POST PARTUM MANAGEMENT
Immediately following delivery insulin resistance falls dramatically. In addition to this, blood glucose falls as glucose passes into breast milk. Breast feeding should be commenced immediately following delivery in order to reduce the risk of neonatal hypoglycaemia. Women with type 1 diabetes will need a reduction of their insulin requirements by about 30% while women with type 2 diabetes could continue metformin or glibenclamide with advise On frequent snacks to reduce the risk of hypoglycaemia. Women with GDM should have their antenatal hypoglycaemic regimen withheld while blood glucose should be monitored premeal and postmeal with advise on frequent snacks. At six weeks postpartum the woman should be reviewed with blood sugar level. The NICE recommends a FBS at six weeks while some studies have shown that this would miss a significant number of women with diabetes, compared to the oral glucose tolerance test.40 Advise on continuing breastfeeding should be reiterated at this point as the benefits of exclusive breastfeeding for at least 3 to 4 months has been demonstrated by a reduction in childhood obesity compared to women with GDM who did not breast feed exclusively for this perio