Pregestational Diabetes

Old

Step 1: View clinicals

A 36 year old woman in her second pregnancy presents for booking at 8 weeks of gestation. She was diagnosed with type 2 diabetes around 3 years ago, which is currently well controlled on Glipizide alone. Her first pregnancy 6 years ago was uncomplicated. Her current HbA1c is 6.7%. An ECG and urine albumin:creatinine ratio are normal


Step 2: Order all relevant investigations

Lipid Profile

Total cholesterol: 200 mg/dL (< 200) HDL: 45 mg/dL (> 40) LDL: 145 mg/dL (< 130) Triglycerides: 160 mg/dL (< 150)

TSH Assay

The Serum TSH level is 1.0 IU/L (normal: 0.4 - 4)

Echocardiogram

The ejection fraction is 65%. There are no valvular or structural abnormalities. There is no evidence of diastolic dysfunction.

eGFR

Her eGFR is 130 mL/min/1.73 m2 (normal: 90 - 120)


Step 3: Select appropriate management

Insulin
Statins
Aspirin
ACE Inhibitors


Score: ★★☆