Everything You Need to Know About Ketones and Pregnancy

First, DKA and ketones are two different things. Take a deep breath. 

We want to avoid DKA during pregnancy because it is very toxic to the baby. However, especially if you are an insulin pump user, there is a chance that you will face having ketones in your system due to faulty pump sites. In this post, we are going to talk about what to do if this happens.

Few tips to avoid ketones:

• When switching your pump site, place a new site on before taking the old site off to make sure that it’s working. If your blood sugar elevates and you think the new site might be bent, you can switch back to your old site until you’re able to replace it.

• Stay hydrated

• When eating meals, make sure to pre-bolus or use the extended bolus mode if eating a high fat/high carb meal

• Carry ketone strips with you so that you can check your levels should your blood sugar get stubborn

• Switch your pump site every 2-days during pregnancy once you’re later in your pregnancy (for me, it was week 24)

• Avoid changing pump site at bedtime to ensure the site is working before falling asleep

What to do if you have ketones:

• If using an insulin pump, inject using an injection

• Drink water (more than necessary) because you want to flush the ketones from your body

• If your BG is within a good range but you are experiencing ketones, eat carbs and bolus to cover the carbs (ketones happen when we don’t have enough insulin in our system, but if your BG is not high you’ll need to consume carbs to prevent going low).

• Drop and do 100 squats

• Take a hot shower (the hot water can quicken the rate at which insulin is absorbed)

• Go for a walk or do some LISS (low-intensity steady state) exercise

Here is the advice my medical team gave me when I was 25 weeks pregnant and experiencing mild to moderate ketones:

• Stay well hydrated (like drink more water than you usually would)

• For lows, pair your carb with a protein to avoid the spike

• As your pregnancy progresses you will become more resistant to insulin. If you are above 150 after 2 pump corrections over 2 hrs, you should immediately take your correction by injection.

• Travel is difficult as it changes your routine. Just try to do the best you can with choices and portions. 

• The usual amount of carbs to treat a low below 65 is 10 gms when you are pregnant. 

• If you are below 50 you can do 20gms.

• If you are low and have insulin on board you will need to eat for the insulin that you have on board. 

• Don’t ever go to bed with high blood glucose while pregnant. 

Takeaway:

• If using a pump, and you inject a correction and blood glucose does not come down after administering a correction or if it’s rising after 2 hours, immediately take correction via injection and try changing your site.

• If your blood sugar is down at least 60 points after 1-2 hours after giving a correction using your pump, then that’s a good sign. Administer corrections using your pump 1-2 hrs until you reach your goal.

• If you inject your correction via injection, an intramuscular injection can often help bring blood glucose down faster because your body will absorb it more quickly.

• Staying extra hydrated and administering insulin is important to help flush ketones and bring blood glucose back down to a normal range.

Blood Glucose Targets During Pregnancy:

Fasting – 65 to 90

Before Meals – 90 – 100

One hour after meals – 130 or less

Two hours after a meal – 120 or less

Bedtime – 100 to 120

A1C target during pregnancy:

<6%

Taja’s Note:

Avoiding DKA and ketones during pregnancy is crucial. However, keeping blood sugar targets in range is a lot of hard work and there will be days when your blood sugar is playing up and it doesn’t necessarily mean that it will have a negative effect on the baby. Do your very best and stay on top of things to avoid ketones, and also, so that you can catch your sugars when/if this happens, and know that you are doing a great job, mama!

It’s good to be aware, yet not live in fear, so take a deep breath and try not to worry. As long as you are proactive and catch things quickly, I think you are doing just fine. XO

DKA is a medical emergency. This is not medical advice and you should seek hospital attention if needed, or if you are experiencing large ketones.