Obs Prexisting DM

Question 1

What are the monitoring needed for preexisting DM

Answer 1

Blood glucose at least 7x a day - after each meal, waking, before each meal
and before bed on insulin
fasting <5.3, 1h post 7.8
Specialist cardiac foetal scan at 19w
Growth scans every 2w from 28-36

Question 2

What are the treatemtns for prexisting DM

Answer 2

Metformin and insulin are the main one

T2DM- educate diet, weight loss
and start metformin to control (add insulin if cant)

t1dm- insulin straight ahead, but dose will increase

folic acid 5MG
aspirin 75mmg

Question 3

Intrapartum management of preexisting DM

Answer 3

Timing decided by foetal size
but if glucose undercontrol - 38-39w
If not, 37w IOL can be needed

is use steroids- need to give insulin extra
sliding scale aim to maintain 4-7mmol/g