Are being managed with VRIII.

2.5.1. Ketoacidosis should be excluded as a matter of urgency.

2.5.2. Women who are suspected or confirmed as having diabetic ketoacidosis should receive level 2 care.

2.5.3. Inform the endocrinologist and the Obstetric Consultant/ Obstetric Registrar on call of admission without delay. In this situation, it is appropriate to attempt to contact the Endocrinologist out of hours.

2.5.4. Senior Obstetrician to review the patient in person and arrange assessment of fetal wellbeing. The main risk is preterm labour and Intra Uterine Death (IUD). Discuss the obstetric management with the designated Obstetrician or call Consultant Obstetrician. If steroids are appropriate, then discuss the implications of this with the Endocrinologist.

See RCHT: Management of Type 1 and Type 2 diabetes in established labour. (Appendix 4).

See also RCHT: Management of Type 1 and Type 2 diabetes for elective caesarean section (Appendix 3).

See also RCHT: Women using CSII/HCL admitted in labour or for elective caesarean section. (Appendix 7).

See RCHT: Management of Type 1 and Type 2 diabetes post-delivery. (Appendix 6).

2.8.1. Whilst establishing breastfeeding, it is important to avoid hypoglycaemic episodes. Women with Type 1 DM should aim to keep glucose levels between 6-10 mmol/l in the initial post-natal period.

2.8.2. Post-delivery, women should be prescribed their pre pregnancy insulin doses.

2.8.3. If breastfeeding, may require a reduction in insulin dose by a further 25%.

2.8.4. Carbohydrate requirements of the mother may increase.

2.8.5. The mother should be encouraged to have a carbohydrate snack or meal before or during each episode of breastfeeding and before bedtime.