Please arrive 15 - 30 minutes prior to your appointment to allow for parking and registration. Parking on the lot is meter parking paid by credit card or pay by phone.

• Upon arriving at BC Women's Hospital (main entrance 93), report directly to the Diabetes Clinic desk 7
• You are welcome to bring a family member or friend with you
• You can eat and drink before your appointment and are welcome to bring snacks with you

Please bring:

• Any supplements, vitamins, and/or medications you are currently taking or a detail list of all medications, supplements or vitamins
• If you have a glucose meter, please bring it along with your blood sugar records

At your first appointment you will meet the nurse and dietitian, often in a group setting with other pregnant individuals experiencing diabetes. This group session will take a minimum of 3 hours.

The nurse will talk with you about diabetes in pregnancy. The information given will depend on the type of diabetes you have.

The dietitian will discuss with you a healthy diet for pregnancy that will also help you control your blood sugar and have a healthy weight gain.

Some things that will be discussed with you in the appointment:

• Your role on the team
• What you need to know before you get pregnant (if you have type 1 or type 2 diabetes)
• What are the effect of pregnancy on blood sugar
• What is the risk to the baby from high blood sugar
• How to manage your condition - nutrition, activity, blood sugar testing, urine testing and giving yourself insulin (if needed)

You will have a chance to ask questions, and will have access to resources so that you do not have to worry about remembering everything.

First follow-up

At the first follow-up diabetes clinic appointment, you will see the endocrinologist (doctor), nurse, dietitian, physiotherapist and social worker (if needed). This appointment will take a minimum of 90 minutes.

The endocrinologist:

• Assesses health, pregnancy and diabetes management
• Advises on diabetes management. This may include insulin, if needed
• Discusses exams or tests that may be required

The dietitian:

• Assesses blood sugars, ketones, weight and hunger
  
• Changes are made to the your eating plan as needed
  
• Answers any food related questions
  
• Discusses insulin (if needed)
  

The nurse:

• Assesses pregnancy and diabetes management
  
• Reviews blood sugar testing
• Teaches insulin (if needed)
  
• Answers any meter question

The physiotherapist:

• Reviews activity and exercise plan
  
• Suggests exercises that may prevent injury and/or discomfort
  

The social worker (if needed):

• Provides psychosocial assessment, counseling, and support, focused on the reason for your referral
• Develops a safe pregnancy and parenting support plan with you and connects you with community resources
• Collaborates with the health care team

Regular follow-up clinic appointments

Your endocrinologist will advise you on how often you need to come to the clinic. Generally, you will return or have a virtual health appointment every 1 to 4 weeks. At these follow-up appointments you will always see speak with the endocrinologist, and you may also see other members of the diabetes team.

Labour and delivery

Planning for labour and delivery is individual, including for those with diabetes in pregnancy.

If you have gestational diabetes mellitus (GDM), you may even go past your due date as you wait for labour to start, as long as you and the baby are healthy. If you have started on insulin, or have type 1 or type 2 diabetes, it is most likely that you will have your baby a week or two before your due date. This is for the safety of your baby.

Some pregnant individuals may have an induction of labour, especially if there is a concern about the health of the pregnancy or baby. Others may have a planned caesarean birth, depending on their individual situation. You will always be involved in the decision-making, and the oppourunity will be made to have your questions answered. The team will help you with advanced planning as much as possible.

During labour, your blood sugar will be closely monitored, and the nurses will keep in contact with the diabetes doctor as needed. Your care after delivery will depend on what type of diabetes you have.

Postpartum

If you have GDM, you will have a blood sugar test before breakfast the day after the baby's birth to make sure that the diabetes has gone away. It is important to discuss nutrition, activity, infant feeding, future pregnancies, and the risk of type 2 diabetes with the team before you go home. A very small number of individuals still have high blood sugar after birth and will need follow-up with the diabetes doctor.

If you have type 1 you may not need insulin for the first day or two after birth, and will need it again when your blood sugars start to go up. If you have type 2 you may need some kind of diabetes medication. You and your doctor will make these decisions. The team will discuss nutrition, activity, infant feeding, future pregnancies, and future diabetes management with you.