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Gestational Diabetes Care Guidelines

Urine Ketone Testing

  • Ketone testing is an important part of monitoring gestational diabetes.
  • Consider urine ketone testing if
    • Patient is obese (> or equal to 26 BMI)
    • Patient experiences weight loss
    • Insulin therapy is initiated
    • Patient has other illnesses
  • Significance of ketonuria needs to consider that, since a number of patients will have ketonuria because of normal pregnancy physiology.
  • Discontinue ketone testing if all results are trace or less.
  • Moderate or higher ketones reflect inadequate calories (starvation ketosis) NOT diabetic ketoacidosis.
  • If results are frequently positive then a referral to an RD for MNT should be considered even if increased calories require initiation of insulin therapy to achieve euglycemia.

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