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Diabetes Midwives

Sliding scales used both in labour and for steroids

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Is anyone using the JBDS guideline for antenatal steroids?

Up to Sliding scales used both in labour and for steroids
June 04. 2018
Anonymous

My diabetes consultant wants us to use the JBDS guideline for antenatal steroids, which involves everyone on metformin and/or insulin requiring antenatal steroids being admitted to hospital, having VRIII immediately after the first dose of steroids until 24 hours after the second dose.  This means a lot of extra work for the midwives, but more importantly, 48  hours of hourly testing for the women

 

Jan Liddie

Diabetes Lead Midwife

Milton Keynes University Hospital NHS Foundation Trust

June 04. 2018
Sarah Carter

Our steroid guidelines are the same Jan, in fact all our diabetic women needing steroids even if they're diet controlled come.in for a VRIII! I'm 8 weeks into post and will be asking why but we over use VRIII across the board so we're going to look at it in every respect. 

Im the Lead Midwife in Diabetes for East Lancashire Hospitals

Sarah Carter 

July 10. 2018
Deborah Bett

Our unit wouldn't cope if all our women came in for VRIII when they had steroids. We individualise the plan so type 1 s normally manage themselves with advice but can come in if they feel they are not coping. Type 2s are advised to give themselves an extra 4 units of fast acting insulin if BM 10 or more, same for GDM on insulin. GDM on diet or metformin are asked to come in if BM is 10 or more. All women have ketone check and BM review at 2nd steroid injection by us. Any woman who are particularly worrying ie PET or IUGR would be admitted. Any woman who isn't coping would be admitted. Any woman with blood ketones 1.0 or more is admitted.

October 10. 2018
Heather Davies

Hi. We admit all patients with GDM, type I & type II for steroids. They have blood glucose levels checked pre and 1hr post-meal, before bed and 2am. If CBG >10 increases to 2hrly monitoring, and if >12 then for sliding scale.

All patients on insulin have insulin dose titration during the process. for example

Short acting meal time insulin Pre meal CBG

 

 

Extra insulin added to usual dose of short acting insulin

 

 

<5.3mmol/l

 

No extra insulin

 

5.3 - 8mmol/l

 

2 units

 

8.1 -10mmol/l

 

4 units

 

10.1 -12mmol/l

 

6 units

 

12.1 -14mmol/l

 

8 units

 

October 11. 2018
JANET LIDDIE

Hi Heather, do you admit GDMs who are diet controlled? Which hospital do you work at? Jan

October 11. 2018
Heather Davies

Yes all types of GDM and pre-existing.

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