Pregnancy & breastfeeding Flashcards
Pregnancy planning in pre-existing diabetes
Reduce risk of congential malformations by:
- HbA1c <48 mmol/mol (6.5%)
- Folic acid 5 mg OD (diabetes = high risk group for neural tube defects)
Insulin treatment
Longer-acting 1st choice:
- Isophane insulin
- May be appropriate to continue using long-acting analogues (glargine or detemir), if good glycaemic control before pregnancy
Continuous S/C infusion pump
- Women with difficulty achieving glycaemia control with multiple daily injections
- Only given to those without significant, disabling hypoglycaemia (continuous insulin = increase risk of hypoglycaemia)
Post-natal
Increased risk of hypoglycaemia
Reduce insulin immediately after birth
Monitor blood glucose to establish dose
Insulin + diabetes - patient counselling
Risk of hypoglycaemia in all pregnant women treated with insulin (ESP in 1st trimester)
- Carry a fast acting glucose e.g. dextrose/glucose drink
- Type 1 prescribed glucagon
Type 2 diabetes
Stop all oral antidiabetic drugs except metformin.
Substitute with insulin
Metformin alone or with insulin
BF - type 2
Continue metformin or resume glibenclamide post-birth
Gestational diabetes
Stop treatment after birth
Gestational - fasting blood glucose <7 mmol/L
1st line = diet + exercise
2nd line = metformin in blood glucose target not met within 1-2 weeks.
Alternative = insulin (also added if metformin alone ineffective)
Gestational - fasting blood glucose >7 mmol/L
1st line = Insulin with or without metformin + dietary and exercise measures
Gestational - fasting blood glucose 6-6.9 mmol/L with hydramnios or macrosomia
1st line = Insulin with or without metformin
Gestational - women intolerant of metformin and do not want insulin
Glibenclamide (from 11 weeks gestation; after oragnogenesis)
Insulin
Insulin requirements increase in 2nd and 3rd trimester
Diagnosis of gestational diabetes
Fasting = 5.3 mmol/L or above
2 hour glucose test = 7.8 mmol/L or above
Targets
Same as diagnosis
