CBG levels.
2.3.9.3. All women should continue increased monitoring for a minimum 12 hours after the last dose of steroids.
2.3.10.1. All diabetic women however treated should expect a rise in CBG levels. The rise may be apparent immediately or take several hours depending on the individual response. Rarely, no, or minimal effect is seen.
2.3.10.2. Women with Type 1 DM are particularly at risk of developing Diabetic Ketoacidosis (DKA).
2.3.10.3. Any type of diabetes, however treated where there is evidence of hyperglycaemia (as documented above) should be admitted for assessment.
2.3.10.4. Where possible seek advice from the diabetes team with the aim of avoiding VRIII.
2.3.10.5. If it is not possible to contact a member of the diabetes team and there is any doubt regarding blood glucose levels, then VRIII should be considered.
2.3.10.6. The impairment in glycaemic control associated with steroid use is likely to offset any benefits obtained for women having a planned caesarean birth between 37-39 weeks. A detailed discussion with the woman will occur detailing risks and benefits. This discussion will be documented by a senior obstetrician in the notes.
2.4.1. Ensure Registered CHA2976: Registered Nurse Assessment for Patient Self-Administration of Insulin - GLP1 via a Pen Device (ideally completed by Diabetes Midwives) is filed in notes.
2.4.2. Individual sharps container should be given.
2.4.3. Insulin should be prescribed on EPMA and marked for self-administration ensuring standard hypoglycaemia and hyperglycaemia management is added.
2.4.4. Women can monitor their own CBG levels/use CGM or Libre sensor. and document on Diabetes Monitoring Chart (appendix 9). At least one CBG per day must be performed on the ward-based meter.
Unwell, any episode of hypoglycaemia or hyperglycaemia (CBG<4 or ≥12mmol/l) then confirm reading on ward-based meter and take appropriate action.