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Reflective practice
Type 1 Diabetes Diagnosed during pregnancy:
The experience that I would like to share has taken place in Antenatal Clinic around the last quarter of 2017.
A 17 years old girl who was 31 week of gestation with her first pregnancy was referred to Antenatal Clinic for an oral GTT due to 4+ of glycosuria. The test has been completed at 11 am. An urgent phone call was received from the lab to report a very GTT high result.
I have
Background:
- Female
- 17 years old
- White Caucasian
- Normal BMI
- 1st pregnancy 31 weeks of gestation
- No family history of Diabetes
- Normal Antenatal examination
Situation and finding:
- Routine Antenatal appointment / previous antenatal appointment 4 weeks ago
- 4+ glycosuria, no history of previous positive glycosuria
- Reported being thirsty but not excessively drinking water
- No record for any previous concerns regarding glucose levels
As per hospital protocol booked for OGTT next day wot 75g of dries carbohydrate (polycal, 113ml)
Result came back
Fasting : 12.7mmol/L
POST Polycal : 19+mmo/L
Patient is brought to Antenatal Clinic (ANC) in few hours :
- Full previous History
- Antibodies screening – Anti GAD and Diabetes screening test done
- Ketone testing. = 0.1mmol/L
- To teach hoe monitoring system and pattern of testing (6-7 times a day before breakfast, bed time and before and after each meal)
- To commence oral diabetes treatment (metformin 500mg BD) and to follow up over by telephone clinic with a plan to titrate in 3 days
Plans:
- Review daily (tell clinic)
- Review blood test as soon as they are available
- Dietician appointment
- Taught patient to test ketones if glucose levels are higher than 13mmol/L and at what levels she needs to contact the hospital.
- Informed Diabetes Centre for a follow up and review in multidisciplinary clinic withn a week.
In couple of weeks:
- All blood results are back,
- Antibodies positive and diagnosed with Type 1 DM
- Diabetologist review done , insulin commenced
- Multiple injection Regime (levemir BD, Humalog pre meals ) and to continue Metformin 1g BD.
- Plan to continue this regime until delivery and have a repeat assessment later.
Unfortunately lost contact after delivery and never had an update.
Learnt :
Organizational skills
Team work
To look out of the box and consider unusual diagnoses for what otherwise might look a different thing
Learnt different type about different approaches when screening for Diabetes
Blood test, Family History and presenting symptoms .