diabetestalk.net

Insulin During Pregnancy Labour And Delivery

6 Insulin During Pregnancy, Labour And Delivery

6 Insulin During Pregnancy, Labour And Delivery

Optimal glycaemic control is of the utmost importance to achieve the best possible outcome of a pregnancy complicated by diabetes. This holds for pregnancies in women with preconceptional type 1 or type 2 diabetes as well as for pregnancies complicated by gestational diabetes. Glycaemic control is conventionally expressed in the HbA1c value but the HbA1c value does not completely capture the complexity of glycaemic control. The daily glucose profile measured by the patients themselves through measurements performed in capillary blood obtained by finger stick provides valuable information needed to adjust insulin therapy. Hypoglycaemia is the major threat to the pregnant woman or the woman with tight glycaemic control in the run-up to pregnancy. Repetitive hypoglycaemia can lead to hypoglycaemia unawareness, which is reversible with prevention of hypoglycaemia. A delicate balance should be struck between preventing hyperglycaemia and hypoglycaemia. Insulin requirements are not uniform across the day: it is low during the night with a more or less pronounced rise at dawn, followed by a gradual decrease during the remainder of the day. A basal amount of insulin is needed to regulate the endogenous glucose production, short-acting insulin shots are needed to handle exogenous glucose loads. Insulin therapy means two choices: the type of insulin used and the method of insulin administration. Regarding the type of insulin, the choice is between human and analogue insulins. The analogue short-acting insulin aspart has been shown to be safe during pregnancy in a randomised trial and has received registration for this indication; the short-acting analogue insulin lispro has been shown to be safe in observational studies. No such information is available on the long-acting insulin Continue reading >>

Gestational Diabetes And Giving Birth

Gestational Diabetes And Giving Birth

The latest guidance from NICE, published in 2015, has extended the time by which women with gestational diabetes should give birth to 40 weeks, 6 days – not much less than the general guidance for all pregnant women, which is 42 weeks. If you have not gone to birth at this point, induction of labour will be recommended. "When I was in the hospital, I felt I didn’t know what was going on. I would have liked more information about that part so I could have been better prepared." Gemma, mum of one The main reason for induction is to prevent stillbirth. For all women, the risk increases when their pregnancy goes past 42 weeks. However, one study has shown that women with gestational diabetes may be at risk earlier. So for this reason, the guidance in England and Wales states that if you have gestational diabetes, you should not go beyond 40 weeks, 6 days. An induction or caesarean may also be advised if your baby is very large (macrosomia) – as this may cause difficulties during the birth. On the other hand induction may also be recommended if the team detects poor growth in your baby. In Scotland, most women with diabetes in pregnancy are induced within 40 weeks. The guidance says that this decision should be determined on an individual basis. If you are taking diabetes medication or insulin, it recommends that you should be assessed at 38 weeks and delivered by 40 weeks. Choices you might need to make for labour and birth Most women with gestational diabetes have a healthy birth. But before you make your birth plan, you may need to take some things into account to make sure you and your baby are safe during and after the birth. If you have gestational diabetes, you will have less choice about where to deliver your baby. This is because you will need to deliver your Continue reading >>

Gestational Diabetes And Induction Of Labour – What You Should Know

Gestational Diabetes And Induction Of Labour – What You Should Know

Gestational Diabetes and Induction Gestational diabetes (GD) was once a relatively rare condition, occurring in about 4% of pregnancies. In recent years, the rate of women developing GD has doubled, and experts believe the incidence of the disease will keep increasing. Most women with GD are told by their care providers they will need to be induced before their due date, destroying their hopes for a natural and intervention free birth. Having GD can have a big impact on mothers’ and babies’ health during pregnancy, but does it really need to change how we give birth? What Is Gestational Diabetes? Gestational diabetes is a condition that only occurs during pregnancy. Certain pregnancy hormones interfere with your body’s ability to use insulin. Insulin converts blood sugar into usable energy, and if this doesn’t happen, blood sugar levels rise. Insulin resistance can cause high blood glucose levels and can eventually lead to gestational diabetes. Some women will have symptoms of GD, while others will have none. Many women can manage the condition without treatment other than dietary and exercise changes. Around 20% of women will need insulin injections. So for many women, well managed diabetes means they can still have healthy babies and normal births. Induction Of Labour Many care providers routinely recommend that women with gestational diabetes be induced around 38-39 weeks. The most common reasons given for induction at this gestation are to prevent stillbirth, and to prevent babies growing too large for vaginal birth. However, the evidence related to induction for women with GD comes from the review of one trial, which looked at 200 women who had either GD, Type 1 or Type 2 diabetes. The World Health Organization states this evidence for induction before 41 w Continue reading >>

Managing Diabetes During Labour

Managing Diabetes During Labour

Your own blood glucose levels in the time leading up to the birth have an important effect on your baby’s blood glucose levels. The higher your blood glucose is, the higher the glucose supply will be to your baby before birth. The extra glucose stimulates the baby’s pancreas to make more insulin. At birth, your glucose supply to your baby suddenly stops, but your baby may continue to produce excess insulin for several hours and even up to one or two days after birth. This can cause hypoglycaemia in the baby. If you have blood glucose levels close to the recommended range during labour, this lowers the risk of your baby having low blood glucose levels at birth. When an induction or caesarean section is planned, your diabetes in pregnancy team will discuss with you a plan for managing your diabetes. This will include adjustment of your insulin doses/pump rates or changing the way insulin will be delivered. When you are in labour, your blood glucose levels will usually be monitored hourly and the amount of insulin you are being given will be adjusted to keep your blood glucose in the normal range. An intravenous (IV) insulin infusion and IV glucose (sugar) are often used throughout labour, which allow small amounts of insulin and glucose to run into your blood continuously. Alternatively, rapid-acting insulin injections every two to four hours may be used during labour to manage your blood glucose levels. If you use an insulin pump, you may be able to continue using it, but with changes to your basal rates and smaller bolus doses. This will only be the case if this can be managed safely at the hospital where you will deliver your baby and blood glucose levels can be kept within the target range. Continue reading >>

Diabetes In Pregnancy: Management From Preconception To The Postnatal Period

Diabetes In Pregnancy: Management From Preconception To The Postnatal Period

See other NICE guidance for NICE information for the public on care for women and their babies during labour (intrapartum care), induction of labour and caesarean section. You should be advised to have your baby in a hospital that has special facilities to care for sick babies 24 hours a day, in case these are needed. During your pregnancy (and especially in the last 3 months), your care team should explain about your options for giving birth. This should include information about the benefits and risks of having your labour induced compared with letting the pregnancy carry on, and of having a 'normal' (vaginal) birth compared with a caesarean section. This is especially important if you are having a large baby. If you have had a caesarean section before, you may still be able to have a vaginal birth this time. If you have certain health problems (such as being very overweight or having spinal nerve‑related problems such as sciatica), you may be advised to see an anaesthetist to talk about the best method of pain relief during the birth. Timing of the birth is important, because if your pregnancy carries on for too long this may increase the chance of problems for you and/or your baby. You should be advised to have your labour induced, or a caesarean section if this is the best option for you, during week 37 or week 38 of pregnancy. You may be advised to have your baby earlier than this if there are complications (such as high blood pressure or a slowing down of your baby's growth). You should be advised to have your labour induced, or a caesarean section if this is the best option for you, before 41 weeks of pregnancy if you have not had your baby by this time. You may be advised to have your baby earlier than this if there are complications (such as high blood press Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

One in twenty pregnant women in Australia is affected by diabetes. Although the disease can cause serious complications for mothers and babies, good planning and comprehensive antenatal care can keep you and your baby healthy. By Joanna Egan. Diabetes is a chronic condition characterised by the body's inability to control glucose levels in the blood. Glucose is a simple sugar found in foods such as breads, cereals, fruit, starchy vegetables, legumes, dairy products and sweets. A hormone produced by the pancreas, called insulin, converts this glucose into energy that is used to fuel the body. When a person has diabetes, they either don't produce enough insulin or are unable to use insulin effectively. This causes glucose to build up in their bloodstream. There are several types of diabetes: Type 1: People with type 1 diabetes don't produce insulin. As a result, they need to monitor their blood glucose levels carefully and require regular insulin injections (up to four times a day). Generally, type 1 diabetes arises in children and young adults, but it can occur at any age. Type 2: This is the most common form of diabetes. Some people have a genetic predisposition to developing the disease but often, it is caused by lifestyle factors such as high blood pressure, obesity, insufficient exercise and poor diet. People with type 2 diabetes produce insulin, but either don't produce enough or are unable to use it effectively. Generally, it is initially managed with healthy eating and regular physical activity, but as the condition progresses, glucose-lowering tablets and/or insulin injections may be prescribed. Gestational diabetes: This form of diabetes develops, or is first diagnosed, during pregnancy. It usually appears late in the second trimester and resolves after childbir Continue reading >>

Insulin During Pregnancy, Labour And Delivery.

Insulin During Pregnancy, Labour And Delivery.

Abstract Optimal glycaemic control is of the utmost importance to achieve the best possible outcome of a pregnancy complicated by diabetes. This holds for pregnancies in women with preconceptional type 1 or type 2 diabetes as well as for pregnancies complicated by gestational diabetes. Glycaemic control is conventionally expressed in the HbA1c value but the HbA1c value does not completely capture the complexity of glycaemic control. The daily glucose profile measured by the patients themselves through measurements performed in capillary blood obtained by finger stick provides valuable information needed to adjust insulin therapy. Hypoglycaemia is the major threat to the pregnant woman or the woman with tight glycaemic control in the run-up to pregnancy. Repetitive hypoglycaemia can lead to hypoglycaemia unawareness, which is reversible with prevention of hypoglycaemia. A delicate balance should be struck between preventing hyperglycaemia and hypoglycaemia. Insulin requirements are not uniform across the day: it is low during the night with a more or less pronounced rise at dawn, followed by a gradual decrease during the remainder of the day. A basal amount of insulin is needed to regulate the endogenous glucose production, short-acting insulin shots are needed to handle exogenous glucose loads. Insulin therapy means two choices: the type of insulin used and the method of insulin administration. Regarding the type of insulin, the choice is between human and analogue insulins. The analogue short-acting insulin aspart has been shown to be safe during pregnancy in a randomised trial and has received registration for this indication; the short-acting analogue insulin lispro has been shown to be safe in observational studies. No such information is available on the long-actin Continue reading >>

Labor, Birth And Recovery

Labor, Birth And Recovery

Although you've been dealing with gestational diabetes during pregnancy, chances are that your labor and the birth of your baby won't differ much from any other mother's. Getting ready for labor and birth Attend childbirth classes and read prenatal education materials. Learn about contractions, relaxation and breathing techniques. Practice these techniques with your partner or labor companion. Talk with your health care provider and your diabetes educator about what to expect during labor. Most women with gestational diabetes go through labor and birth without complications. If you've been taking insulin, discuss with your health care provider how insulin needs will be managed during labor. During labor Your blood glucose levels will be monitored. Sometime during labor, or perhaps shortly after your baby's birth, your level will probably return to normal. You and your health care provider may decide that a Cesarean birth is safest for you and your baby. Talk this possibility over in advance with your health care provider and with your partner. Include any preferences in your birth plan. Your baby's recovery During the first few hours after birth, your baby's blood glucose level will be monitored carefully. If your blood glucose level was high before the birth, your baby's blood glucose level may be low after birth. If needed, extra glucose may be given to your baby. Your recovery After your baby's birth, your blood glucose levels should return to normal (less than 100 fasting and less than 140 two hours after eating). Your health care provider may have your levels tested while you're still in the hospital. At your first postpartum visit, your blood glucose level will be tested. Continue reading >>

How To Manage Insulin During Pregnancy

How To Manage Insulin During Pregnancy

Pre-conception and 1st trimester Maintaining the best possible glucose control before and at the start of pregnancy can reduce the risk of complications for the baby. However, it is also a time of increased risk of hypoglycaemia for the mother, so insulin doses may drop later in the first trimester. 2nd trimester At this point, the placenta is fully developed and hormone levels begin to rise steadily, causing insulin requirements to increase as well. In particular the pre-meal boluses may have to be increased to keep tight glucose control after meals. 3rd trimester Because insulin is absorbed more slowly and can be less effective at lowering glucose in late pregnancy, you may need to give larger doses even earlier, up to 30 to 40 minutes before eating. Maintaining tight glucose control throughout the last trimester can help to enhance the baby’s final organ development, maintain a normal birth-weight and reduce the risk of hypoglycaemia for your newborn baby. Labour and delivery During delivery, glucose levels will be closely monitored to ensure they remain within the target range. Small boluses of insulin may be required, with many women opting to continue insulin pump therapy during delivery. Immediately after delivery and up to 24 hours post-delivery, insulin requirements can decrease significantly and blood glucose target levels may be changed. Back at home Adjusting to life with the new baby often means unpredictable sleeping and eating schedules, which can be a challenge when also managing diabetes. For nursing mothers glucose levels may drop quickly during and after feeding, making it important to check blood glucose levels regularly and reduce insulin doses when required. After a month of pump therapy my HbA1c dropped from 8.3% (67 mmol/L) to 6.2% (44 mmol/L) Continue reading >>

Diabetes In Pregnancy

Diabetes In Pregnancy

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 2 Diabetes article more useful, or one of our other health articles. This article deals with pregnancy in patients with pre-existing diabetes. See also separate Gestational Diabetes article. Epidemiology Diabetes is the most common pre-existing medical disorder complicating pregnancy in the UK. Up to 5% of women giving birth in England and Wales have either pre-existing diabetes or gestational diabetes[1]. The number of people with type 1 diabetes and the prevalence of type 2 diabetes amongst women of child-bearing age are increasing. Pregnancies of women with diabetes are regarded as high-risk for both the woman and the baby[2]. Of women who have diabetes during pregnancy, it is estimated that approximately 87.5% have gestational diabetes, 7.5% have type 1 diabetes and the remaining 5% have type 2 diabetes[1]. Possible complications Diabetes in pregnancy is associated with risks to the woman and to the developing fetus[1]. Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes. Diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (eg, hypoglycaemia) are more common in babies born to women with pre-existing diabetes. Pre-conception care and good glucose control before and during pregnancy can reduce these risks. Increased risk of complications of diabetes Ketoacidosis may occur during the pregnancy. Progression of microvascular complications including retinopathy and nephropathy: poor Continue reading >>

Insulin During Pregnancy, Labour And Delivery

Insulin During Pregnancy, Labour And Delivery

Optimal glycaemic control is of the utmost importance to achieve the best possible outcome of a pregnancy complicated by diabetes. This holds for pregnancies in women with preconceptional type 1 or type 2 diabetes as well as for pregnancies complicated by gestational diabetes. Glycaemic control is conventionally expressed in the HbA1c value but the HbA1c value does not completely capture the complexity of glycaemic control. The daily glucose profile measured by the patients themselves through measurements performed in capillary blood obtained by finger stick provides valuable information needed to adjust insulin therapy. Hypoglycaemia is the major threat to the pregnant woman or the woman with tight glycaemic control in the run-up to pregnancy. Repetitive hypoglycaemia can lead to hypoglycaemia unawareness, which is reversible with prevention of hypoglycaemia. A delicate balance should be struck between preventing hyperglycaemia and hypoglycaemia. Insulin requirements are not uniform across the day: it is low during the night with a more or less pronounced rise at dawn, followed by a gradual decrease during the remainder of the day. A basal amount of insulin is needed to regulate the endogenous glucose production, short-acting insulin shots are needed to handle exogenous glucose loads. Insulin therapy means two choices: the type of insulin used and the method of insulin administration. Regarding the type of insulin, the choice is between human and analogue insulins. The analogue short-acting insulin aspart has been shown to be safe during pregnancy in a randomised trial and has received registration for this indication; the short-acting analogue insulin lispro has been shown to be safe in observational studies. No such information is available on the long-acting insulin Continue reading >>

More in insulin