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Re: 35w diabetic needing less insulinFrom: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk)Mon Mar 25 14:01:56 1996
In message <960324221828_100724.2333_EHU118-1@CompuServe.COM>, STEWART PRINGLE <100724.2333@compuserve.com> writes >Tomorrow we are delivering (by C/S) a 35w diabetic mainly on the grounds that >her insulin requirements have halved over the last 2 weeks. If this reflects >uteroplacental dysfuncton then shouldn't a normal UA Doppler be reassuring? We >haven't done any tests of lung matuirity but we have just given her steroids >without too much effect on her glucoses. Any hard facts on steroids at this >gestation in diabetics? Fetal activity, CTG/NST's and BPP have been normal and >there is no evidence of PIH in this 28y prim. I wonder if we're doing the right >thing but am accepting the opinion of those more experienced in this situation. > 1 Without any real evidence of fetal compromise and with near certainty of significant RDS ( and other maternal and fetal morbidity ) on one hand and various options for fetal assessment and monitoring this seems decidedly heavy handed. 2 There is evidence that steroids don't work so well in diabetics. 3 Diabetics ( babies of ) are more prone to RDS than non-diabetics at similar gestation. 4 Babes delivered by elective CS pre-labour at this gestation are very much more likely to have respiratory problems ( RDS/wet lungs/tachypnoea ). 5 I've seen a few diabetics with falling insulin requirements at this stage. The way we managed them was to give them less insulin ! The idea that falling insulin requirements indicates failing placental function seems to be just anecdote. Personally I'd only do a CS in a diabetic with a clear indication before 38 weeks. I always give steroids ( at any gestation ) to my diabetics prior to pre-labour CS.
--
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
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