diabetes in P and BF

Question 1

Women with pre-existing diabetes who are planning on becoming pregnant should aim to keep their HbA1c conc below

Answer 1

below 48mmol/mol (6.5%) if possible without causing problematic hypoglycaemia

Any reduction towards this target is likely to reduce the risk of congenital malformations in the new-born

Question 2

diabetes in pregnancy is associated with risks to the woman compared with pregnancy in non diabetes

name 2 risks

Answer 2

pre eclampsia
rapidly worsening retinopathy

Question 3

Women with pre existing diabetes who are planning to become pregnant should take the following supplement

Answer 3

folic acid 5mg

5mg = dose for women who are at high risk of conceiving a child with a neural tube defect

Question 4

which oral antidiabetics need to be discontinued before pregnancy, or as soon as unplanned pregnancy is identified

Answer 4

all except metformin

substitute with insulin

Question 5

which drug can be continued immediately after birth and during BF for pt with pre existing T2D?

Answer 5

metformin

Question 6

which drugs need to be avoided while BF?

Answer 6

ALL except metformin

Question 7

When can women with diabetes be treated with metformin as adjunct or alt to insulin

Answer 7

in the preconception period and during P when the likely benefits from improved BG control outweigh the potential for harm

Question 8

limited evidence suggests that the following insulin can be associated with fewer episodes of hypo, a reduction in postprandial glucose excursions and an improvement in overall glycaemic control compared with regular human insulin

Answer 8

RA insulin analogues

(LAG lispro aspart glulisine)

Question 9

what is the first choice for long acting insulin during pregnancy

Answer 9

isophane insulin

however in women who have good BG control before pregnancy with the long acting insulin analogues, it may be appropriate to continue them

Question 10

when may continuous SC insulin infusion via insulin pump therapy be appropriate

Answer 10

pregnant women who have difficulty achieving glycaemic control with multiple daily injections of insulin without significant disabling hypoglycaemia.

Question 11

All women treated with insulin during pregnancy should be aware of the risks of hypoglycaemia, particularly in the …… trimester, and should be advised to always carry a fast-acting form of glucose, such as ….(2)…..

Answer 11

1st trimester

e.g. dextrose tabs, glucose containing drink

Question 12

what should pregnant women with T1D also be prescribed

Answer 12

glucagon for use if needed.

Question 13

women with pre existing DM that are treated with insulin during pregnancy are at increased risk of ……. in the postnatal period

Answer 13

HYPOglycaemia

reduce insulin immediately after birth

monitor BGC carefully to establish approrpiate dose

Question 14

medication for diabetic complications - the following should be discontinued and replaced with alt antihypertensive suitable for pregnancy

Answer 14

Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists should be discontinued and replaced with an alternative antihypertensive suitable for use in pregnancy before conception or as soon as pregnancy is confirmed

e.g. 1st line labetolol, then MR nifedipine, then methyldopa

Question 15

Statins should be discontinued …. before attempting to concieve

Answer 15

3 months

Question 16

Management of gestational diabetes if pt has fasting plasma glucose <7

Answer 16

1. diet and exercise changes alone

if BG targets not met within 1-2 weeks, prescribe metformin

insulin if metformin CI/unacceptable

insulin can be added to metformin if metformin alone is not effective

Question 17

management of women with gestational diabetes who have fasting BG >7 at diagnosis

Answer 17

insulin immediately, with or w/o metformin PLUS diet and exercise

Question 18

management women who have a fasting plasma glucose between 6-6.9 alongside complications e.g. macrosomia (growth beyond an absolute birth weight) or hydramnios (accumulation of excess amniotic fluid)

Answer 18

consider for immediate insulin treatment with or w/o metformin

Question 19

when should women with gestational diabetes discontinue hypoglycaemia treatment

Answer 19

immediately after giving birth.