2.2.7. All women with Type 1 and 2 DM should have an HbA1c taken in the 1st trimester of pregnancy and repeated in the 3rd trimester, ideally this should take place when attending clinic at the 28/40 appointment.
2.3.8.1. Women with diabetes who are at risk of pre-term delivery should receive Dexamethasone or Betamethasone (as per Preterm Birth, Optimisation and Delivery Clinical Guideline). If steroids are required, women with Type 1 DM should be considered for admission to Wheal Rose. VRIII (variable rate intravenous insulin infusion) may be required to avoid rapid deterioration in CBG levels. See VRIII policy for use in pregnancy and labour in Appendix 5.
2.3.8.2. With a planned admission an individual plan will be made by the endocrinologist or diabetes team. Should this not be possible then all doses of insulin should be increased by 20%. Women who have a continuous subcutaneous insulin infusion (CSII) or hybrid closed loop therapy (HCL) should aim to continue to use with additional insulin adjustments. Follow Insulin Pump Therapy (Continuous Subcutaneous Insulin Infusion (CSII)) for Adults during Admission Clinical Guideline.
2.3.8.3. With an unplanned admission, most women are able to administer extra doses of rapid acting insulin according to CBG levels therefore liaise with the woman when deciding appropriate action to an elevated CBG reading.
In the absence of CGM/Libre, monitor capillary blood glucose (CBG) levels every hour if ≥ 12mmol/L then measure again after one hour. If still ≥ 12mmol, check blood ketone levels. If blood ketone levels ≥ 0.6 but < 1.5mmol/L consider commencing VRII or a bolus of rapid acting insulin (after discussion with the woman).
2.3.8.4. If >12 mmol at any point and blood ketone levels ≥1.5 mmol/l commence Variable Rate Intravenous Insulin Infusion (VRIII) as there is an increased risk of diabetic ketoacidosis.
2.3.9.1. Women with Type 2 DM regardless of treatment can be managed as an outpatient, unless there are concerns from the diabetes team regarding pre-steroid diabetes control. If managed by diet and exercise and/or Metformin or insulin women should be advised to check CBG levels before and 1 hour after each meal and before bed.
2.3.9.2. If two consecutive readings are 12 mmol/l, 1 hour apart regardless of treatment they should be advised to contact Maternity and will be advised admission for management of