Diabetes in Pregnancy Clinic

Pre-Existing Diabetes

• Known type 1 or type 2 diabetes mellitus pre-dating pregnancy
• Refer prior to pregnancy, whenever possible, for pre-conception counseling and optimization of glycemic control, which has been shown to reduce the risk of congenital malformations and pregnancy complications

HbA1c of 6.5% or Greater

Predating or during pregnancy These women will be immediately accepted into the Diabetes in Pregnancy Clinics, without the need for a glucose challenge test, since this is in keeping with a diagnosis of overt diabetes.

Gestational Diabetes (GDM)

Defined by 2013 Canadian Diabetes Association Preferred Approach*, which is defined as either:

• A venous glucose of ≥11.1 mmol/L on a 50g oral glucose challenge test OR
• One or more values, on a 2 hour 75g oral challenge test, greater than or equal to the following blood glucose targets:
  • Fasting ≥ 5.3 mmol/L
  • 1 hour ≥ 10.6 mmol/L
  • 2 hour ≥ 9.0 mmol/L

Gestational Diabetes (GDM) in a Previous Pregnancy

Gestational Diabetes (GDM) in a previous pregnancy:

Please rescreen women as per the 2013 Canadian Diabetes Association Preferred Approach.

*If there is a high suspicion of pre-pregnancy diabetes, screening should be considered anytime during the pregnancy, including early on in pregnancy. If testing is negative, repeat screening for GDM is recommended at 24 – 28 weeks gestation.

Since women who have had Gestational Diabetes in a previous pregnancy have a high rate of progression to type 2 diabetes, we recommend screening of these women for diabetes prior to conception.

We strongly encourage all women of child-bearing age with pre-existing type 1 and type 2 diabetes to discuss family planning regularly with their health-care team. Once your client has indicated she is thinking about pregnancy within 6 months to one year, please refer her to one of our four Calgary diabetes in pregnancy clinics.  Our team of Registered Nurses, Registered Dietitians and Endocrinologists will work with her to ensure she has optimal glycemic control and medication adjustment (folate supplementation, substitution for medications safe in pregnancy) prior to conception.

Of course, we know that many pregnancies are not planned. In these cases, please ensure your client with type 1 or type 2 diabetes is referred to us as soon as possible. We will support her management of type 1 or type 2 diabetes throughout pregnancy and postpartum.

Canadian Diabetes Association (CDA) guidelines advise all women be screened for gestational diabetes (GDM) between 24-28 weeks of pregnancy (or at any stage if indicated). If your client is diagnosed with gestational diabetes please ensure timely referral to the diabetes in pregnancy clinic at the hospital site she will be delivering.

Clients who are referred to a diabetes in pregnancy clinic in Calgary can expect a phone call from the specific hospital site they are referred to. An initial assessment appointment will be arranged with either a Registered Nurse or a Registered Dietitian. If your client has gestational diabetes (GDM) her initial appointment may be in a group setting for a ‘Gestational Diabetes’ class. If your client has pre-existing type 1 or type 2 diabetes she will be seen individually. We encourage clients to visit this educational website prior to their initial appointment.

Your client will be expected to obtain a glucometer either from a pharmacy, or from our clinic at their first appointment. Referring physicians are asked to provide a prescription for diabetes testing supplies. You can access our pdf referral form here: (referral form link). We recommend most GDM clients test their blood sugar four times a day: fasting and two hours after each meal. Women with pre-existing diabetes may be testing blood sugar at least six times a day. Along with testing blood sugar, she will be asked to record food intake and follow healthy nutrition guidelines for pregnancy as taught by the clinic staff.

Care for each woman is individualized based her unique situation. Our staff strive to ensure she feels supported in every interaction. Access to a social worker for financial or other psychosocial concerns is available at most sites, or at our main Diabetes Centre Calgary location.

Your client will be booked with follow-up appointments either by phone or in person at the clinic as needed. We recognize how challenging it can be for our clients to attend frequent in person appointments and we aim to respect their time and energy. All women with pre-existing type 1 or type 2 diabetes will be assessed by an Endocrinologist. Clients whose GDM is managed through nutrition and lifestyle may not require an Endocrinology assessment unless insulin is required for treatment. You can expect thorough chart notes to be faxed detailing the plan of care for your client.

We inform each woman of the importance of phoning in and/or attending appointments prepared with nutrition and blood glucose testing data. Our clinic staff will contact you if your client is not following-up with us as we have requested.

Your client’s care during labour will depend on which type of diabetes she has. Women with pre-existing type 1 or type 2 diabetes will usually have orders entered into Sunrise Clinical Manager (SCM) by Endocrinologist prior to delivery. We have a close working relationship with the family physicians who do low risk obstetrics as well as the Obstetricians. The Endocrinologist on-call will be consulted in hospital as needed. Insulin needs drop significantly post-delivery. Physician orders for post-partum insulin doses will be provided either prior to delivery or in hospital.

Postpartum teaching, including how to prevent type 2 diabetes is provided to all women with gestational diabetes prior to delivery. Clinics do not see women with GDM post-delivery. Referring or family physicians are asked to provide lab requisition for postpartum oral glucose tolerance test. Women with pre-existing type 1 or type 2 diabetes will be booked a follow-up appointment, usually 6 weeks post-delivery with the endocrinologist, Registered Nurse and Registered Dietitian. The Endocrinologist will communicate a discharge plan to responsible physicians. This plan is developed in collaboration with your client and will reflect her health status, overall glycemic control, and plans for future pregnancies.