A 26-year-old woman with Type 1 diabetes at 22 weeks presents with two days of vomiting and abdominal pain. Glucose is 230 mg/dL, urine ketones are strongly positive, pH 7.18, bicarbonate 11 mEq/L. She is surprised she developed ketoacidosis despite near-normal glucose. The BEST explanation is:
- A Pregnancy induces a state of accelerated starvation with enhanced lipolysis, so ketoacidosis develops at lower glucose levels ✓
- B Pregnancy increases renal threshold for ketones, masking earlier warning glycosuria
- C Placental insulinase causes erratic insulin absorption from subcutaneous sites
- D Human placental lactogen directly stimulates hepatic ketogenesis independent of insulin
Correct answer: A. Pregnancy induces a state of accelerated starvation with enhanced lipolysis, so ketoacidosis develops at lower glucose levels
Explanation
Pregnancy is a state of accelerated starvation: reduced fasting glucose, enhanced lipolysis and free fatty acid availability mean that diabetic ketoacidosis in pregnancy can occur at glucose values under 250 mg/dL, unlike the marked hyperglycaemia typical outside pregnancy. Management follows standard principles of fluids, insulin infusion and potassium replacement. Renal threshold actually falls in pregnancy, increasing glycosuria, which makes option B factually wrong and the easiest distractor to eliminate.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.