Our cookies

We use cookies, which are small text files, to improve your experience on our website.
You can allow or reject non essential cookies or manage them individually.

Reject allAllow all

More options  •  Cookie policy

Our cookies

Allow all

We use cookies, which are small text files, to improve your experience on our website. You can allow all or manage them individually.

You can find out more on our cookie page at any time.

EssentialThese cookies are needed for essential functions such as logging in and making payments. Standard cookies can’t be switched off and they don’t store any of your information.
AnalyticsThese cookies help us collect information such as how many people are using our site or which pages are popular to help us improve customer experience. Switching off these cookies will reduce our ability to gather information to improve the experience.
FunctionalThese cookies are related to features that make your experience better. They enable basic functions such as social media sharing. Switching off these cookies will mean that areas of our website can’t work properly.

Save preferences

Learning zone:
Diabetes in pregnancy

Resources and guidelines relating to diabetes in pregnancy, which are designed to help clinicians improve their practice.

Last updated April 2024

NICE Guideline

  • ACSA standard Local policy for pre-operative preparation including diabetic management

Management of diabetic ketoacidosis in antenatal patient

Overview of the Management of diabetic ketoacidosis in antenatal patient scenario


Multidisciplinary obstetric team; obstetricians, anaesthetists, midwives. Diabetic medical / obstetric team. Obstetric physicians

Suggested clinical learning outcomes

  • Knowledge of effects of DKA on both mother and baby Diagnostic indicators for DKA
  • (1) Ketonaemia >3.0mmol/L 2) Hyperglycaemia >11mmol/L or known diabetes 3) Acidaemia bicarbonate<15mmol/L and / or pH<7.3)
  • Management of acute presentation of DKA

Suggested non- clinical learning outcomes

Local guidelines for management of DKA in pregnancy are available, including recommended treatment targets, fluid resuscitation and frequency of monitoring requirements

Availability of blood gas machine Availability of blood ketone monitor

Consider where it is best to manage this case? With 1:1 care, hourly bloods and full monitoring


  • Ensure goals for management of DKA are clear for the whole team Involve specialist teams to assist management – diabetic teams / general medical teams
  • Clear handover to new members of the team
  • Closed loop communication at all times


The overview of the scenario is a known type 1 diabetic patient who goes into DKA as a result of an infection. You could combine this scenario with a Covid 19 simulation if it would help to practise that too. Otherwise the sepsis could be triggered by a UTI.

32 year old, P1, 30 weeks pregnant presents to triage with vomiting and headache. She gives a vague history of increased urinary frequency 2 days ago and since then has become increasingly unwell with headache and lethargy. Her blood sugars are high which is what has brought her to triage.

She has reduced her insulin dose as she was not eating anything, Observations HR 130, BP 100 / 75 RR 30bpm saturation 99% on air. BM 22 mmol/L
pH 7.2

Lactate 3
Capillary ketones 5.0mmol/L
Urinary ketones ++++, leucocytes and nitrites present

Debrief topics

Following your simulation, consider how you will disseminate crucial learning points with the wider MDT.


  • How was the initial management of DKA?
  • Did you have access to a blood ketone machine?
  • Were you aware of the treatment goals for managing DKA, including the target speed of improvement of biochemical parameters?
  • If you had this case again, is there anything that you would do differently?
Close menu