Type 1 and 2 DM

Question 1

BSL targets

Answer 1

Fasting <5.5

2hr post prandial <6.5

Question 2

Eye checks

Answer 2

Increased risk of retinopathy with improved control

Ophthalmology check at start of pregnancy if no check within last 3 months and recheck at 28 weeks

If diabetic retinopathy also check at weeks 16-20

Question 3

Indications for nephrology referral

Answer 3

Cr>120

ACR>30mg/mmol

Protein>0.5g/day

Question 4

Preventative PET Mx

Answer 4

Increased risk of PET (increases further if poor glycemic control in trimester one)

Offer prophylaxis to all women

Question 5

BSL target during delivery

Answer 5

BSL 4-7

Avoid hypoglycaemia

Question 6

Post partum BSL Mx

Answer 6

Return to pre-pregnancy insulin dose

OR

Reduce insulin by 25-40%

Question 7

Risks during pregnancy for patients with pre-existing diabetes

Answer 7

Maternal: increased insulin requirements (usually doubles and rises from 18/40), ketosis, worsening retinopathy, increased proteinuria, miscarriage, PET, increased c/section rate, HT

Fetal: congenital abnormalities, increased perinatal mortality, macrosomia, late still birth, jaundice, 2-3% risk T1DM if mother has it

IOL usually 37-38+6/40

Question 8

Hypoglycaemia

Answer 8

BSL <4

Severe if BSL <3