diabetes_mellitus_flashcards

Question 1

What medications should be adjusted pre-conception for diabetes mellitus?

Answer 1

Advise to stop all glucose-lowering agents except metformin and insulin. Stop ACEi and ARB and use alternative antihypertensives.

Question 2

What dose of folic acid is recommended pre-conception and until when?

Answer 2

High-dose folic acid 5mg OD from pre-conception until 12 weeks gestation.

Question 3

When should HbA1c be measured during pregnancy?

Answer 3

At the booking appointment.

Question 4

How often should appointments with the joint diabetes and antenatal clinic be arranged?

Answer 4

Every 1-2 weeks.

Question 5

What conservative advice should be given antenatally for diabetes management?

Answer 5

Ensure mother is up to date with retinal and renal screening. Give advice about possible implications of diabetes on pregnancy.

Question 6

How frequently should capillary blood glucose be monitored by the patient?

Answer 6

A minimum of 7 times/day (check fasting, pre-meal, 1-hour post-meal, and bedtime glucose daily).

Question 7

What are the target glucose levels for pre-prandial and post-prandial readings?

Answer 7

Pre-prandial target = <5.3 mmol/l, 1-hour post-prandial target = <7.8 mmol/l, 2 hours post-prandial target = <6.4 mmol/l.

Question 8

What should be advised to women taking insulin during pregnancy?

Answer 8

To keep their capillary blood glucose above 4mmol/l at all times.

Question 9

What specialist scan is recommended at 19-20 weeks for diabetic pregnant women?

Answer 9

Specialist foetal cardiac scan.

Question 10

How often should serial growth scans be performed antenatally for diabetes?

Answer 10

Every 4 weeks from 28-36 weeks.

Question 11

When should maternal retinal and renal screening be repeated?

Answer 11

If abnormal at booking, repeat at 16-20 weeks. In all cases, repeat at 28 weeks.

Question 12

What medical advice should continue until 12 weeks gestation?

Answer 12

Continue high-dose folic acid 5mg OD and low-dose aspirin 75-150mg OD from 12 weeks gestation.

Question 13

What should be advised to patients about insulin resistance during pregnancy?

Answer 13

They may need to increase their insulin doses after 20+0 weeks based on capillary blood glucose measurements.

Question 14

When should elective birth be organized for type 1 or 2 diabetic women with no other complications?

Answer 14

Between 37+0 – 38+6 weeks (IOL or CS).

Question 15

When should delivery be considered earlier than 37 weeks?

Answer 15

In the presence of foetal or maternal complications.

Question 16

What additional therapy is needed if antenatal corticosteroids are given?

Answer 16

Additional insulin therapy must be given concurrently to maintain normoglycaemia.

Question 17

Where should birth take place for diabetic women?

Answer 17

In a hospital.

Question 18

How often should capillary glucose be monitored during labour and birth?

Answer 18

Every hour.

Question 19

What is recommended for women on insulin during labour?

Answer 19

Commence a sliding scale during labour, aiming for blood glucose levels between 4-7 mmol/l.

Question 20

When should neonatal blood glucose be checked postnatally?

Answer 20

Within 4 hours of birth to exclude neonatal hypoglycaemia.

Question 21

When should women feed their baby postnatally?

Answer 21

Within 30 minutes after birth and then every 2-3 hours until their pre-feed capillary glucose maintains at least 2.0 mmol/l.

Question 22

What should be done for women postnatally regarding diabetes care?

Answer 22

Refer women back to their routine diabetes care arrangements.

Question 23

What adjustments should be made to insulin and metformin doses postnatally?

Answer 23

Adjust doses back to those of pre-pregnancy immediately after birth.