[CG] Ketone testing in diabetes and pregnancy

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If urinary ketones are ≥1+ AND the blood glucose is <10mmoL/l AND the patient is well and eating properly then the patient should be advised to repeat the test after eating (up to 30% of women have urinary ketones while fasting in pregnancy). If the urinary ketones are still ≥1+ then the patient should attend Maternity Assessment. 

If blood ketones are >0.3mmol/l OR the patient is unwell the patient should attend maternity assessment. 

Further assessment in Maternity Assessment should include:  

  1. Repeat urinary ketones and blood ketones
  2. Random blood glucose and U&E’s including venous bicarbonate
  3. History and examination

If repeat blood ketones <0.3mmol/l (if blood ketones not available, urine ketones ≤1+)  AND plasma glucose <10 AND venous bicarbonate is ≥17 AND no concern regarding mother or baby then the patient may be allowed home. Arrange to see at diabetic ANC within 1 week. Additional follow up or advice may be obtained through the Diabetes Consultants or Diabetes specialist nurses between 9am‐5pm Monday to Friday or Medical Registrar overnight and weekends. 

If blood ketones >0.3mmol/l (if blood ketones not available, urine ketones >1+) OR plasma glucose >10 AND venous bicarbonate is <17 OR concern regarding mother or baby then arrange assessment by the Obstetric Medical staff with a view to admission for the antenatal pregnancy insulin regime. Arrange venous gas and if H+ is elevated then Senior Obstetric and Medical review should be arranged immediately. The Diabetes Consultant or Diabetes Specialist nurse should be informed (9am‐5pm Monday to Friday). Further assessment can be sought from the Medical Registrar, On‐call Obstetric Consultant or On‐call Medical Consultant overnight and at weekends. 

If blood ketones <0.3mmol/l (if blood ketones not available, urine ketones ≤1+)  AND plasma glucose <10 BUT venous bicarbonate is <17 then arrange venous gas and assessment by Obstetric medical team as low bicarbonate level is not related to diabetes. If the patient is clinically well and H+ is normal then the patient can be discharged following satisfactory obstetric review. 

Last reviewed: 12 January 2017

Next review: 30 April 2022

Author(s): Robbie Lindsay

Approved By: Obstetrics Clinical Governance Group