Clinic appointments

Following a positive diagnosis of gestational diabetes you will usually be asked to attend hospital for a diabetes clinic appointment, returning for regular appointments throughout the rest of your pregnancy.  The frequency of appointments may differ from one hospital to another and may depend on how well you control your blood sugar levels.

You may be asked to attend group meetings with other diabetic mothers or in some areas they may hold 'breakfast club' meetings where you are given set foods to eat and then test your levels.  Please note, breakfast clubs are not common practice.

At these clinic appointments you could meet with any number of professionals, but who's who?
  • diabetic midwife (dmw) - a midwife who specialises in diabetes
  • diabetic specialist nurse (dsn) - a nurse who specialises in diabetes
  • phlebotomist - a specialist who collects blood from patients
  • sonographer - a specialist who performs ultrasound imaging
  • dietitians - a specialist in dietary advice
  • consultant obstetrician - a specialist consultant in pregnancy and childbirth
  • consultant diabetologist - a specialist consultant in diabetes
  • consultant endocrinologist - a specialist in disorders of the endocrine system (hormone related conditions), such as diabetes and hyperthyroidism

The sound of meeting so many different healthcare professionals may feel daunting, but you will usually have separate appointments to see different people and may go from one to another. They won't all be a room staring at you! You may attend an appointment one week and only see two medical professionals and another appointment see many of those mentioned above.

Tips to make the most of your clinic appointments:
  1. Make a list of questions to take with you - It is very hard to remember everything you want to know in the appointments and so if you've written a list, this will help you. Below you can find a list of good questions to ask, if you need ideas
  2. Write down information during your appointment - sometimes you may be feeling overwhelmed and not take in information.  Try to note things down as they are mentioned so that you can refer back to anything later at home when you've had a chance to relax
  3. Take something to occupy you - a book/magazine/e-reader/tablet etc. Clinic appointments can take a long time! Especially if you're seeing a lot of people
  4. Take a snack & drink with you - if you're there a long time, you may not find GD friendly options in vending machines, canteens etc. (plus they can be expensive!)
  5. Warning! - Be prepared that very often the diabetes clinic is run alongside other clinics and so you may see ladies there drinking full sugar coke and getting seen before you - panic not!  They may not be attending your clinic or have gestational diabetes
  6. Take someone with you for support if you can -  It's a lot to take in and sometimes, having your partner or a family member or friend with you will put you more at ease
  7. Don't worry - nothing terrible is going to happen, this is about looking after your baby and you.

 

Possible questions to ask at your clinic appointment:
  • What are your test targets and times? (make sure you write these down)
  • If testing after meals, should you test from one or two hours after the first OR last bite of your meal?
  • How often will you be seen in clinic?
  • Do you need to report your blood glucose readings back to your diabetes team? If so, how and when should you do this?
  • Is there a contact number you can call, text or email for emergencies?
  • Will you be seen by the same diabetic health care professionals at all appointments?
  • Can you refill your prescription for lancets and test strips through your own GP - do you need a letter?
  • Can you still see your community midwife, now that you are being consultant led?
  • Is there an emergency contact for you, should you have any problems?
  • How many over target readings would it take before medication or insulin is introduced?
  • Is Metformin used at this hospital?
  • Will you be given additional growth scans and at what gestation?
  • Does being medicated to control the gestational diabetes have any impact on the type of birth you will be advised to have? i.e. will you be induced, are they happy for you to have a water birth?
  • Is induction or planned caesarean section offered to patients diagnosed with GD, if so at what point/gestation
  • What are the methods of induction available to you?
  • Is it hospital policy that a sliding scale (insulin & glucose IV drip) is used during labour?

doctor

 

facebookA FAQ of newly diagnosed GD Mums is "what should I expect at my first appointment?" and so the best way to answer this question was to ask the members of the Facebook support group!

Care, advice and guidance for patients varies dramatically across the UK & ROI and so there is not a simple answer to this question. Therefore the answers below are from a group post during April 2015. We asked, "what happened at your first clinic appointment?"...

Not much. Told how to use the blood sugar kit. And told me what my reading should be. And a leaflet on gd and what foods to eat

 

Saw diabetic nurse and dietitian. Given machine, shown how to test and limits for levels. Dietary advise was pretty poor she just read out of a leaflet. Sent for hba1c bloods.

 

My first apt I didn't know what to expect, but when I booked in the receptionist said oh you're just here to see the diabetic midwife (dmw) - great thought I and took my seat. First I was seen by who I call the pee lady, that tests your sample at the beginning of each visit and takes your notes from you, then an obstetrician, then a dietitian (LONG talk from her) then a diabetes nurse, then the dmw (who gave me the glucose monitor and went through the testing procedure with me) finally sent me through to a phlebotomist for more bloods. I'd had a growth scan in the last two weeks too which was discussed.

 

I had a growth scan, saw the obstetrician to talk about it, then saw the dietitian she gave me my bs kit and leaflets talked about food etc but in my opinion the dietitian was just a waste of time really x

 

My 1st appt was a bit of a step into the unknown as they said they'd ring if my GTT results indicated GD on the Friday. I was rung the following Monday to be told off for not attending my 1st appt. I gave them a massive what for as I told them they hadn't invited me to an appt nor had they given me any results. Anyway, the 1st appt was a bit nervewracking as I'd heard of GD but no idea really what it was. The DSN explained it all and answered all my questions. Gave me the monitoring equipment and made sure I understood how to use it. Gave me the letters for my GP for the repeat prescriptions for testing equipment, explained several outcomes, sent me off to the dietitian and then packed me off home in a daze x

 

My first appointment explained to me why I was there and they showed me how to use the machine and gave me a leaflet and log book and sent me on my way, it was actually this page that gave me answers x

 

It was a bit rubbish this time, second time with gd so not much explanation given! First time I saw diabetic nurse that explained everything really well, dietitian also came in and gave me leaflets etc (looking back now, some of the info she gave me wasn't great). They booked appointment with consultant and also booked additional scans 28,32 and 36 weeks. I also got given blood testing kit. The diabetic nurse rang me every other day at first to see how I was doing and when they decided to put me on insulin she gave me an injecting lesson using saline water (I think). This time I just got given new blood testing kit, insulin and booked extra scans. I feel like I've pretty much had to beg for information about the long lasting insulin (never used this first pregnancy and diet). I would just say, make sure you ask any questions you have, even if you think they sound daft x

 

On arrival a nurse weighed me, took my blood pressure and tested my urine then back in the waiting area where I was offered a cup of tea. Then called in to see a diabetic doctor who was very nice and explained that the first step was to try diet alone and if that didn't work we would discuss medication. Then into a room with my antenatal doctor who checked me over, did a blood test and booked me in for a growth scan. Then finally the diabetic nurse who advised on what was good to eat and some would be trial and error. Long appointment but I no longer go to antenatal's because my doctor comes to me in the diabetes clinic. X

 

I had ggt test and positive result on the Thursday and first diabetic clinic the following Wednesday - first seen diabetic consultant who went through things in detail with me then went to see the diabetic nurse who showed me testing kit etc then the dietician who went through my diet with me telling me were changes needed to be made etc then I was with another nurse getting bloods weight etc done - after that down to the antenatal clinic for growth scan etc - I was given a dedicated mobile number to the diabetes team and told to ring through my numbers on the Monday - seen both diabetes and antenatal every 2 weeks until 34 weeks when I changed to weekly - when I was fortnightly on the weeks I wasn't being seen I had to ring in with numbers - that pretty much it- not at the end of my gd journey yet but really happy and impressed with my care x

 

My first appointment was at the Day Assessment Unit rather than clinic. The midwife and a diabetes nurse explained my diagnosis, and what it meant, and how to use the kit, and they explained what it meant for the rest of my pregnancy ie diabetes and obs clinics, more scans. They booked me in for my first clinics, gave me my orange notes and contact numbers, and sent me on my way x

 

I saw consultant who diagnosed my GD at 28 weeks, I was referred for a growth scan straight away. Then went on to see the diabetic midwife, who gave me my glucometer, showed me how to use it, gave me my prescription for my lancets and my test strips and my recording sheets. She explained briefly what GD was and told me that nearly all women can control it by diet alone!!!!!! Until I came to this group I was feeling like a complete failure for not being able to control my fasting sugar until I saw from you other ladies how common it actually is! I test 7 times a day and my targets are pre-meals below 5 and after meals below 7. I ring through my results every week and see the dmw anytime I attend the clinic.

 

I saw the dmw she explained how to use the testing kit, told be worse case scenarios and what would happen if it was controlled. Gave me a basic print out of food I could eat, told me what my levels should be then I had to go back a week later to see dmw when they put me on metformin. My first growth scan was 4 weeks after diagnosis at 31+4 weeks this is when I saw consultant who deals with growth scan then diabetic consultant then the dmw as the consultant had put me on slow release insulin. Then I'm seen fortnightly either by just the dmw or by the Gd team.

 

I was very nervous and emotional on the day. I went to the normal antenatal clinic and waited to see the nurse for urine, weight and blood pressure and then over to the clinic waiting room. After an hour wait I saw the diabetic midwife who was just lovely and didn't mind me crying on her! She didn't make me feel bad or fat like I imagined. She talked thru the 'risks' to baby and her main concern if they didn't control it. Told me I would be induced at 38 weeks. And would have to have a hospital birth with monitoring. I expressed my worries as wanted an active birth and she reassured me I may be able to use the mobile monitoring if available. Was told I would get regular scans for size and also see a dietician. After showing me the testing machine and when I needed to test I went to the dietician. He didn't really give me much info tbh. It was mainly just the common sense healthy eating guide really. I told him what I are most days and he guided me what I needed to avoid from it and what portions I should be eating. I then had to book my next app for 7 days times in which I would be scanned too. And off I went! I felt a lot better, but still knew nothing really lol! So I read lots online via baby centre and joined here and that helped more . Feel very supported by the hospital tho and I've seen them fortnightly since and spoke to them on the phone when I've had higher readings x

 

First appointment at 11 weeks was waiting for date scan the next week. Met with a diabetic nurse who was happy to answer any questions. She gave me my monitor and showed me how to test. Explained the levels should be between. Gave me leaflets and telephone numbers to ring for help at hospital and booked me an appointment with dietitian. Explained I should email my numbers to the diabetic team every 2 weeks but if they were high to let them know before. They put my mind at ease and were very helpful x

 

My first app after being diagnosed was a class were we met a dietician, a physiotherapist and the diabetic midwife! We were also given our testing kit and showed how to use it and we were told what our target sugars should be! That was on a Thursday and u had to go in the following Tues fasting to get bloods taken before an after food then we went to the midwife to get blood pressure and urine checked and then it was off to the diabetic doc, he said I will have to go on tablets next week if sugars don't improve with diet only which the have not! I will be seen every 3 weeks and I have to ring in every week with my readings! I hope this makes sense it's all new to me too so I'm still learning!

 

1st appt was in the diabetic outpatient ward in the hospital. Saw DMW who briefly explains GD, went through my notes and gtt results. She did make clear that it wasn't due to anything that I had done. Then went through to diabetic nurse and dietician. Given testing kit and shown how to use it. The dietician ready off a leaflet and said to eat normally just exclude fruit juices and and eat low fat diary instead of full fat/semi. Wasn't very helpful and I learned so much more from here. Subsequent Appts were at the diabetic clinic in the maternity unit.

 

I was tested at 28 weeks, 2 readings were high so I was booked in for a lifestyle class with 20 women. A midwife explained GD, dietician for food and physio midwife for exercise. They do not hand out testers unless you end up on insulin so you attend a breakfast club every week for fasting bloods, then toast & tea & bloods again in an hour. There is also a growth scan booked for 34 weeks x

 

I saw the diabetic specialist midwife who took details of diet and said where to change things (common sense info really and I'd done most changes). Explained what GD was and gave me a leaflet and showed how to use testing kit. I got booked in for the full clinic for the second appointment

 

I was contacted 2 days after my GTT by the Diabetic midwife who made an appt to see me the following day. She was great at explaining GD, what it meant and what changes I had to make. She showed me how to work the BS machine and went through the dos and don'ts of a GD diet (but did stress that it's trial and error and differs per person). She said she wanted me to try and diet control for first week but said that she would be surprised if I managed it on diet alone as my post GTT reading was 10.8 (I felt re-assured by her honesty but still gave it a good shot). She then booked me in for consultant / scan appts and I call her whenever I get more than a couple of high readings. I wasn't weighed or anything and haven't been at any of my appts.

 

My first appointment was with the diabetes nurse and all she wanted me to do initially was test my blood so she gave me all the equipment, glucometer, test strips etc and showed me how to use them and when to record my results, immediately afterwards she swapped with the dietician who went through my diet with me. She explained about limiting carbs and avoiding sugar. I wasn't weighed at this point, not until I saw the consultant a week later. To be honest that was pretty much it for my first appointment! Xx

 

I was diagnosed at 14 weeks after the 12 weeks blood test they do to check for downs. my results came back and my MW noticed my bloods were a tad on the high side, not a lot she said was still over. She didn't feel satisfied sending me home saying all was ok so she booked me in for a GTT the following week with the blood clinic. She explained everything to me what the GTT was and the procedures. Had my GTT the following week and the next day I got a call from the DMW to say my results were really high (17!!) but was 11 even before the glucose drink was taken  I got admitted into hospital, and in that 24 hours I was hooked up to machines, bloods checked on the hour, my BS went up to 17 again, down to 3 back up to 10 and down to 7. I felt rotten! But in all this the medical team explained everything to me, told me what was happening and why it was happening. I was discharged the next day, after seeing the specialist diabetic consultant, and my dedicated DMW who explained GD to me, why it's happened and what the risks were. They were amazing! Later than afternoon I was shown how to use my machine, and how to inject insulin. DMW gave me as much info on food as possible but she had to book me in to see the dietician on the Monday. Well I wish I could say the same amazing service and advice for my dietician. Her advice was rubbish, basic info which you would be given to a type 1/2 diabetic, complete opposite to the advice and info I have found on her, which please note is the best advice and works! My DMW agrees as she had 2 GD pregnancies herself. I go and see her every few weeks and I get weighed she goes through my readings (which I go through with my DMW anyway and she's happy with) and then she asks me what I eat and says I shouldn't be eating fats etc as it doesn't work - when my numbers clearly show it does. This group and my DMW is where I learnt all my info from and why now 7 weeks into GD I am a happier GD mummy x

 

I was diagnosed on the Friday in the antenatal clinic and had an appointment for the following Monday morning at the diabetes clinic. Turned up there for 930 and there were 3 of us taking part in a 'workshop' which involved seeing a diabetic consultant, diabetic midwife and dietician as a group. Each session was interactive, we asked questions which they answered, we were given information and diet sheets plus the glucose readers. They explained how our care would now be shifted to the hospital and that we'd see them every fortnight. The workshop was a new approach for them and they asked for feedback from all of us and it came back positive. We were there about 2 and half hours in total. I went in knowing absolutely nothing about GD but came away feeling well informed and supported

 

After my gtt I was called in to see a consultant who explained what gd was and how it would be monitored throughout the rest of the pregnancy. I was then referred to the specialist diabetes clinic at St Helens hospital to see a dietician and diabetic nurse who would provide further guidance. The session at St Helens hospital was a group session so I was with two other recently diagnosed women. We then had an informal chat with the dietician who gives us some advise on the dos a day don't of gd diet. The diabetic nurse then talked through how to use the test kit. The whole thing was very relaxed and really put you at ease and made you realise it was a manageable condition. Also having other gd mum's to be in the group was a nice touch as you realised your not alone and got to hear some first hand experiences of different people.

 

I was diagnosed on the Monday at 28 weeks I was advised my results were different to what they had seen and that they may retest me but they were not really sure and to attend clinic on the Thursday. I panicked I was told my fasting was impaired but after the glucose were fine. I went to the clinic then took for bloods asked what they were for and they couldn't explain just that I would have them once a month. Found out we're for a1c. Was told to sit and wait again then went to see the dietician who was ok. Was given bs kit shown what to do and given targets. Was told if had a high reading to call in otherwise would see me in 2 weeks. I have had a high reading twice but called the nurse and was told not to worry. Obviously I worried. My appointment is tomorrow so hopefully find out more. I have had no growth scans discussed or offered. I had no idea about GD and came out confused lost and upset everything went so fast. Thanks to this group I now have questions for my next appointment and finally feel settled with what I am doing. Sure this will change after tomorrow's appointment ha. Xx

 

With my first I was diagnosed with the routine GTT at my GPs at 28 weeks. From there my community midwife care stopped and I went under consultant care. My appointments were weekly & from the start consisted of:Giving a urine sample and getting a printout result a few minutes later and also weighing myself in one room. I'd then give my notes & urine results to the midwife in the main waiting area. I'd then be called by a ward midwife to do my blood pressure. I'd then be called in by the diabetic midwife who'd listen to baby with a Doppler and I'd tell her any concerns. At my first appointment it was the diabetic midwife who gave me my blood glucose meter and showed me how to use it and record readings. Later when I started insulin, it was also her who showed me how to inject I'd then be called in by the dietician who at the first appointment gave dietary advice and at subsequent ones went through my food diaries with me. I'd then be called by the diabetic consultant who went through my numbers with me and suggest any insulin increases. At the first appointment he talked through all the various medications that I may end up on. I'd then be called by the obstetrician who went through any problems in the pregnancy, GD or otherwise. I'd then go for bloods (including fortnightly Hba1C) I'd then go book the next weeks appointment at reception & be free to go. I had growth scans at 28, 32, 34 & 36 weeks. With my other 3 I was diagnosed at 16, 8 and 6 weeks by self testing with my monitor at home & my GP made a referral straight away. I was under consultant care from the start with them. They really were long appointments. Minimum of 2hrs. But I do feel they were worth it as they were very thorough and covered every angle & aspect. I always had to test 7 times a day. 1st thing, before breakfast 1hr post breakfast Before lunch 1hr post lunch Before dinner 1hr post dinner Before bed To begin with I had to call every 3 days with my results and they tended to increase my insulin over the phone each time. After a while with my last 2 babies they explained when and why to increase the insulin doses myself every 3 days.

 

I am 19 weeks pregnant tomorrow and was told i had GD at 17 weeks after having a 16 week GTT. I have used this group for support which has been great as I didn't have my first Diabetic Education session until yesterday. I was really worried as I am a first time mum and didn't know what to expect. I attended a group session at the hospital with about 7 other women. We were spoken to by the dietitian who told us all what we should and shouldn't eat. She explained in a lot of detail about the condition and the outcomes of having a GD baby. She told use we all have one week to regulate our numbers and have them in target range,before or consultants appointment next week. I will have to go to weekly sessions every Tuesday to the hospital to see the consultant, midwife and diabetes team. We were told that we have a target of 5.9 before meals and 7.8 after. I have to test 4 times a day. I was told to ring the diabetes team if i have 3 or more high reading. We were give our blood sugar reading kits and shown how to use them. I won't be seeing the consultant till next week. So that was about it till next week. x

 

I had a routine consultant's appt at 28weeks as I was already high risk due to losing my first baby at 39 weeks. I had taken my gtt a couple of days before and they broke it too me that it was positive. I can't remember my readings as it was in 2011. They were completely honest with me about my risks and complications. I saw the diabetic nurse who mentioned what I needed to cut out and explained how to use my bs testing monitor. They gave me loads of leaflets and arranged for me to see a dietician. It was stressed that I shouldn't go hungry and it wasn't my fault. They also issued a letter to my gp informing him of the diagnosis. It was a long appt and I felt informed about gd.

 

I was diagnosed at 25 weeks. (Due to previous 10lb11 big baby) diagnosed on a Friday and told to go to diabetic clinic later that day. Wasn't GD specific clinic, just general diabetic. Saw dietician and diabetic nurses who were so lovely. I was so scared I ended up crying but they were fab. Told to monitor blood over weekend and report back Monday. Monday came, blood sugar not the best so put on insulin on the Tuesday. A very small amount and they don't give pregnant ladies metformin at all in my hospital. Showed me how to use the needle and it's nothing. Don't feel it at all. Everything going great from then, reporting back twice a week with readings, insulin adjusted etc 2 weeks later I saw diabetic consultant and diabetic dr at antenatal. Had routine midwife checks, the DR was amazing. She talked through everything and really reassured me. Was with her for about 45 minutes just chatting about everything. Consultant was well, uninterested! Knew nothing about me or my history. Was with him for 5 mins tops. He was very much 'just doing his job' had quick scan with him, quick chat about baby's size and that was that. So apart from consultant iv had a lovely experience so far, if you can call having GD lovely! Everyone has reassured me and been comforting. Even got a good relationship with diabetic nurses I talk to on the phone when giving readings. Friday I was called "a dozy mare!" by one as is messed up my insulin the night before! It's all very relaxed but I'm getting great care too. Xx

 

My first appointment lasted three and a half hours I thought it was because I'm having twins but no it was a routine first appointment! I first went in to see the mad wife as she called herself she weighed me tested my urine and asked the usual midwife questions. Then the diabetic nurse Who gave me my targets tested my blood and gave me my starter testing kit , explained Gd and a tissue as I started crying. Next was the dietitian who basically told me that nothing was really of the menu but I should limit carbs and sugary food and drinks , she said low fat milk , cheese, meat, yogurt and anything else that edible is best , I even had a booklet saying a Welsh cake or small bowl of ice cream is fine. On to the consultant she was lovely and re assuring she told me that because my next scan was already booked she wouldn't inter fear with but made an appointment for me in two weeks time and told me that most mums with Gd have their baby's at 38 weeks but because I'm having twins I would go sooner but didn't say how soon! Then the doctor lovely old chap took about 10 mins to tell me how long he had been in his profession! He did also tell me that because of my high gtt results was convinced I had type 2 diabetes before I got pregnant and the pregnancy made it worse he also said that one metformin tablet was the equivalent of a twenty minute walk and if I didn't want to take them get walking more Sorry for the long post at the moment I can't fault the health care I'm getting apart from the dietitian

 

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