TAM (Treatments and Medicines) NHS Highland
Adults with pre-existing diabetes have been identified as being more vulnerable to severe complications of COVID-19.
Women with existing diabetes in pregnancy should be advised to strictly follow social distancing measures.
At the booking appointment women with pre-existing diabetes should be given the usual advice as outlined in NHS Highland Diabetes in Pregnancy Guideline. The need to limit visits to hospital and out of home during the COVID-19 pandemic should be emphasised.
Referral to the Obstetric Diabetes antenatal service should be made in the usual way and arrangements for telephone, NHS Near Me or face-to-face review will be made as appropriate by the obstetric and diabetes teams in consultation. Women with pre existing diabetes should be referred to the diabetes specialist nurse and then offered an appointment with the multidisciplinary obstetric diabetes team to ensure optimum glycaemic control. It is likely that early face-to-face review will be recommended around the 11-14 week dating scan and if possible these should happen on the same day. Ideally the result of early booking blood will be available at that appointment. Discussion will cover:
- Blood glucose monitoring (continuous monitoring or sensor or finger prick) and the process for remote review of blood glucose control.
Full download of insulin pump data and review by insulin pump team
- Appropriate prescriptions for blood glucose and/or ketone monitoring, and medications which should be obtained by repeat prescription through primary care.
Assessment by Specialist Diabetes Dietician
- Provision of additional materials to support blood glucose monitoring, diet and sick day rules (written and/or online).
- Information on hypoglycaemia avoidance and awareness for women using insulin. Reminder of driving regulations.
- Prescription for folic acid 5mg and low dose aspirin 150mg.
- Home blood pressure monitoring / urinalysis if available.
- Plans for additional bloods to monitor glycaemic control, aiming to keep HbA1c <48mmol/mol.
- Care planning which involves the diabetes specialist nurse or midwife.
There is likely to be reduced access to retinal screening and therefore this should be offered to women with relevant eye symptoms or known retinal changes prior to pregnancy.
Review of home capillary blood sugar levels should be undertaken by e mail or telephone (as is the current practice) by the diabetes team.
Women should continue to have routine antenatal care with their midwifery team where possible.
The joint obstetric diabetes team should aim to review women as a minimum at 20, 28, 32 weeks. It may be necessary to schedule some or all of these appointments as face to face antenatal appointment depending on the clinical situation and assessment of risk.
Some of these appointments may be suitable for remote review by telephone or NHS near me after community midwifery review.
Some of these appointments may be suitable for remote review by telephone or NHS near me after ultrasound examination in Caithness.
The joint obstetric diabetes team should review women at 36 weeks gestation to assess maternal and fetal condition and plan timing and mode of birth. It is likely this meeting will be a face to face antenatal appointment.
Additional scans and / or face to face visits may be required as determined by assessment of individual clinical situations.
Regular phone or email communication between obstetric, diabetes and community midwife teams will be essential to plan care and follow-up.
Women affected by COVID-19 and who are symptomatic should be aware of the potential effects of infection on blood sugar control will need more frequent review of home capillary blood sugars and ketones (where appropriate. All pregnant women with diabetes should be advised of this.