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



  • 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




  • 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 .











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