We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
A toolkit for patients, carers and family members
This toolkit is for you if:
Family members, friends and carers may also find this toolkit helpful.
Details of support organisations and other places where you can find out more information is in the sources of further information section.
This page explains the recommendations in a guideline produced by the Scottish Intercollegiate Guidelines Network about managing diabetes during pregnancy.
Recommendations in the guideline are based on different types of evidence. Some of it comes from current research, some from the clinical experience and opinions of healthcare professionals, and some from people with lived experience.
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There are two different types of recommendations on this page
Diabetes is a health condition that affects how your body handles glucose, a type of sugar in your blood. When you have diabetes, your body:
Type 1 diabetes is when the pancreas produces little to no insulin, a hormone necessary for regulating blood glucose levels.
Type 2 diabetes is when the body becomes resistant to the effects of insulin or doesn’t produce enough insulin to maintain normal blood glucose levels.
Gestational diabetes is diabetes that can develop during pregnancy. It affects women who haven’t had diabetes before. Gestational diabetes is not as common as type 1 or type 2 diabetes, but is increasing. It affects at least 4–5 in 100 women during pregnancy, or 1 in 20 pregnancies in the UK.
For more information on types of diabetes, please see Diabetes UK’s website.
Before becoming pregnant, it’s important that you manage your diabetes well.
What should I do before planning pregnancy to manage my diabetes in the best way?
You should use reliable contraception until you reach your target HbA1c as discussed with your healthcare team. Research shows that when diabetes is well-managed before conception, pregnancy outcomes are much better.
Recommendation based on the research evidence
Before planning a pregnancy you should:
• aim for an HbA1c as low as possible without excessive hypoglycaemia (abnormally low blood glucose).
Without a doubt my pregnancy was the hardest thing I have ever done. But it was so incredibly worth it. Read Sarah’s story.
Recommendation based on clinical experience
Before planning a pregnancy you should:
mmol/mol is a way to measure how much glucose has been in your blood over the last three months. It shows the amount of glucose-coated hemoglobin (protein in red blood cells) compared to normal hemoglobin, helping people with diabetes see how well they’ve managed their blood glucose levels.
Recommendation based on clinical experience
When setting goals for your HbA1c, your healthcare professional should consider other things too. These include whether you have high blood pressure and the condition of your eyes and kidneys.
Recommendation based on clinical experience
If you have type 2 diabetes and are thinking about getting pregnant, your healthcare professional might suggest sending you to a specialist to support your diabetes. They might recommend using continuous glucose monitors (CGMs) if your blood glucose levels aren’t where they should be before pregnancy.
Information
The following information should be discussed with you:
You can ask about any of these points if they are not discussed with you.
When you go to your healthcare appointment(s), we encourage you to ask four key questions that will help you and your healthcare professionals make decisions together. This will make sure the care is right for you.
Learn more about “It’s OK to ask”
Learn more about realistic medicine
Care during pregnancy (antenatal care) is essential for all pregnant women to ensure the health and well-being of the mother and the developing baby. If you have diabetes and become pregnant, antenatal care becomes even more important because of the potential complications that diabetes can introduce during pregnancy.
Both your diabetes and pregnancy care teams should talk to you early on in your pregnancy. This should happen soon after you find out you’re pregnant, before your first official antenatal appointment.
Information
Your healthcare professional should make sure you:
CGM is a medical device that tracks glucose levels in real time throughout the day and night. CGM continually monitors your blood glucose, giving you real-time updates through a device attached to your body. CGM helps you to maintain optimal glucose levels, reducing the risks of complications like having a big baby, pre-eclampsia and neonatal hypoglycaemia.
Recommendation based on the research evidence
If you have type 1 diabetes, healthcare professionals should make sure you can have CGM during pregnancy if you would like it. If you have type 2 diabetes, healthcare professionals should consider whether CGM is right for you during pregnancy.
Maintaining blood glucose targets during pregnancy is important for you and your baby’s health. If your pregnancy was not planned, it’s important to contact the diabetes team to support you and help manage your diabetes. It can be difficult to reach the target. Try not to worry. Your health care team can support you to get as close as possible.
The table below shows the glucose levels you should aim for:
| Type of diabetes | Before meals | One hour after meals | Two hours after meals | Before bed |
| Type 1 | Between 4 and 6 mmol/L | Less than 8 mmol/L | Less than 7 mmol/L | Greater than 6 mmol/L |
| Type 2 | Between 4 and 6 mmol/L | Less than 8 mmol/L | Less than 7 mmol/L | Greater than 6 mmol/L |
| Gestational diabetes | Less than 5.5 mmol/L | Less than 8 mmol/L | Less than 7 mmol/L | Greater than 6 mmol/L |
Recommendation based on the research evidence
If you are monitoring your glucose levels in pregnancy using CGM, your team will monitor your overall glucose patterns. They will recommend your blood glucose levels are in the range 3.5-7.8 mmol/L at least 70% of the time.
Recommendation based on the research evidence
If you already have diabetes, it’s good to aim for glucose levels close to those in people who don’t. This may reduce the risk of having a large-for-gestational age baby and the need for an emergency Caesarean section.
Recommendation based on the research evidence
If you have gestational diabetes, it's beneficial to aim for glucose levels similar to those in people without diabetes (see table above). This can help reduce the risk of having a Caesarean section, a large-for-gestational-age baby, neonatal hypoglycaemia and pre-eclampsia. To reach these target glucose levels, you might need more medication and closer monitoring during pregnancy.
Recommendation based on the research evidence
Sometimes, to reach lower blood glucose targets, you may need more glucose-lowering medications, such as insulin. More follow-ups with healthcare professionals may also be needed.
Ketones are chemicals produced when your body breaks down fat for energy.
Recommendation based on clinical experience
If you have type 1 diabetes, you should monitor ketone levels in your blood if your blood glucose level is 10 mmol/L or higher, or you are ill. Checking blood ketones helps assess the risk of diabetic ketoacidosis (DKA), a serious complication of diabetes characterised by high ketone levels and acidic blood.
Information
It’s important to talk with your healthcare professional about when and how you plan to give birth. You should aim to talk about it as soon as possible after becoming pregnant. You will be able to create a birthing plan that is the best possible for you and your baby. This can be recorded in your case notes too. Final decisions about when and how to deliver your baby will be made during the third trimester of your pregnancy.
It was really important for me to be able to discuss my delivery options with my healthcare team throughout my pregnancy. After having an emergency c-section with my first baby I really wanted to try for a vaginal birth after caesarean with my second. My team was so supportive of this decision. We created a plan and put this in place on how we would ensure I was able to manage my diabetes throughout the induction and labour.
Some babies may be delivered prematurely. Often no cause is found and it may or may not be related to your diabetes. Premature babies may need urgent neonatal care and you will be supported by your healthcare team. Further details are available from the charity Bliss.
Recommendation based on the research evidence
If you have uncomplicated type 1 or type 2 diabetes, it’s recommended that you have an elective birth by induction or Caesarean between 37 and 38 weeks +6 days of pregnancy. Elective birth by induction or Caesarean is the planned decision to either induce labour or perform a Caesarean section rather than waiting for labour to start naturally. If you have uncomplicated gestational diabetes, delivery can wait until 40 weeks.
Recommendation based on the research evidence
If you have gestational diabetes, plan to give birth by 40 weeks and 6 days at the latest. If you haven’t given birth by then, you should be offered an induction or a Caesarean section if necessary. Your healthcare professionals will consider an earlier birth if there are any complications for you or your baby.
A surgical procedure to deliver a baby through a cut in the mother’s abdomen and uterus, often performed when vaginal delivery is not possible or advisable.
A medical intervention to stimulate uterine contractions artificially to start the process of childbirth when it doesn’t start naturally.
Gestational diabetes is a type of diabetes that develops during pregnancy and disappears after giving birth. It happens when your body can’t produce enough insulin to meet the extra needs during pregnancy, leading to high blood glucose levels. This happens because pregnancy causes insulin resistance. If not managed properly, gestational diabetes can increase the risk of complications for both you and your baby during pregnancy. Having gestational diabetes increases your risk of going on to develop type 2 diabetes.
There are some risk factors for gestational diabetes that should be recognised by healthcare professionals.
If any of these risk factors apply to you, you may be offered screening for gestational diabetes during pregnancy.
Recommendation based on the research evidence
If you are over age 40 and pregnant, you should be screened for gestational diabetes.
Recommendation based on the research evidence
You should be considered for screening for gestational diabetes if you are aged 35-40 and pregnant or you have a history of polycystic ovary syndrome.
How do healthcare professionals diagnose gestational diabetes?
Healthcare professionals can use the oral glucose tolerance test (OGTT) to diagnose various types of diabetes, including gestational diabetes.
The OGTT checks how your body processes glucose. After fasting for 8-10 hours, your blood is tested. Then, you drink a 75-gram sugary solution, and your blood is tested again after 1 and 2 hours. This helps diagnose diabetes and gestational diabetes.
Recommendation based on the research evidence
If your test shows any of these results, you will be diagnosed with gestational diabetes:
Recommendation based on the research evidence
A trained healthcare professional should give you dietary advice and tips about staying active.
Recommendation based on clinical experience
You should have access to a dietitian for nutritional advice, whether you're following a specific diet plan or not. This support can be offered one-to-one or in group sessions, depending on what works best for you.
Advice about diet will often be to reduce refined carbohydrates (processed carbohydrates such as white bread, white rice, pasta made from wheat flour and sugary cereals), avoid gaining a lot of weight and increase your physical activity. Specific dietary recommendations may vary based on your individual needs and preferences.
Recommendation based on the research evidence
Physical activity is important for women with gestational diabetes and can help improve glucose control. You should aim for 150 minutes of moderate physical activity each week while pregnant. You can spread this time across different days and do various activities to stay active and healthy.
Recommendation based on clinical experience
Diabetes teams should strongly encourage you to take part in physical activities that suit you.
There is limited evidence about whether myo-inositol and probiotics will help. Women should consult their healthcare professional before considering these supplements.
Recommendation based on the research evidence
If you need medication to control your gestational diabetes, your healthcare professional will suggest metformin or insulin first.
Recommendation based on the research evidence
Diabetes teams should talk to you about the specific side-effects of metformin and insulin, including the fact that metformin crosses the placenta. Studies have shown that children exposed to metformin during pregnancy may have slightly lower birth weights.
Placenta: A temporary organ in pregnancy. It carries nutrients and oxygen from mother to baby, and removes waste.
Your healthcare professional will discuss what changes are needed after delivery, and support you in managing your diabetes.
After the birth, if you have type 1 diabetes, you will need a reduction in insulin doses. You’ll work on a plan, supported by the diabetes team, to return to your pre-pregnancy insulin doses.
If you have type 2 diabetes and needed insulin during your pregnancy, your insulin dose may decrease or even be stopped, depending on your needs. Depending on your plans for future pregnancies, you may want to think about different oral or injectable therapies.
Information
The following information should be discussed with you:
What will happen if I had gestational diabetes?
If you had gestational diabetes, it’s important to monitor for glucose intolerance after pregnancy. Adjustments may include stopping metformin and insulin as necessary.
Gestational diabetes increases the risk of developing type 2 diabetes and cardiovascular disease later in life. Detecting glucose intolerance soon after pregnancy will mean your healthcare professionals can give help to prevent or delay the onset of diabetes and reduce the risk of complications.
Information
The following information should be discussed with you:
Recommendation based on the research evidence
If you’ve had gestational diabetes, it’s important to know that you could have it again in future pregnancies. There are risks with this, so when you're planning to get pregnant in the future, your doctor might suggest testing for diabetes beforehand to make sure you and your baby stay healthy.
What are the options for testing glucose intolerance after pregnancy?
Tests commonly used include fasting blood glucose and HbA1c. The fasting blood glucose test measures the level of glucose in the blood after you have fasted for at least eight hours. You do not need to fast for the HbA1c test. These tests can detect diabetes, impaired fasting glucose and impaired glucose tolerance after your baby is born.
Recommendation based on the research evidence
After giving birth, if your blood glucose levels returned to normal, you should be offered the following:
If you haven’t had a fasting blood glucose test by 13 weeks, you should still be offered one, or an HbA1c test as an alternative.
Healthcare professionals will not routinely offer a 75g 2-hour OGTT.
Recommendation based on the research evidence
If your postnatal test is a fasting blood glucose test:
Recommendation based on the research evidence
If your postnatal test is an HbA1c test:
Most centres in Scotland measure HbA1c 3 months after delivery and offer entry to the type 2 diabetes Framework for prevention, early detection, and intervention.
Helpline: 0141 212 8710, Monday to Friday, 9am–6pm
Diabetes Scotland provides a wide range of information on diabetes including leaflets, fact sheets, details of support groups and advice on all aspects of diabetes. The Diabetes UK Learning Zone offers videos, quizzes and interactive tools for managing diabetes day-to-day which are tailored for each individual.
Dietary advice for women with gestational diabetes
Tel: 01224 248677 (Scotland), 07442 332872 (Central Scotland)
Email: scotland@jdrf.org.uk
JDRF uses research to cure, treat and prevent type 1 diabetes, accelerates access to type 1 diabetes treatment technologies and medicines and supports people living with type 1 diabetes.
Through its international JDRF network, funding of UK researchers, advocacy work with the NHS and the support it provides to people with type 1 diabetes, JDRF helps to prevent, treat and ultimately find cures for type 1 diabetes.
Insulin Dependent Diabetes Trust
Tel: 01604 622 837
The Insulin Dependent Diabetes Trust is run by people living with diabetes to raise awareness of important issues for people with diabetes. It provides information in non-medical language.
The Insulin Pump Awareness Group was formed and run by a group of people who are pump users, likely to use pumps in the future, or parents of children with type 1 diabetes.
Gestational diabetes elearning site www.elearning.mydiabetesmyway.scot.nhs.uk/courses/gestational-diabetes-course/
My Diabetes My Way is NHSScotland’s interactive diabetes website that helps to support people who have diabetes and their family and friends.
Other national organisations
Tel: 111
NHS 24 is an online and out-of-hours phone service providing the Scottish people with access to health advice and information 24 hours a day, 365 days a year.
Tel: 0800 224 488
This is the national health and care information service for Scotland. It gives information and links to resources. It supports people with diabetes and health conditions that can develop during pregnancy.
Breathing Space
Tel: 0800 83 85 87 (Monday to Thursday, 6pm to 2am, Friday to Monday, 6pm to 6am)
Breathing Space is a free and confidential phone and webchat service for anyone in Scotland over the age of 16 who may be feeling down or experiencing depression and need someone to talk to.
Tel: 0300 330 3311
The British Heart Foundation provides a telephone information service for people looking for information on health issues to do with the heart. It’s website also provides a range of information on its website.
Chest, Heart and Stroke Scotland (CHSS)
Tel: 0131 225 6963
CHSS aims to improve the quality of life of people affected by chest, heart and stroke illnesses by offering information, advice and support in the community. It produces leaflets on the links between diabetes, heart disease and stroke.
Bliss is the leading charity for babies born premature or sick. It helps ensure that babies receive the best care by supporting families and healthcare professionals, campaigning for change and supporting research.
Citizens advice bureaux are local independent charities that provide free, confidential and impartial advice to people who need it.
Driver and Vehicle Licensing Agency (DVLA)
The DVLA is an executive agency of the UK Government Department for Transport. It is responsible for issuing driving licences and vehicle registration certificates. It also records driver endorsements, disqualifications and medical conditions. People who use insulin for more than 3 months to control their diabetes must inform the DVLA.
Maternal Mental Health Alliance
The Maternal Mental Health Alliance (MMHA) is a network of over 120 organisations that provide care and support for parents and families, including national organisations offering online or telephone support.
Helpline: 0808 1961 776.
PANDAS helps to support and advise any parent who has a perinatal mental illness. The website has a directory of local support groups.
Our guidelines are based on the most up-to-date scientific evidence. We read research papers to find evidence for the best way to diagnose, treat and care for patients. If we cannot find this out from the research evidence, we ask healthcare professionals to use their clinical experience and judgement to suggest treatments.
You can read more about us by visiting www.sign.ac.uk or you can phone 0131 623 4720 and ask for a copy of our booklet ‘SIGN guidelines: information for patients, carers and the public.
The Scottish Intercollegiate Guidelines Network (SIGN) writes guidelines which give advice for healthcare professionals, patients and carers about the best treatments that are available. We write these guidelines by working with healthcare professionals, other NHS staff, patients, carers and members of the public.
We are happy to consider requests for other languages or formats. Please phone 0131 623 4720 or email sign@sign.ac.uk
Management of diabetes in pregnancy (SIGN)