Diabetes in Pregnancy

Option List:
A. Admit for induction of labour.
B. Admit to control glucose.
C. US for foetal weight
D. US for Umblical Artery Doppler
E. CS at 38 weeks.
F. Reassure and send her home
G. Reassurance and reassess at 2 weeks
H. Induction of labour at 37-38 weeks
I. Increase pre-lunch insulin
Each of the following clinical scenarios relates to a woman with diabetes. From the list of options above, for each woman select the single most appropriate option. Each option may be used once, more than once or not at all.

1. A para3 know case of diabetes is on insulin, came for routine ANC check up at 33 weeks with HbA1c of 7.4%, urine glucose 2+ and US showing foetal growth below 10^th percentile. What is the appropriate next step?

2. Para 2 known case of type1 diabetes at 36 weeks of GA on insulin. Her HbA1c 6.5% came after lunch to diabetic joint clinic. Her urine analysis shows glucose 2+. US babies 40th percentile. Patient is otherwise stable.