The Diabetes team consist of multidisciplinary professionals that care for you throughout your pregnancy in a variety of ways and these include: Consultant Obstetricians (pregnancy doctors) Consultant Diabetologists, Diabetes specialist nurses, dietitians and midwives.

The team are here to help keep optimal control of your diabetes during your pregnancy as this will help reduce the complications that may arise if your diabetes is not well controlled.

What to expect during your pregnancy

Your first diabetes antenatal appointment will usually be with the Consultant for diabetes and the Diabetes Specialist Midwives/Dietitians, this appointment can include:

• Taking a history of your diabetes
• Review of your diabetes treatments and medications; including your method of testing your blood glucose
• Discuss your current meter and ensure you have enough needles and strips, that they are in date and that you have ketone meter strips
• Offer of free continuous glucose monitoring will be discussed for a period of 12 months (Dexcom G6)
• Baseline diabetes and pregnancy bloods including a HbA1c and kidney function
• A referral to the eye screening department for regular checks throughout your pregnancy
• A review by the dietitian
• Leaflets and discussions on:
  –  Sick day rules
  –  Hypoglycaemia – ensuring you have treatments on you at all times
  –  Driving rules
  –  National Pregnancy in Diabetes audit
• Please bring your glucose meter, records of blood sugar monitoring with you to each antenatal visit as this is vitally important for advice on diabetes control. If you are using a flash or continuous glucose monitoring system then this will be reviewed at these appointments as well.
• Regular ultrasound scans will be offered throughout your pregnancy which include:
  –  7- 9 weeks early viability scan
  –  12 week dating scan – with offer of screening for chromosome abnormalities
  –  20 week anatomy scan
  –  3 – 4 weekly growth scans from 28 weeks until delivery
• We will offer you regular diabetes review from your first appointment which can be face to face or telephone/virtual appointments; these are vitally important appointments as the hormones produced by your body to maintain your pregnancy can affect your control and alterations to your insulin will need to be made throughout. However in between your appointment if you wish to discuss your blood sugar results please contact the diabetes team (numbers below).
• You will also see your own local Community Midwife as well as the team at various times and she will give you her contact number at the first booking appointment.

What to expect during delivery: 

• At around 34- 36 weeks the team will be having a discussion with you regarding the method of delivery which is appropriate to you, including the timing of delivery which is usually between 37 – 38+6 weeks gestation. The discussion will include vaginal or caesarean section delivery depending on the size of your baby and diabetes control/complications.
• If we need to give you steroids at this point to help mature the babies lung’s if early delivery is planned, then you will require admission to the antenatal ward for a couple of days as steroids increase your blood sugars and an insulin infusion will be required to help control them
• Your Community Midwife will offer you an appointment at around this time to discuss your birth plan and the Diabetes Specialist Midwife will discuss this with you in the clinic as well, as well as planning for the next pregnancy.
• We will offer you a harvesting of colostrum expression pack if suitable at this time, as your baby is at risk of low blood sugars after delivery and early breast feeding help stabilise this, having colostrum that has been expressed during your pregnancy can help.
• Throughout your labour your blood glucose will be monitored every hour to help maintain them between 4 – 7, this tight control is to reduce the baby having low blood glucose once delivered. An infusion of insulin and dextrose will usually be used to help control them
• Once you have delivered you will usually go back to your pre pregnancy insulin amounts, please be aware you are at risk of low blood glucose now and your control can be slightly relaxed to help reduce this risk. Your diabetes team will have a discussion with you towards the end of your pregnancy.
• Once you are home and settled with baby an appointment will be sent out from your usually diabetes care provider, if you have not received an appointment 3 months following delivery please contact them.

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