Diabetes in pregnancy NICE Flashcards
(44 cards)
Risk of T1/T2DM on pregnancy?
Increased risk miscarriage, congenital malformation, stillbirth neonatal death
Reduced but not eliminated with good glycaemia control
Pre-pregnancy advice T1/T2DM
Lose weight if BMI >27
5mg folic acid until 12/40
Monthly HbA1ca aiming <48 6.5%
T1DM fasting BM 5-7 on waking and before meals 4-7
Stop other agents other than insulin and metformin
Stop ACEi/ARBs/statins
Retinal assessment
Renal assessment - measure alumbinuria
If HbA1C above which level should you advice against pregnancy until lowered?
> 86 10%
Which long acting insulin is 1st line in pregnancy?
Isophane insulin (NPH insulin) or can continue long acting analogues (detemir/glargine)
When to refer to nephrologist before stopping contraception
Serum creatinine >120 or
urinary albumin creatinine ration >30
eGFR < 45
Which women are at risk of GDM
BMI >30
Previous >4.5kg baby
Prv GDM
1st degree relative with GDM
Ethnicity with high prevelcne
Glycosuria 2+ 1 occasion, or 1+ on 2 occasions
If previous GDM when to offer testing
Either early self monitoring
or
75g 2 hr OGTT as soon as after booking and at 24/28 weeks gestation
If other risk factor when to perform OGTT
24-28 weeks
Dx women with OGTT if
Fast >5.6
2hr >7.8
After GDM Dx, how quickly should be seen in JANC?
1 week
What risks should be explained to GDM
Fetal macrosomia
Trauma during birth (her and baby)
IOL and CS
Neonatal hypoglycaemia
Perinatal death
Reduced with BM control
For which women can a trial of diet and exercise be offered
If fasting BM <7
If targets not met within 1-2 weeks offer metformin
If fasting BM >7 in GDM Dx
Offer immediate treatment with insulin +/- metformin
Diet and exercise changes
If BMI 6-6.9 and complications such as macrosomia/hydramnios
Immediate Insulin +/- metformin
Diet and exercise
If Type 1 or Type 2/GDM on multiple day insulin, when to test Bus
Fasting
Pre-meal
1 hours post meal
Bedtime blood glucose
T2DM or GDM managing with diet or single therapy or intermediate/long acting insulin
Fasting
1 hour post meal
What are the BM targets for fasting, 1 hour after meal, 2 hour after meal
fasting 5.3
1 hour 7.8
2 hour 6.4
If on insulin aim >40
When to measure HbA1c for pre-existing
At booking, consider in 2nd/3rd trimester
> 48 associated with risk to pregnancy
Why need to rate insulin infections sites
Avoid cutaneous amyloidosis
How to minimise risk of hypoglycaemia
Educated women on insulin treated DM from 1st trimester
Always have fasting acting form of glucose available
Provide glucagon to T1DM, explain to partner/family for to use
Consider continuo subcut insulin - if multiple daily injections of insulin, multip hypos
Who should be offered real time continuous glucose monitoring?
T1DM or T2DM/GDM if problematic hypos, unstable BMa
Offered intermittently scanned continue BM monitoring if unable to use rtCGM or patient preference
How to minimise risk of DKA
Type 1 DM - offer blood ketone testing strips
T2DM/GDM: advise if unwell or high BM seek medical attention
Test blood ketones early if DM and high BMs/unwell
If suspected DKA - level 2 critical unit
When to offer retinal assessment?
Pre-exisiting DM
1st appointment
If they have DM retinopathy - again 16-20 weeks
Another test 28 weeks
When to offer renal assessment, when to refer to nephrologist?
At 1st appointment if not done in last 3 months
refer if
Creatinine >120
urinary albumin: creatinine ration >30
Total protein excretion >0.5g/day
