Home' Australian Pharmacist : Australian Pharmacist October 2015 Contents Australian Pharmacist October 2015 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
Although the long-term safety of oral
medicines has not been established,
neither glibenclamide nor metformin
have been shown to cause any
congenital abnormalities and outcomes
data from studies are reassuring.
Metformin crosses the placenta
and concentration in the fetus is
increased due to amniotic recycling.
Glibenclamide has been shown to cause
hypoglycaemia in the neonate.
Australian category C in pregnancy.
A 2015 review stated that glibenclamide
was inferior to both insulin and
metformin, while metformin
(plus insulin when required) performed
slightly better than insulin.
Guidelines suggest specialist care is
necessary for women prescribed oral
medicines. Situations where a specialist
may need to consider an oral agent
• fear of needles
• difficulty maintaining the insulin
• severe obesity requiring high doses
Metformin and glibenclamide are
not approved for use in pregnancy in
Australia. There is little or no data in
pregnancy for the other groups of oral
antidiabetic medicines and are advised
to be avoided.
Will I always have diabetes?
Although the mother’s BGLs usually
return to normal after birth, there is an
increased risk of her developing type
2 diabetes mellitus in future. Her child
may also be at risk of developing type
2 diabetes later in their life.
should have another glucose tolerance
test 6–12 weeks after birth.
tests are normal, she should be tested
with a fasting or random glucose test
every 12 months or offered a glucose
tolerance test every two years. This is
especially important if she is planning
subsequent pregnancies. Also, a woman
with a history of GDM should be
offered early screening (around week
12–16 and repeated at 26 weeks) for
What else can I do?
For women who are planning a
pregnancy, pharmacists should advise
about pre-pregnancy care. This will
include information about diet,
nutrition, exercise and folic acid (folate)
supplementation. Folate requirements
double during pregnancy.
Folate supplementation around the
time of conception and during early
pregnancy has been shown to reduce
the risk of neural tube defects.
While the general recommendation
is folic acid 500 micrograms orally,
daily from at least one month before
conception and in the first three months
of pregnancy, women with diabetes
(and other risk factors for neural tube
defects), are recommended to take a
higher dose, i.e. folic acid 5 mg orally.20
Pharmacists can counsel women
about GDM through in-store health
promotions, diabetes clinics or as part of
their everyday service.
Some counselling tips for pharmacists:
• Talk to women about pre-pregnancy
care, especially if they enquire about
OTC vitamins and supplements for
• Counsel women with PCOS and/or
diabetes about preconception care
• Advise women that lifestyle
management including weight
management, healthy eating, a low-GI
diet, BGL monitoring and correct
exercise strategies are all part of
• Provide pregnant women who are
prescribed diabetes medicines with
any additional information required
and counsel on their correct use.
Pregnant women with GDM may also
qualify for a Diabetes MedsCheck.
• Demonstrate the correct injection
technique including priming the
injections, and how to store and travel
• Demonstrate how to correctly measure
BGL and keep accurate records.
• Counsel women on how to
recognise symptoms of and manage
• Encourage women with GDM to
register with NDSS.
Where can I find more
Further information can be found at:
• Australian Diabetes in Pregnancy
Society (ADIPS): www.adips.org/
• Diabetes Australia: www.
• National Diabetes Services Scheme
• National Health and Medical Research
Council (NHMRC) Australian Dietary
Natasha’s case continued:
Although Natasha tells you she has no
family history of diabetes, she does
have other risk factors that predispose
her to gestational diabetes – her age
(over 40) and her weight. Her first
baby was about 4.5 kg, which also
increases her likelihood of developing
GDM. You explain to Natasha the risk
factors of GDM and the complications
of untreated GDM. You explain how
GDM is managed with diet and exercise
but sometimes medicines may be
necessary. If her doctor prescribes
medicines, it is important she take them
to prevent complications for the baby
and herself. You show her the variety
of blood glucose monitors available
and how to test for BGLs. You reassure
her and recommend she returns to
the pharmacy to purchase the blood
glucose meter after the results of her
test are confirmed. You would then
discuss how Natasha could closely
monitor her BGLs during her pregnancy.
In the meantime, you offer her a
Self Care Fact Card on Diabetes type 2
and names of websites she can visit to
get further information.
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