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Re: 35w diabetic needing less insulin From: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk) Mon Mar 25 13:23:23 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Gary Kleinman: "Lack of Healthy Options?" Previous message: Gary Kleinman: "Re: Lack of Healthy Options?" In reply to: Roland Armstrong: "Re: 35w diabetic needing less insulin" Next in thread: DoctorJoe@aol.com: "Re: 35w diabetic needing less insulin" In message <199603250603.AAA01220@server.northernnet.com>, Roland Armstrong <rjarm@northernnet.com> writes >I believe the data to deliver based on decreasing insulin requirements has >been long outdated. This used to be used before ultrasound, BPP, OCT's, >etc. I personally would not deliver on this basis alone. I would however >strongly consider amniocentesis for maturity at this point and deliver if >mature. Steroids usually increase blood sugars and are not worthwhile at 35 >weeks. > I'd agree with most of this but not about the worthlessness of steroids. To say you'd do amniocentesis for lung maturity and then say no to steroids seems to be contradictory. Steroids improve lung maturity. If you think lungs mightn't be mature surely there is some merit. All the reviews say steroids decrease by half the incidence of RDS *at any gestation*. Sure for most women steroids at 35 weeks are not of great value because RDS risk is low. However it is increased by pre-labour CS and diabetes. There is even a multicentre trial running of steroids prior to elective term CS ( = ASTECS ). Yes steroids do Sometimes increase blood glucose, but its chronic hyperglycaeima that's the problem not 24 hours worth. -- Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) 01525-222849 (home) Fax: 01582-497424 email: Malcolm@mgriff22.demon.co.uk "It is dangerous to be right on a subject on which the established authorities are wrong." (Voltaire) Next message: Gary Kleinman: "Lack of Healthy Options?" Previous message: Gary Kleinman: "Re: Lack of Healthy Options?" In reply to: Roland Armstrong: "Re: 35w diabetic needing less insulin" Next in thread: DoctorJoe@aol.com: "Re: 35w diabetic needing less insulin"

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