However I don't have diabetes - I am staggered that she didn't offer you more advice.

As a diabetic you should be being monitored for ketones more than most, as they are a sign of much more serious diabetic complications DKA ( diabetic ketoacidosis) which if severe can be life threatening. On the other hand anyone not taking enough food in can have ketones in their urine.

The very least with your background that she should be doing is making sure you have this rechacked within a fairly short time scale and monitored closely.

Personally I would suggest an appointment with your GP within the next cpouple of days and if you start to feel unwell or have raised BM's than seek medical advice quickly

Thanks for your replies.
nailpolih thankyou
springysunshine I am following the diabetic diet to the letter but they have told me my carb tolerence is so bad at the moment-my levels cant even take porrige ir cereal- i have had to cut them down so low.I'm sure thats why i'm feeling hungry.
She isn't sending my urine off for testing but has palmed me off to the hospital mw as i'm having so many things going on.
potplant I have been told to steer away from carb snacks as its playing havoc with readings.Not the most helpful MW in the world eh?!

dorisisapinkdragon Oh bugger that doesn't sound too good.I have an appt with the diabetic mw on Thurs so it will be checked then.My Blood pressure was up today as well-i'm not surprised to be honest.

I had ketosis in pregnancy too, as I couldn't keep anything down. I had to eat more (in my case, anything) and drink loads of water (I ended up on a drip).

I also had ketones, they are a sign of dehydration and I had to be admitted and put on a drip. I really would go to the hospital and make sure there are not too many ketones. Don't worry if there are, it is easily sorted but it should be seen to.

I had GD and had ketones in urine every time they checked towards the end - they didn't seem to think there was any big deal about it - just asked me if I hadn't eaten or had been sick. I think it was just the diabetic diet doing it.

Thankyou.
I will make sure i drink loads from now on incase thats having any effects.
I have turned into a real worry head today.I think things are getting on top of me today.Just feeling utterly miserable and cheesed off.
Sulk over.

nobodysfool,

ketones are a serious worry in diabetics if you have high blood sugar - like double figures high (alhough I think my clinics tollerance was 8.5) other than that it is probably due to not eating enough - or not drinking enough.

In all 3 of my pgcys I have had massive ketones - and have been IDD (insulin dependant diabetic) they ended up giving me a blood ketone monitor, as my blood sugars were always OK.

If you do have high blood sugar and showing ketones please call your maternity unit. You could ask your GP/MW for a prescription for ketone sticks so you can monitor your own urine.

It sounds like you need to be refered to a dietitian, as you certainly shouldnt be hungry, if your body isn't dealing with carbs then you need to be on insulin rather than starving yourself.

For me when I was pregnant a typical days diet was

breakfast, bowl of allbran with milk,
snack, a piece of fruit
lunch, 2 slices of bread with tuna,
snack, another piece of fruit, 2 digestive biscuits
dinner, vegetarian sausages, baked beans, baked potato
snack, 2 slices of toast and cup of milk

which although it was good carbs (wholemeal bread) there was certainly enough to keep me full.

Hopefully your diabetic team will sort you our pronto, but if you are hungry Im assuming that is why you are showing ketones.

You sound like you are having a hard time - hoping things start falling into place.

Thanks squidgybrains
I have seen the dietician and took along my food diary to prove i wasn't cheating and she said my fasting results were the main prob and suspected i may end up on medication.
I cant even eat all bran as it sends my readings up.Tried yoghurt with grape nuts and a mini baby bel for breakfast-told i must eat protein at every meal to lower my level for breakfast (nice combo eh?).
Level seemed ok all day until my evening meal-salad,chicken and wholemeal pitta bread.It went up to 8.1?!!
I think its the small amount of carbs that is leaving me hungry.AARRGGHH!!!I follow the diet to the letter and still can't get it under control I cant seem to win at the moment.
I'm really worried about the meds route and what effect it would have on the baby.Did any of your dc need to go into special care because of diabetes problems?

I went to see GP yesterday as I thought I had a UTI (I am 28 weeks) He dipped my urine, only ketones were positive despite me just having had breakfast.

wallaoo doesn't make much sense does it?

Nobodysfool,

it sounds like you do need medication. I started on insulin at 26wks with DS1 and then at 5wks with DD and 6wks with DS, It is rare to start as early - expecially I wasn't diabetic to begin with!

the lowest GI breakfast (which will effect your sugars least) is allbran so if you can't tollerate that I would say you do need to start meds. Grapenuts are actually high in sugar - they are malt and have maltese in them in a high level. A good cheat to lower the GI of a meal is some citrus, (dark chocolate over 70% is good when you are following a GI diet but perhaps not when you are pregnant)

Wholemeal pitas are not that low GI either - wholemeal pasta is though, and some breads. Boiled new potatoes are much better than baked potoatoes and chips are not too bad (as the fat stops the Carbs being absorbed as quick)

You wont win I am sorry to say - towards the end of your pregnancy your sugar levels get harder to control and your insulin requirements go up.

All my DC required a stay in special care due to my GD - but none required any treatment as a result. Just some monitoring.

The insulin (I can't think of any other med they would use so excuse me if I am wrong) would benifit the baby as it would regulate his/her sugars internally. Without them your baby is at higher risk of hypoglycemia when born I would assume as he/she would be used to high sugar levels and then have low sugar when they come out. Most diabetic babies just end up a bit bigger but they can also have slighly more imature lungs (I don't know why) I never had any issues as I was very strict with my sugar levels and my long term blood sugars showed that I was maintaining normal levels so my kids were all just under 7lbs.

You need to tell them that you are feeling hungry on the diet you are eating, but take some comfort in the fact that even if you ate nothing your blood sugar would still rise.

Hoping that they sort you out soon!

Wallaroo - it could have been that you just hadn't flushed the ketones that may have built up over night out your system. Really ketones are not a concern unless you are diabetic and your sugars are high, or you have them continually.

sorry that sounds a bit disjointed and impersonal - if you have any questions feel free to ask, I am more than happy to help

when i suggested dark chocolate I was meaning perhaps not when you are diabetic and pregnant

hoping the above is of some help

best regards
SB

So,sorry i have got my dense brain on,if i have an orange after all bran it should lower the reading even more?And the same goes for dark chocolate?Blimey will give that a go!
Glad to hear all your dc were fine.
They mentioned metformin as medication and have done a search on it and it seems to be used for pcos and fertility.Very odd.
Thanks for taking the time to talk to me about this.I really do appreciate it.

AHH metformin - yes it is a good drug for lowering blood sugar, they were never very keen on using it in pregnancy but things seem to have changed with it in the last couple of years and I stayed on it (i used it for PCOS then) when I was pg with DS2

Metformin is a very old diabetic drug - I will warn you now it can give you terrible side effects - the worst being an upset tummy and the loo will become your best friend if that happens - still the running to the loo might kick start things off and then you wont have to worry about the GD :O It works by making the insulin that you do have work more effectively and there for lowering your blood sugar (simplyfied version)

yes if you eat an orange (or grapefruit or a salad with some lemon dressing is good too(not for breakfast perhaps) following some all bran it will lower your blood sugar due to the acid (it is low GI and will lower the GI of other things in your meal) and yes dark chocolate has such a low GI that it is a great snack for low GI diets (just a little as you still need to watch the cals when dieting)

The thought is that Met doesn't transfer over the placenta so your baby will only get the lowered blood sugar effects so all good

I am off to bed - but will be back tomorrow if you want some more ramblings from me :O

Thanks again and i'm sure i will think of some more daft questions.

I used to have scrambled aggs for breakfast sometimes with bacon and or grilled tomatoes and mushrooms. None of these put my blood sugars up by much. It was a great excuse to have a fry up type breakfast!

mrsboogie, no none of these foods were as they are all protien only carbs effect your blood sugars.

Poxy bleeding levels have gone silly today they are all over the place.
Just as well i'm seeing the diabetic midwife in the morning.

Interseting thread, when PG I had Ketones but was negative for diabetes, I did lose wieght early on though. MW put it down to not eating enough but tbh I did nothing but eat - and healthily too. I found it very worrying as every appointment she would find protien and ketone (are they the same?) and occasionally blood in my urine. But every follow up test was negative.

I hope you manage to get yours under control. All I can say is that DD was a healthy and average 7.4 at birth and had no problems

Thanks callme it is strange how these things keep popping up the going just hoping they will have gone by my appt tom.

I know nothing about diabetes atall, but i had major ketones in my urine sample along with lots of blood and protiene, i was kept in for ages.

My high ketone level was due to the fact that i was so sick everyday of my pregnancy i was surviving on i.v fluids and vitamin drinks (bleugh!) and the odd Rich Tea biscuit.

I hope everything is ok and you go on to have a safe delivery and a healthy baby.