Chronic Medical Conditions: Diabetes - Case Information                                         

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Would you know how to counsel Miss Grainger regarding her diabetes with respect to her future potential pregnancy?

 

 

Patient:  Miss Grainger 

 

Miss Grainger's History & Medications

 

Counsel Miss Grainger about the risks for pregnancy associated with pregestational diabetes. Counsel her to get her HbA1C between 6 and 7%. Provide effective contraception until she can achieve these levels. If she cannot reach these levels, she should be advised that she is at greater risk for having a fetus with congenital abnormalities should she become pregnant without optimal blood sugar control.

 

Evaluate her for end-organ damage—check BP, look for retinopathy, cardiovascular changes, nephropathy, or neurological damage.

 

After she has achieved optimal glycemic control and has begun trying to conceive, take her off Glimeperide and Metformin. Begin an insulin regimen that meets her needs.

 

She should be counseled to present early for prenatal care once she conceives as this will allow adequate planning for care of her disease and evaluation of the fetus.