Diabetes, Pregnancy And Breastfeeding

Question 1

For pre-existing diabetes

Answer 1

• diabetes can lead to complications like pre - eclampsia, retinopathy, congenital malformations
• foetal development
• Give folic acid 5mg to women planning to get pregnant
• keeping HBA1C <48mmol/mol

Question 2

Pregnancy and breast feeding

Answer 2

All oral anti diabetic drugs except metformin should be discontinued before pregnancy (or as soon as unplanned pregnancy is identified) and replaced with insulin during intercurrent

• metformin can be given in pregnancy and breastfeeding

Question 3

Which insulins can we use in pregnancy

Answer 3

• rapid are the best because there’s less chance of acting hypo
  =Aspart
  =Lispro

Insulins (long acting/medium)
- isophane insulin (1st choice)
- determined or glargine(only if on these and good control before pregnancy )

Question 4

Monitoring

Answer 4

High risk of hypo with insulin especially in the 1st trimester, advise patients to carry glucose/dextrose/glucose drink
- prescribe glucagon (for use when needed) for type 1 diabetics

Medications for diabetic complications:
- discontinue ACE/ARBS and replace with methyldopa or labetolol in preganancy
- discontinue statins

Question 5

Gestational diabetes

Answer 5

1) Diet and exercise alone
2)metformin
3) adds insulin it metformin not effective