Caring for the Diabetic Mother Flashcards
What is the prevalence of diabetes in pregnancy? (with reference)
NICE (2015) 5% of women have diabetes in pregnancy
Define Type 1 diabetes
Type one diabetes is an absolute lack of insulin produced by the pancreatic beta cells due to damage or destruction. They will need to be on insulin.
Define Type 2 diabetes
Type 2 diabetes is insulin resistance or insufficient insulin production. It can be treated with diet and exercise or may need metformin or insulin.
GDM
Diabetes identified in pregnancy caused by pregnancy induced insulin resistance.
What are target blood glucose levels?
Fasting - 5.3mmol/l
1 hour post meal - 6.4mmol/l
2 hour post-meal - 7.8mmol/l
What are the general principles of care for women with diabetes? (ref)
NICE (2015) advocate a thorough care plan for women with diabetes including education and risks throughout pregnancy, labour and postnatally. Multidsciplinary contact and healthy lifestyle advice should also be included.
Pre-Conception Care
NICE (2015) Encourage women to have good glucose control prior to getting pregnant as it reduced adverse birth outcomes.
Inform women of risks associated with diabetes in pregnancy.
Booking Appointment
If previous diabetes, take a detailed history including medication, complications and inform women of risks including care plan, birth, BF, PN etc
Women should also be informed of target glucose levels.
1 hour post-meal and at bedtime. Information should ideally be given in verbal and written form.
A care plan including contact with diabetic team and ANC care should be arranged every 1-2 weeks of pregnancy.
Women with previous diabetes should have a HbA1C test at booking to establish severity.
Women should be offered retinal and renal testing if not had for 3 months.
Women with previous GDM should have GTT booked at booking as well as at 24-28 weeks.
Women with type one or other on insulin should be testing blood sugars fasting, pre-meal,
AN Care, main differences
Scans every 4 weeks form 28 weeks to test for fetal growth and liquor,
Renal and retinal testing
GTT at 24-28 weeks for high risk ladies. If GDM, referral to diabetic specialist within 1 week. Diet and exercise controlled for 2 weeks and if not, put on metformin.
At 36 weeks, information given about timing of birth, analgesia, glucose monitoring, BF, contraception and follow up.
When are diabetic women recommended to give birth?
Type 1 and 2 - IOL at 37-38+6
GDM no later than 40+6
Intrapartum care for diabetic women
Type one have an IV infusion throughout lasbour.
GDM + type 2 should monitor glucose levels hourly. If they are not maintained between 4 and 7 they may also need infusion.
If GA is needed, BM’s to be done every 30 minutes.
PN care for diabetic women
GDM stop taking drugs. Monitor glucose pre-meal for 24 hours. If above 7, refer to diabetic tea,m otehrwise arrange GTT at 6 weeks. Give advice on diet and exercise and advise about risk of GDM in future pregnancy as well as developing type 2 diabetes.
Type 1 - adjust insulin acordingly. If BF, Gregory et al. 2008 suggests reducing insulin by 30%
Type 1 and 2 - Reduce levels of drugs.
