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Treatment for diabetes in pregnancy - Anya Wright

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Frequency of appointments for women diagnosed with type 1,type 2 and gdm

Up to Treatment for diabetes in pregnancy - Anya Wright
May 09. 2013
Edwina Lee

Hello I would be interested to know how frequently women are seen by the obstetric and diabetes teams in different trusts. Do you use a particular pathway or is the care on a more individualized basis? How do you maintain contact with these women between appointments? Thanks for any information

May 14. 2013
heather chandler

Tend to see the women on the frequency determined by how well they are controlled if OK probably 4 weekly if not then could even be weekly.

the obstetrician sees the women early in their pregnancy and again when they attend for growth scans, otherwise i see them with the diabetes team

May 14. 2013
Edwina Lee

Hello Heather, thanks for that information, we tend to follow appointments initiated by the obstetricians and keep contact with women by phone to review blood glucose levels on a weekly basis. I was interested to know how other people worked to see what improvements we could make.

May 24. 2013
suzannah kelly

we see women on an individual basis. usually if well controlled and complient with telephone contact we see monthly untill 32 weeks then fortnightly and weekly after 36 weeks. if poor control then as needed.

May 24. 2013
jan liddie

We see women 4 weekly, as per NICE, unless otherwise indicated.   Where possible I ask the women to email me weekly in between appointments, and I either ring them or email back.  This gives me a paper record of their readings, and allows me to keep on top of my ever-increasing caseload.  However a recent change from gold gel blood bottles to grey fluoride oxalate bottles (more accurate) has caused a doubling of my diagnosis rate and our clinics are rapidly expanding.  Do any units have a specific GDM clinic?

 

May 24. 2013
jan liddie

We see women 4 weekly, as per NICE, unless otherwise indicated.   Where possible I ask the women to email me weekly in between appointments, and I either ring them or email back.  This gives me a paper record of their readings, and allows me to keep on top of my ever-increasing caseload.  However a recent change from gold gel blood bottles to grey fluoride oxalate bottles (more accurate) has caused a doubling of my diagnosis rate and our clinics are rapidly expanding.  Do any units have a specific GDM clinic?

 

May 29. 2013
sara miall

We run two clinics, one is the joint antenatal/diabetes clinic which has the whole team including endocrinologists, DSN and dietitian for the ladies with pre-existing diabetes and those who have gestational diabetes but require metformin or insulin. The other is for the women with GDM who are diet controlled which has the obstetrician and DSM only. The obstetrician and I both have our own lists and this tends to work well allowing the women some normality. We see the women every 2-4 weeks, and weekly from 36 weeks. We also offer regular telephone support if required. I also run a seperate clinic for discussing GDM diagnosis, giving dietary advice and teaching HBGM.

June 11. 2013
Edwina Lee

Hello Jan, myself and my colleague are thinking about offering email as a form of contact for our women and I would like to ask how you are finding this, what difficulties have you encountered and what are the positives?

July 04. 2013
Sadie Hafford

I see all new GDM women and keep in touch with phone calls/email. If diet controlled see cmw/any consultant. If on insulin or preexisting then through the joint clinic following normal pathway unless diabetes complications arise.

 

 

 

 

 

 

 

July 04. 2013
Sadie Hafford

I see all new GDM women and keep in touch with phone calls/email. If diet controlled see cmw/any consultant. If on insulin or preexisting then through the joint clinic following normal pathway unless diabetes complications arise.

 

 

 

 

 

 

 

September 04. 2013
suzannah kelly

Hi

we are currently looking to restructure our clinics mainly due to increasing number of gestational diabetics. How are other units managing their workload?

Am also interested in those units who have duel trained midwives (those who take on the role of diabetes nurse as well as midwife) and those who do not have a diabetes nurse in antenatal clinic.

 

September 05. 2013
Jane O'Brien

We are having to run extra clinics but as I am able to do nurse/midwife they are stand alone midwife clinics without the MDT. Women come between scans if the consultants agree it is appropriate. Although I am a DSM that can prescribe and act as a DSN we still have a DSN in the weekly clinic otherwise there would be no cover for my annual leave.

September 06. 2013
suzannah kelly

can i ask Jane what the DSN does when you are in clinic same time? I can understand her being there when you are on A/L ?

September 10. 2013
heather chandler

When our clinic started to become too big to manage we had a midwife led clinic set up so that I could see the women as a follow up in between their scan appointments rather than coming to the main clinic, only problem with that was if they needed to have medication added and needed prescription, just takes a little while to track someone down who can do that for me. Next year all being well that won't be a problem as now on the NMP course!!

We also have the added bonus of the consultants having an outpatient clinic on the same day at our community hospital, so although they are seen seperately they still get the majority of the team to see them, I go down also when I know women booked in, they have their scans there too.

Regards DSN in the clinic, she is mainly there when either our Diabetologist or myself are not in clinic. sometimes if we have the luxury that the rest of the Hospital is covered she may come along as well. having her there means that I can concentrate on discussing labour, feeding, A/N expression and just normal pregnancy things!!

November 04. 2013
Jane O'Brien

As with Heather's clinic it means I can concentrate on midwifery things rather than profiles if there is a full team present in clinic. With everyone's holidays that doesn't happen very often. It also means less waiting for the women as our clinics are very busy these days.

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