What are midwives doing about the Green-top 7 guideline published in Oct 2010 (http://www.rcog.org.uk/files/rcog-corp/GTG%207.pdf) which recommends ante natal steroids for women delivered before 38+6 by elective CS. Does anyone have any guidelines on how to handle this with Type 1, Type 2 and GDM on insulin as Sonia's trust deliver all their ladies on insulin at 38 weeks. This is causing problems with BG Levels/need for insulin infusion prior to delivery, especially with Type 1.

Message from Helena Broude, Diabetes Specialist Midwife at Pennine Acute Hospitals Trust We do a cardiac scan at 20 weeks (4 chamber view and out flow tracts) for Type 1. Does anyone do anything different? Thanks a lot Helena

Sally Barker, Diabetic Specialist Midwife, Frimley Park NHS Foundation Trust is looking into developing a DVD on diet for the women with gestational diabetes and wondered if any unit already has one or has done any work like this.

Currently all our women with GDM attend the Joint ANC. Do any of you have separate clinics for women with GDM controlled with diet or metformin? If so, what is the managemant pathway? Many thanks.

Do you have a policy specifically for DKA in pregnancy? Also do you always use sliding scale in labour? And are your women always fasted in established labour. In otherwords could you send me a copy of your labour policies for GDM, DM1 and or DM2 Mandy Cooper, Primary Care Facilitator-Diabetes, Nobles Hospital, Isle of Man .

Rachel Earp, Diabetes Midwife, East and North Hertfordshire NHS Trust wants to know if any of you have a source of leaflets which discuss Gestational Diabetes in other languages - most importantly Urdu, Hindi and Bengali. She uses the Accu Chek monitor for these women and can suppport their teaching with their leaflet, but this information is directed simply at use of the monitor.

At present we get our GDM and T2DM women to test their blood glucose pre meal one day, keeping BM's between 4.0-5.5, and 2 hours post prandial, keeping below 7.0. Our T1 women just test pre meal, keeping between 4.0-5.5. They don't do any post prandial testing. We had a discussion about changing to NICE guidelines, as one of the other hospitals in our trust uses them. How many units use the NICE guidelines, what do you tell the women about testing 1 hour post prandial - is it at the start of the meal, end of the meal, 1 hour after giving their insulin? Also did you have any problems when changing your targets and monitoring? Do you get your T1 women to test post prandial at all? We are auditing our outcomes at the moment to see if they are better, the same or worse than the national outcomes to see if we have any evidence to say that we should change to NICE guidelines, and we are also going to wait til next year as NICE is due to update then. In the meantime any information would be gratefully received. thanks Kirstin Clark Ysbyty Glan Clwyd, N Wales

Sadie Hafford, Diabetes Specialist Midwife at South London Healthcare NHS Trust would like any relevant info or ideas regarding normalising diabetes for a presentation to be given to the Head of Midwifery etc.. She has included communication, breastfeeding, continuity of care, etc Are there any relevant lit/reviews to add to this?

Mandy Cooper, Primary Care Facilitator-Diabetes,Isle of Man wants to know if anyone can share their differing sliding scales used both in labour and for steroids.

Recently our lady with a pump had a LSCS she had been fine throughout pregnancy until the night prior to LSCS she had a hypo, it was treated with glucogel and then had a glucose infusion started which she maintained normal blood glucose levels with her pump. She reports being anxious, not eating as much as normal and thus probably giving herself a bit too much insulin, it was also quite a warm day,so everything was explainable but i just wondered if anyone else had experience of a LSCS with a pump and whether they advised reducing cho ratio for meal prior or any other tick or just see what happens!! all thoughts and experience welcome!