Diabetes, Ketone Testing in Diabetes and Pregnancy (360)

Objectives

This guideline covers diagnosing the management of ketone testing with diabetes in pregnancy.  It aims to improve care within the clinical environment and ensures quicker, more accurate diagnosis of concerns and the importance of accurate ketone testing and to specify the most effective treatment/pathway for the women.

Scope

GGC Maternity staff. This guidance is written for and applies to Obstetric, Midwifery and Diabetology staff involved in caring for pregnant women with diabetes- and any other members of the maternity multi-disciplinary team. 

Audience

All midwives, obstetric staff and anyone else providing clinical care or guidance to women who require Ketone testing, should observe the guidelines and ensure that local protocols and medical advice from a specialist is sought.

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Diabetic ketoacidosis in pregnancy can be life threatening for mother and fetus.

Women with type 1 diabetes are at most risk and are likely to be able to monitor blood ketones at home. Women with type 2 diabetes or gestational diabetes are also at risk during illness or after steroids even in the context of normal glucose.  Diabetes teams will advise on home monitoring of ketones.  All women with diabetes during pregnancy should be tested if admitted or assessed in daycare.