IDF - working for people with diabetes around the world© IDF (Europe) 1998

A Desktop Guide to

Type 1 (Insulin-dependent) Diabetes

Sections 19-21: Pregnancy, Surgery, Ketoacidosis

19 Pregnancy and contraception
20 Surgery and diabetes
21 Ketoacidosis


TYPE 1 DIABETES - 19 - PREGNANCY AND CONTRACEPTION
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19 PREGNANCY AND CONTRACEPTION

Avoid destroying the normal experience of pregnancy through
overzealous application of medical technology

But good blood glucose control from before conception is critically important

19.1 Contraception

Enquire :

    • as to need for contraceptive advice if pregnancy not intended

Advise :

19.2 Pre-pregnancy management

Enquire as part of Annual Review as to pregnancy intentions :

Start folic acid 400 g daily

Stop statins

Optimize blood glucose control ( Sections 9-13 ) :

Assess and normalize blood pressure :

Assess retina and treat as indicated

Review education and repeat as needed

Urge to stop smoking

19.3 Pregnancy care

Organize joint obstetric care in a designated centre :

Provide support for continuing good blood glucose control :

Examine eyes each trimester

Provide regular obstetric care :

Provide a normal safe delivery :

Provide easily accessible advice for post-pregnancy blood glucose control

Caution about hypoglycaemia risk if breast feeding; may need further insulin dose reduction

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TYPE 1 DIABETES - 19 - PREGNANCY AND CONTRACEPTION

TYPE 1 DIABETES - 20 - SURGERY
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20 MANAGEMENT OF DIABETES DURING SURGERY

20.1 Organization

Prepare a local care protocol

Disseminate the protocol to relevant professionals

20.2 Management

Optimize blood glucose control pre-operatively ( Sections 9-13 )

Delay major surgery if possible when :

  • HbA1c
  • >9.0 %, or
  • fasting glucose
  • >10.0 mmol/l ( >180 mg/dl ), or
  • post-prandial
  • >13.0 mmol/l ( >230 mg/dl )

    Screen for complications which may affect surgery risk; alert the surgical team :

    Manage blood glucose / insulin :

    Encourage supervised self-management while in hospital

    20.3 Surgical glucose-insulin-potassium ( GIK ) regimens

    ( Top of page ) ) ( Top of 'Surgery' )
    TYPE 1 DIABETES - 20 - SURGERY

    TYPE 1 DIABETES - 21 - KETOACIDOSIS
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    21 MANAGEMENT OF DIABETIC KETOACIDOSIS

    21.1 Organization

    Prepare a local care protocol

    Disseminate the protocol to relevant professionals

    21.2 Management

    Fluid replacement :

    Insulin :

    Potassium :

    Bicarbonate :

    Infection :

    General care

    Review cause to reduce risk of recurrence

    ( Top of page ) ( Top of 'Ketoacidosis' )
    TYPE 1 DIABETES - 21 - KETOACIDOSIS

    ( Top of page ) ( Guidelines contents list ) ( Guidelines index )