Diabetes In Pregnancy

Question 1

What is important to mention in pre-conceptional counseling for a diabetic?

Answer 1

Very tight blood sugar control NB starting at least 3/12 belfry pregnancy commenced
Postprandial

Question 2

What changes are seen in T1 in a diabetic patient?

Answer 2

No metabolic hormonal changes

Nausea and vomiting –> hypoglycaemia common

Question 3

What changes are seen in T2&T3 in a diabetic?

Answer 3

Increase in hormones affecting metabolic status:

• human placental lactogen / human chorionic somatotrophin
• elevated free cortisol
• other steroid hormones

Question 4

How does treatment change in T2/3?

Answer 4

More meds needed to achieve pregnancy goals for blood glucose
Pregnancy goals= FBS

Question 5

How is the insulin sliding scale determined?

Answer 5

Check blood glucose 30min before eating
4.1-6.0 use 6 units insulin (4 type 1)
6.1-8.0 use 12 units (8 type 1)
8.1-10.0 use 18 units (12 type 1)
>10.0 use 24 units (16 type 1)

Question 6

What is the diabetic woman at risk for during labour and what precaution is usually taken?

Answer 6

Emergency C/S. Usually NPM

Question 7

What medication is needed during labour and why?

Answer 7

Continuous insulin and IV glucose
Need insulin - subcutaneous pump at 1-2 units per hour- to absorb sugar
Need glucose- 100ml 5% dextrose per hour- because NPM
Aim for blood glucose between 4-6

Question 8

How does management of a diabetic change immediately postpartum?

Answer 8

Need for insulin/meds plummets after delivery
HPL inhibited anterior pituitary which takes time to restore function
Use sliding scale for insulin
Will likely be discharged on too low dose of insulin therefore need close monitoring

Question 9

What problems are seen in the fetus of a diabetic mother?

Answer 9

Macrosomia
Anomalies- especially cardiac and NTDs
Unexplained mature stillbirths
Polyhydramnios

Question 10

What are the problems for the neonate of a diabetic mother?

Answer 10

Birth trauma - shoulder dystocia
Hypoglycaemia
Immature
Polycythemia
Jaundice
Respiratory distress syndrome

Question 11

Is there a difference in severity of problems in a type 1 versus type 2 diabetic?

Answer 11

No

Question 12

Is metformin safe and effective in pregnancy?

Answer 12

Yes.
Safe in PCOS
Reduces prevalence of GDM
Safe in type 2 pregestational DM
No evidence of teratogenicity

Question 13

Is glibenclamide safe and effective in pregnancy?

Answer 13

Safe in gestational DM, can be combined with metformin in GDM
Not as effective in pregestational DM
No evidence of teratogenicity

Question 14

What is gestational diabetes?

Answer 14

Any abnormality of carbohydrate metabolism (IGT and DM) first diagnosed during the index pregnancy

Question 15

How is GDM diagnosed?

Answer 15

In pregnancy
FBS >5.4
2 hour post 75g glucose challenge >7.9