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PM.76 A Question of Probity: Phantom Blood Glucose Value Recording in a Self-Monitoring Pregnant Diabetic Woman
  1. A Adeyemo,
  2. M Hicks,
  3. A Kulkarni,
  4. Z Ramsey-Marcelle
  1. North Middlesex Hospital, London, UK

Abstract

Introduction A successful doctor-patient relationship is based on perceived mutual trust. The importance of this is underscored in pregnant diabetic women where self monitoring of blood glucose (SMBG) levels by patients’ informs and directs shared clinical decisions which impact significantly on their lifestyle, diet and medication adjustments so that a good pregnancy outcome is achieved.

Case Report A 29 yr old para2 woman with type 2 diabetes was booked and followed up in the combined antenatal diabetic clinic through her third pregnancy. She required metformin and subcutaneous insulin injections to control her blood glucose prior to conception. These were continued in pregnancy with an increase in the frequency of blood glucose monitoring. At 28 weeks of pregnancy, it was noted that blood glucose values recorded in her logbook over the course of 8 weeks consistently showed fasting levels <5 mmol/l and 1 hr postprandial levels <7 mmol/l despite HbA1C levels of 72 mmols/mol (8.7%) and ultrasound scan showing fetal macrosomia and significant polyhydramnios. A review of her glucometer identified difference in the values stored in the memory and that recorded in her logbook. This discrepancy was brought to her notice and she divulged falsifying the values. She was delivered by emergency caesarean section for fetal compromise at 32 weeks gestation.

Conclusion Accuracy of home metres and diary logs needs to be confirmed at regular intervals, and SMBG values should not be the only criterion for diabetes management during pregnancy.

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