1
|
Dashora U, Levy N, Dhatariya K, Willer N, Castro E, Murphy HR. Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes - an updated guideline from the Joint British Diabetes Society for Inpatient Care. Diabet Med 2022; 39:e14744. [PMID: 34811800 DOI: 10.1111/dme.14744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022]
Abstract
This article summarises the Joint British Diabetes Societies for Inpatient Care guidelines on the management of glycaemia in pregnant women with diabetes on obstetric wards and delivery units, Joint British Diabetes Societies (JBDS) for Inpatient Care Group, ABCD (Diabetes Care) Ltd. The updated guideline offers two approaches - the traditional approach with tight glycaemic targets (4.0-7.0 mmol/L) and an updated pragmatic approach (5.0-8.0 mmol/L) to reduce the risk of maternal hypoglycaemia whilst maintaining safe glycaemia. This is particularly relevant for women with type 1 diabetes who are increasingly using Continuous Glucose Monitoring (CGM) and Continuous Subcutaneous Insulin Infusion (CSII) during pregnancy. All women with diabetes should have a documented delivery plan agreed during antenatal clinic appointments. Hyperglycaemia following steroid administration can be managed either by increasing basal and prandial insulin doses, typically by 50% to 80%, or by adding a variable rate of intravenous insulin infusion (VRIII). Glucose levels, either capillary blood glucose or CGM glucose levels, should be measured at least hourly from the onset of established labour, artificial rupture of membranes or admission for elective caesarean section. If intrapartum glucose levels are higher than 7.0 or 8.0 mmol/L on two consecutive occasions, VRIII is recommended. Hourly capillary blood glucose rather than CGM glucose measurements should be used to adjust VRIII. The recommended substrate fluid to be administered alongside a VRIII is 0.9% sodium chloride solution with 5% glucose and 0.15% potassium chloride (KCl) (20 mmol/L) or 0.3% KCl (40 mmol/L) at 50 ml/hr. Both the VRIII and CSII rates should be reduced by at least 50% after delivery.
Collapse
Affiliation(s)
- Umesh Dashora
- Conquest Hospital, The Ridge, St Leonards on Sea, UK
| | | | - Ketan Dhatariya
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nina Willer
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Erwin Castro
- Conquest Hospital, The Ridge, St Leonards on Sea, UK
| | - Helen R Murphy
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
2
|
Dashora U, Murphy HR, Temple RC, Stanley KP, Castro E, George S, Dhatariya K, Haq M, Sampson M. Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes. Diabet Med 2018; 35:1005-1010. [PMID: 30152588 DOI: 10.1111/dme.13674] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 11/28/2022]
Abstract
Optimal glycaemic control before and during pregnancy improves both maternal and fetal outcomes. This article summarizes the recently published guidelines on the management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units produced by the Joint British Diabetes Societies for Inpatient Care and available in full at www.diabetes.org.uk/joint-british-diabetes-society and https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. Hyperglycaemia following steroid administration can be managed by variable rate intravenous insulin infusion (VRIII) or continuous subcutaneous insulin infusion (CSII) in women who are willing and able to safely self-manage insulin dose adjustment. All women with diabetes should have capillary blood glucose (CBG) measured hourly once they are in established labour. Those who are found to be higher than 7 mmol/l on two consecutive occasions should be started on VRIII. If general anaesthesia is used, CBG should be monitored every 30 min in the theatre. Both the VRIII and CSII rate should be reduced by at least 50% once the placenta is delivered. The insulin dose needed after delivery in insulin-treated Type 2 and Type 1 diabetes is usually 25% less than the doses needed at the end of first trimester. Additional snacks may be needed after delivery especially if breastfeeding. Stop all anti-diabetes medications after delivery in gestational diabetes. Continue to monitor CBG before and 1 h after meals for up to 24 h after delivery to pick up any pre-existing diabetes or new-onset diabetes in pregnancy. Women with Type 2 diabetes on oral treatment can continue to take metformin after birth.
Collapse
MESH Headings
- Administration, Intravenous
- Adult
- Delivery, Obstetric/methods
- Delivery, Obstetric/standards
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/therapy
- Female
- Fetal Organ Maturity/drug effects
- Glucocorticoids/therapeutic use
- Humans
- Hyperglycemia/blood
- Hyperglycemia/therapy
- Hypoglycemic Agents/administration & dosage
- Insulin/administration & dosage
- Insulin Infusion Systems
- Labor, Obstetric/drug effects
- Labor, Obstetric/physiology
- Parturition/drug effects
- Parturition/physiology
- Pregnancy
- Pregnancy in Diabetics/blood
- Pregnancy in Diabetics/therapy
- Prenatal Care/methods
Collapse
Affiliation(s)
- U Dashora
- Conquest Hospital, St Leonards on Sea, UK
| | - H R Murphy
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - R C Temple
- Norfolk and Norwich University Hospital, Norwich, UK
| | - K P Stanley
- Norfolk and Norwich University Hospital, Norwich, UK
| | - E Castro
- East Sussex Healthcare NHS Trust, St Leonards on Sea, UK
| | - S George
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - K Dhatariya
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospital, Norwich, UK
| | - M Haq
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - M Sampson
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospital, Norwich, UK
| |
Collapse
|
3
|
Abell SK, Boyle JA, Courten B, Knight M, Ranasinha S, Regan J, Soldatos G, Wallace EM, Zoungas S, Teede HJ. Contemporary type 1 diabetes pregnancy outcomes: impact of obesity and glycaemic control. Med J Aust 2016; 205:162-7. [DOI: 10.5694/mja16.00443] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/09/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Sally K Abell
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Monash Women's Services, Monash Health, Melbourne, VIC
| | - Barbora Courten
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| | | | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
| | - John Regan
- Monash Women's Services, Monash Health, Melbourne, VIC
| | - Georgia Soldatos
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| | - Euan M Wallace
- Monash Women's Services, Monash Health, Melbourne, VIC
- The Ritchie Centre, Monash University, Melbourne, VIC
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| |
Collapse
|