DIABETES IN PREGANCY + GESTATIONAL DIABETES

Question 1

What are the two types of diabetes in pregnancy?

Answer 1

1. Pre-existing diabetes
   - So they have Type 1 or Type 2 and then become pregnant
   OR
2. Gestational diabetes
   - They develop diabetes during pregnancy
   - Once given birth, diabetes disappears

Question 2

What is the risk to the mother if there is diabetes in pregnancy?

Answer 2

• Pre-eclampsia
• Rapidly worsening retinopathy
• Miscarriage

Question 3

What is the risk to the fetus if there is diabetes during pregnancy?

Answer 3

• Congenital malformations
• Stillbirth (neonatal death)

Question 4

What is the advice for women with preexisting diabetes who want to become pregnant?

Answer 4

• Aim for HbA1c < 48mmol/mol
• Take folic acid 5mg daily

Question 5

What is the target capillary blood glucose concentration in women with preexisting type 1
diabetes during the pre-conception period?

Answer 5

Waking:
5-7 mmol/l
Before meals at other times of the day:
4 - 7 mmol/l

Question 6

What is the target blood glucose concentration during pregnancy?

Answer 6

Fasting: 5.3 mmol/l
1 hour after meal: 7.8 mmol/I
2 hours after meal: 6.4 mmol/I

And if on insulin, to keep blood glucose above 4 mmol/l

Question 7

Folic acid regime in pregnancy and type 2 diabetes

Answer 7

• T2DM
• Metformin
• Folic acid supplementation: folic acid 5mg preconception and until week 12 pregnancy

Question 8

What do you do to the oral antidiabetic drugs if they have preexisting diabetes and want to become pregnant and during pregnancy?

Answer 8

• All oral antidiabetics except metformin should be stopped
• Replaced with insulin, isophane insulin is the first-choice for long-acting insulin during pregnancy
• So, metformin and/or insulin

Question 9

What is the first line choice of insulin in pregnancy?

Answer 9

• Isophane insulin
• May be appropriate to continue using long-acting analogues (glargine or detemir), if good glycaemic control before pregnancy

Question 10

What is the risk of insulin treatment during pregnancy?

Answer 10

• Risk of hypoglycaemia (particularly in first trimester)
• Pregnant women should be advised to carry fast-acting forms of glucose e.g. dextrose tablets or glucose-containing drinks
• Pregnant women with Type 1 diabetes should also be prescribed glucagon for when they need it.

Question 11

Post-natal

Answer 11

Increased risk of hypoglycaemia
Reduce insulin immediately after birth
Monitor blood glucose to establish dose

Question 12

If patient taking statins / ACE-I / ARBS →

Answer 12

DISCONTINUE
hypertension alt = labetalol/ methyldopa

Question 13

BF - type 2

Answer 13

Continue metformin or resume glibenclamide post-birth

Question 14

Gestational diabetes

Answer 14

Developed during pregnancy
Stop treatment after birth

Question 15

RF - gestational diabetes

Answer 15

• BMI > 30 (adjusted for ethnicity)
• Previous macrosomic baby weighing 4.5kg or more
• Previous gestational diabetes
• Family history of diabetes (first-degree relative with diabetes)

Question 16

Which tests are used to diagnose gestational diabetes?

Answer 16

• HbA1c
• cBG
• Oral glucose tolerance test
  (OGTT)

Question 17

What is involved in the oral glucose tolerance test?

Answer 17

1. Measuring blood glucose after fasting
2. Then measuring after 2 hours after a standard anhydrous glucose drink

Question 18

Diagnosis of gestational diabetes

Answer 18

Fasting = 5.6 mmol/L or above
2 hour glucose test = 7.8 mmol/L or above

Question 19

Fasting BG < 7mmol/L

Answer 19

1. Diet and exercise
2. Metformin
3. Insulin if metformin CI, not tolerated or ineffective

Question 20

Fasting BG > 7mmol/L

Answer 20

1. Insulin immediately + metformin + changes in diet and exercise

Question 21

Glibenclamide

Answer 21

discontinued???