1. Alison Barry GESTATIONAL DIABETES FORUM

2. Gestational Diabetes Mellitus Diabetes Education

3. Objectives GDM rates in Metro South Components of diabetes education plan specific to women with GDM Resources available Barriers and challenges Benefits of multidisciplinary approach GP engagement

4. GDM

5. GDM in QLD

6. GDM diagnosis Report released from RANZCOG have endorsed new diagnostic criteria – 2 weeks ago July 2014 – 28/40 universal OGTT Cease to offer 50g GCT To be adopted no later than 01.01.2015 RANZCOG – Michael Permezel - President

7. GTT Diagnosis

8. Differs at individual health centres

9. Diabetes Education Following diagnosis -> education is vital Optimal -> within 1/52 of diagnosis Reduce maternal anxiety Correct information – up to date Encourage partner or support person to attend Challenge of working within a limited timeframe

10. Key Components of Education Overview of Gestational Diabetes Implications for mother and baby Home blood glucose monitoring (HBGM) or (SBGM) Review by Dietitian NDSS – National Diabetes supplies scheme Obstetric assessment Medical assessment

11. DVD – Diabetes Australia Brochures/Pamphlets Demonstration Useful websites eg ADIPS, DA, ADEA, You2 connect Must be culturally appropriate. Education Tools

12. Blood glucose monitoring Arrange use of meter – free of charge scheme Demonstrate use of meter Lancet / finger pricking device Record book Disposal of sharps Sites for performing tests Timing of tests – ie QID -Before breakfast & 1 or 2 hrs after each main meal – refer to local protocols

14. Recognised as important adjunct therapy Appropriate for pregnancy Eg walking, swimming, pregnastic, water aerobics Recommended in absence of obstetric & medical complications Culturally appropriate Physical Activity

15. Insulin Therapy Decision made by treating doctor Based on BSL’s, gestation and clinical evidence eg SGA or LGA baby Individual education session Dose Device Injection Sites Injection Technique Timing of injections Disposal of sharps Management of hypo’s

16. Metformin Studies conducted in Aust and NZ to assess safety and efficacy of use during pregnancy MiG study Follow up studies on offspring Increased usage since MiG study

17. Insulin & Metformin Translations ArabicPunjabi BengaliSimple Chinese FarsiTamil FilipinoThai HinduTraditional Chinese JubaTurkish Vietnamese

18. Insulin Therapy Arabic

19. Insulin & Metformin Translations ArabicPunjabi BegaliSimple Chinese FarsiTamil FilipinoThai HinduTraditional Chinese JubaTurkish Vietnamese

20. Metformin Bengali

21. Vital GTT – 6 - 8 weeks postnatally Follow up by dietitian Follow up by midwife Discuss – lifestyle issues, weight management, diet, exercise, future pregnancy, contraception Annual fasting glucose with GP Post natal follow up

22. Alerts Need to look at the whole picture Sometimes clinical scenario doesn’t match GDM What to consider BGL – good glycaemic control Self reported dietary modifications and increased physical activity Clinically LGA Significant maternal weight gain USS – fetal macrosomia

24. Meter downloaded

25. Normal pathway now altered Heightened anxiety and stress at diagnosis Impedes ability to learn Guilt Concern for baby Potential separation from baby at birth Will my baby have diabetes? Psychosocial Issues

26. Management Full explanation of GDM Implications for pregnancy Regular contact with specialist team Ensure plan for birth in partnership with woman Education – management of diabetes during delivery and postpartum Routine care during labour Monitor BGL’s – local protocols Anticipate shoulder dystocia Notify Paediatricians. Neonatal hypoglycaemia – test @ 1,2 & 4 hours.

27. Useful websites ADIPS – Australasian Diabetes in Pregnancy Society www.adips.org Diabetes Australia www.diabetesaustralia.com.au You2 Connect www.You2.org.au

28. Conclusion When a pregnancy is complicated by diabetes a multidisciplinary team approach provides the best care for a mother and her baby to achieve an optimal outcome.

29. Avoid

30. Aim to achieve Healthy mother and baby

31. Questions & Discussion