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If macrosomia or polyhydramnios on USS, refer to Diabetes ANC directly.
If USS normal, review by midwife for diet and lifestyle advice. CBS monitoring for 1 week and review by Diabetes Specialist Midwife. If CBS <5.5 fasting and <7.0 post-prandial, for repeat 1 week CBS monitoring at 33/40 and repeat growth scan at 36/40.
CBS values and patterns are reviewed in association with dietary, especially carbohydrate intake.
Further patient education regarding the significance of monitoring blood sugars in pregnancy and the effect of dietary intake on CBS readings.
In some cases, a further week of monitoring with tight dietary control
Progression to Insulin treatment if CBS still high.
Patients may need a full basal Bolus type regime with TDS short-acting Novorapid and Insulatard nocte ab initio or insulin at certain times of the day to begin with. Insulin requirements gradually increase up to week 37/40, then decline.
For selected cases, Metformin or Glibenclamide are used.