Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What management plan should be implemented for a pregnant patient with Type 2 Diabetes experiencing mild ketones in urine?

1. No adjustment is necessary if blood glucose is controlled

2. Increase bedtime basal insulin dose

3. Increase dietary fat intake to prevent weight loss

4. Add a substantial bedtime snack with prandial insulin

The correct answer is: Add a substantial bedtime snack with prandial insulin

In the case of a pregnant patient with Type 2 diabetes who is experiencing mild ketones in the urine, adding a substantial bedtime snack with prandial insulin is the most appropriate management plan. The presence of ketones, even if mild, indicates a degree of insulin deficiency or inadequate calorie intake, which can be concerning during pregnancy. Managing diabetes during pregnancy requires careful control of blood glucose levels to support both the mother's and the fetus's health. The production of ketones suggests that the body may be breaking down fat for energy due to insufficient carbohydrates or insulin to properly utilize glucose. By adding a bedtime snack, the goal is to ensure that the patient has an adequate intake of carbohydrates that can help prevent the development of further ketones while also stabilizing blood glucose levels throughout the night. Prandial insulin can assist in facilitating the use of that carbohydrate intake effectively, thereby minimizing the risk of ketone production. In contrast, simply maintaining current management without adjustment may overlook the potential risks associated with ketosis during pregnancy. Increasing basal insulin doses might not be necessary if blood glucose levels are already well controlled, and increasing dietary fat intake is not a suitable strategy, as this does not address the underlying issue of insulin availability and may actually increase the risk of further ket