Diabetes - Introduction

Question 1

% pregnant women with diabetes

Answer 1

• 87.5 % GDM
• 7.5 % type 1
• 5 % type 2

Question 2

Pre - existing diabetes targets

Answer 2

• Fasting plasma glucose level of 5–7 mmol/litre am

- BM 4–7 mmol/litre before meals at other times of the day

Question 3

GDM diagnosis

Answer 3

• Fasting plasma glucose level of 5.6 mmol/litre above or

- 2‑hour plasma glucose level of 7.8 mmol/litre or above

Question 4

If pt diagnosed with GDM needs to keep BMs

Answer 4

• Fasting: 5.3 mmol/litre
• 1 hour after meals: 7.8 mmol/litre
• 2 hours after meals: 6.4 mmol/litre

Question 5

HbA1c above which level should not get pregnant

Answer 5

86 mmol/l

10%

Question 6

Types of insulin to use in pregnancy

Answer 6

• Isophane insulin (also known as NPH insulin) as the first choice for long‑acting insulin
• Consider continuing treatment with long‑acting insulin analogues (insulin detemir or insulin glargine) in women with diabetes who have established good blood glucose control before pregnancy

Question 7

Glycosuria in pregnancy

Answer 7

• 2+ or above on 1 occasion or of 1+ or above on 2 or more occasions may indicate undiagnosed gestational diabetes
• Perform GTT

Question 8

If fasting glucose on GTT > 7

Answer 8

Go straight to metformin/insulin

Question 9

If fasting glucose 6.0 - 6.9 with macrosomia and polyhydramnios

Answer 9

Go straight to metformin/insulin

Question 10

Consider glibenclamide in GDM

Answer 10

• If woman declines insulin

- If woman cannot tolerate metformin

Question 11

Renal parameters that need referral in diabetic pts

Answer 11

• Serum creatinine 120 micromol/litre or more
• Urinary albumin:creatinine ratio is greater than 30 mg/mmol
• Total protein excretion exceeds 0.5 g/day
• Thromboprophylaxis should be considered with nephrotic range proteinuria above 5 g/day (albumin:creatinine ratio greater than 220 mg/mmol).