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Ketoacidosis, for women with type 1 diabetes

High blood glucose levels can put you at risk of a serious condition called diabetic ketoacidosis (DKA).

If there is not enough insulin for your body cells to use glucose for energy, your blood glucose levels will rise and your body will break down fats instead (as another energy source). However, fat breakdown leads to your body forming ketones which you can detect in your blood or urine. High blood glucose levels and ketones can result in DKA, requiring hospitalisation.

Ketoacidosis may occur when you are unwell, have morning sickness, forget to take your insulin or don’t take enough insulin or there is a problem with the delivery of insulin from your insulin pump. Vomiting or a very low carbohydrate diet are also risk factors for ketoacidosis in pregnancy. In pregnancy, ketones may be present without blood glucose levels being high, which if left untreated can develop into ketoacidosis.

The risk of ketoacidosis increases during pregnancy and is very dangerous. Ketoacidosis can be life-threatening for both mother and baby.

Always check for ketones if:

  • your blood glucose level is elevated (e.g. 12–15mmol or higher for 2 hours or more),
  • you are unwell, or
  • have symptoms of ketoacidosis such as nausea, vomiting and/or stomach pain, increased thirst and/or a dry mouth, increased urination, rapid breathing or shortness of breath, fruity-smelling breath, or feeling drowsy, weak, or confused.

To check for ketones you can use a monitor which can detect both glucose and ketones in your blood. If you do not have access to blood ketone monitoring, you can check for ketones using urine monitoring strips (these are available where you buy your blood glucose monitoring strips).

However, blood ketone monitoring is recommended wherever possible, as it is more accurate than urine testing.

If your blood glucose levels are high and there is any sign of ketoacidosis; your blood ketones are 1.5mmol/L or more (or urine ketones 2+ or more); or you have nausea/vomiting where you are unable to hold down fluids, seek urgent medical attention (call your doctor, credentialled diabetes educator, diabetes nurse practitioner or go to the Emergency Department of your nearest hospital.