T1DM/T2DM

Question 1

T1DM/T2DM preg mx - AN/IP/PN

Answer 1

• Precon - FA/ACEI/Bloods/Vax/HbA1c<6
• Contraception till optimized then F/U to do bloods/MCS/folate/vaccination + routine preg advice - food safety/exericse etc…
• M risk - cx/DKA/Hypo/PIH/PET/IOL/CS
• F risk - Anom/LGA/FGR/Poly/PTB/SB
• N risk - RDS/hypo/DM…
• HbA1c, end-organ cx (eye/renalcard)
• Baseline PET screen +/- TTE
• Cease any teratogens
• MDI - Obs/Obs Med/Dietician/DNE
• Optom/Opthal rv each trimester
• Tertiary morph/Fetal echo/Serial G/S
• Regular Multi-D ANC - screen for PET
• LDA +/- Ca + Folate 5mg
• Monitor for dropping insulin req
• Lifestyle - etoh/smoke/exercise/Wt
• Timing
  38/40 (T1DM)
  39/40 (T2DM)
• MOD - vag > CS unless EFW>4kg
• IP - slide scale vs insulin infusion
• PN - reduce insulin dose-avoid hypo, BF, contraception, F/U endo re: DM mx, pre-preg counselling future preg - aim HbA1c <6

Question 2

Mx of DKA in pregnancy
(hypothetical)

Answer 2

DDx
- infection
- non-compliance
- pump failure
- starvation (N&V)

Mx
- high foetal mortality
- MDI - Obs/Endo/ICU/ Neo
- Bloods/MCS (? rx reversible factors)
- Correct & stabilization of mat conditio
- Admission/ICU
- correct K before insulin (hypergly)
- IVT (improve perfusion, hypergly)
- RTS/Obs USS +/- CTG
- +/- steroid +/- MgSo4 if Del
- follow-up - rv, serial G/S, D&E
- advice - avoid triggers