Ketosis

Ketosis occurs when the liver’s glycogen stores are depleted, and the body makes glucose from fatty acids and amino acids. Severe ketosis is called ketoacidosis. It is accompanied by dehydration, lethargy, nausea and/or vomiting, confusion, tachycardia, and hypotension, and can progress to coma. In addition to maternal effects, ketoacidosis has been associated with toxicity to the developing fetus. Ketonemia (ketones in the blood) is indicated by measuring ketones in the urine (ketonuria). Ketotic breath (fruity, with an acetone smell) is another indicator of ketoacidosis.

Urine ketones are generally checked daily, in the fasting state (usually first morning urine) and during the day when meals are missed, if the client is ill, if blood glucose levels are >200 mg/dl, in women with insufficient energy and/or carbohydrate intake, and women experiencing weight loss during pregnancy. (NCM)

Potential Causes of Ketosis in Women with GDM

• Inadequate energy or carbohydrate intake
• Omission of meals or snacks
• Prolonged intervals between meals (e.g., >10 hours between bedtime snack and breakfast)
• Possible worsening of glucose status, with blood glucose >200 mg/dl
• Illness
• Inadequate insulin dose