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Insulin Needs After Delivery

Insulin And Delivery

Insulin And Delivery

Continuous infusion of both insulin and glucose hasbeen proven valuable to control maternal glucose levels during labor and delivery. In patients with well-controlled diabetes who are scheduled for induction of labor or elective cesarean delivery the usual dose of insulin is given at bedtime; and morning insulin is withheld in patients with less than 20 U. Insulin can be discharged. In Denmark we prefer to give the patient normal diet and insulin until she is in a state of induction and then keep fasting with iv. Glucose 60 ml/h and insulin on sliding scale every 4 hour as shown below. If Caesarean section 1/2 to 1/3 of morning insulin as insulin retard and then iv. glucose and sliding scale as above. One unit of insulin decrease the glucose level by ~ 1 mmol/l. Continuous electronic fetal heart rate monitoring Continue intrapartum intravenous solution until next scheduled meal and other reason to maintain IV line (stopping IV without providing other carbohydrates source may result in hypoglycemia). Up to 80% of diabetics newly diagnosed in pregnancy will not need insulin postpartum. Many insulin dependent diabetics will have markedly reduced requirements after delivery. One-half of pre-pregnant long action insulin dose only when one can be certain patient is eating diet. When using the sliding scale - only give 5 - 10 units for 4+ urine glucose; no insulin for 3+ urine glucose. Unless acetone, then 5 - 10 units. Adjust until desired blood glucose control. a.FBS< 7 mmo/L b.2 hr PPBS in 8-11 mmol/L range Regular diet postpartum unless elevated plasma glucose. For obese women, low caloric weight reduction diets are initiated at 2 weeks postpartum if not lactating. On at least 50% give 1/3 insulin as before delivery and after 1-3 month the insulin requirement is as before Continue reading >>

After The Birth With Type 1 Or 2 Diabetes

After The Birth With Type 1 Or 2 Diabetes

Your insulin dose should be reduced to about a quarter less than the dose you were taking before you became pregnant to make sure you don’t become hypoglycaemic. If you treat you diabetes with insulin and are breastfeeding, you are at higher risk of having a hypo so you should keep a snack available before or during feeds. Your diabetes team should discuss all this with you before you have your baby. Most women are able to have skin-to-skin contact with the baby just after they are born, and you should be able to keep your baby with you unless there is a medical reason they need to be admitted into intensive or special care. You and/or your baby may receive some extra care and monitoring just after the birth if needed, and you will definitely need to stay in hospital for at least 24 hours, until the team are happy that your baby has healthy blood glucose levels and is feeding well. Once the team is happy that you and the baby are healthy, the regular appointments at the diabetes clinic will stop, but you still need to keep on top of your care. After you are discharged from antenatal services, you will be referred back to your standard diabetes service. Managing your glucose levels with a new baby If you were taking insulin before you became pregnant, you or your healthcare team will need to monitor your glucose levels regularly to check what dose you should be on now. Many women find it very difficult to maintain the levels of control they had before they became pregnant once they have a baby to care for and nights of broken sleep. Talk to your team about the level you can aim for. Breastfeeding with type 1/2 diabetes You can return to your previous medications as soon as your baby is born. But if you are breastfeeding, you need to make sure that any medication you ar Continue reading >>

What Happens After Birth With Gestational Diabetes?

What Happens After Birth With Gestational Diabetes?

The healthcare team will usually stop any diabetes-related medication as soon as you have given birth. However, you or your baby will receive extra monitoring, and perhaps extra care, as a result of the gestational diabetes. Your baby after the birth Gestational diabetes can directly affect your baby’s blood glucose levels. That means that he could be born with low blood glucose. This could lead to serious consequences if it is not treated, but your team will be aware of these risks and will know what to do. He may also have jaundice (which is usually harmless if treated) and may also have increased risk of breathing difficulties. You will be encouraged to feed your baby within half an hour after birth and then every two-to-three hours until his blood glucose levels stabilise. Two-to-four hours after the birth, the healthcare team will test his blood glucose level. They will do this by pricking his heel to get a drop of blood for testing. Your baby will not enjoy this, but try not to let it upset you. The test is done to keep your baby safe. If your baby’s blood glucose remains low, he might need some extra help to increase his blood glucose levels, such as being put on a drip or being tube fed. He may need to spend some time being monitored or treated in the neonatal unit – especially if there are extra complications. However the hospital will try to keep him in the ward with you wherever this is possible. "I was an emotional wreck afterwards for a whole week, crying all the time. I didn't like seeing my baby with tubes in him and he had jaundice as well so we weren't allowed to go home. But now, he's fabulous; constantly crawling around, he's a really busy baby!" Aisha, mum of one You after the birth Your blood glucose should be tested before you leave the hospi Continue reading >>

Insulin Changes During Pregnancy

Insulin Changes During Pregnancy

Insulin requirements tend to change constantly throughout pregnancy as different hormones take effect and your baby grows. You need to be prepared to adjust your insulin doses on a regular basis. It is not uncommon to need to make adjustments to your dose at least once a week. If you are not sure how to adjust your insulin doses, ask your diabetes in pregnancy team for advice. Adjusting insulin doses in pregnancy is more challenging than usual, so make sure you know how to get in touch with your diabetes team and be prepared to contact them more often. Early pregnancy changes Many women find it extremely challenging to maintain optimal blood glucose levels in the early stage of pregnancy with so many hormonal and physical changes occurring. For around the first six to eight weeks of pregnancy your blood glucose levels may be more unstable. Following these early pregnancy changes to your blood glucose levels, you may find that your insulin requirements decrease until the end of the first trimester. You may need to adjust your insulin doses at this time to reduce the risk of severe hypos occurring, sometimes without much (or any) warning. Preventing a hypo is better than treating one. Try not to miss any meals or snacks and check your blood glucose levels regularly. Mid to late pregnancy changes From the second trimester of pregnancy, especially after 18 weeks your insulin requirements will usually start to rise. By around 30 weeks you may need as much as two or three times your daily pre- pregnancy insulin dose. This is because the hormones made by the placenta interfere with the way your insulin normally works - as the pregnancy hormones rise, so does your need for insulin. At this stage you are likely to need more mealtime, rapid-acting insulin, compared with the long- Continue reading >>

Diabetessisters

Diabetessisters

If you have type-1 diabetes, expect your insulin needs to change dramatically through the course of your pregnancy. The proportion of basal (background) to bolus (mealtime) insulin does not change much, but the total amount of insulin required goes through a complete metamorphosis. Do the doses simply rise or fall steadily throughout pregnancy? Of course not! This is diabetes were talking about. Nothing is simple. For most women, insulin needs during pregnancy follow a pattern similar to a log flume ride found at an amusement park. Let me explain. Youre just waiting in line to get on the log flume ride, totally oblivious to what youre in for. You probably dont even know youre pregnant, and insulin needs are no different than what they were before you conceived. In log flume terms, this is like when you first get into the log boat, and the added weight makes it sink slightly. This phase is an amazing time: Youve just found out that youre pregnant, and youre quite excited. As the embryo evolves into a fetus, the autoimmune process that has been beating down your pancreas all these years starts to ease up. This allows your pancreas to start secreting a bit of insulin on its own. The result: a reduction in the need for exogenous (pumped or injected) insulin. Low blood sugar is common during this phase, as many women are taken by surprise that they are producing some of their own insulin again. Temporary reductions to both basal and bolus insulin are usually necessary to prevent frequent bouts of hypoglycemia. A 25% reduction in insulin requirements is not uncommon. This is the part of the log flume ride when you get on that long, slow conveyer belt up to the top. You know what happens to your body and the baby during this phase: growth, growth and more growth. Well, the sa Continue reading >>

Peripartum Management Of Diabetes

Peripartum Management Of Diabetes

Go to: INSULIN AND GLUCOSE THERAPY DURING INTRAPARTUM PERIOD The hepatic glucose supply is sufficient during the latent phase of labor, but during the active phase of labor the hepatic glucose supply is depleted so calorie supplementation is required. During the active phase of labor, the supplementation is mostly in the form of intravenous glucose as the oral supplementation is restricted.[13] The guidelines for insulin therapy during pregnancy mostly suggest infusion of insulin and glucose. The protocols for use of insulin during pregnancy are mostly based on studies in type 1 diabetes mellitus patients. An audit of 40 pregnancies over a 4 year period was conducted to find out the blood sugar control during labor using the insulin glucose infusion and it demonstrated the practical use of a simple regimen for control of blood sugar during pregnancy. Mean blood glucose of 94 ± 40 mg/dl (5.2 ± 2.2 mmol) before delivery and 85 ± 33 mg/dl (4.7 ± 1.8 mmol) just before labor prevented neonatal hypoglycemia.[14] In women with type 1 diabetes mellitus, a glucose infusion with insulin is mostly required during the latent period of spontaneous labor, but when the patients go into active labor the requirement of insulin drops to almost zero and the glucose requirement is equivalent to that required during rigorous exercise There is an eight-fold increase in the glucose substrate requirement during this time. In women with type 1 diabetes mellitus, a protocol with a normal saline infusion can also be used and when the blood sugar falls below 70 mg/dl then an intravenous glucose drip can be started[15] while some protocols favor the use of glucose infusion at the rate of 125 mg/h with a simultaneous use of insulin infusion at the rate of 0.5-1 unit/h.[16,17] Both protocols are 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 >>

Expecting The Best: Diabetes, Pregnancy, And Blood Glucose Control

Expecting The Best: Diabetes, Pregnancy, And Blood Glucose Control

by Laura Hieronymus, RN, MSEd, CDE and Patti Geil, MS, RD, LD, CDE Pregnancy can be a special and exciting time in a woman's life. The anticipation begins as soon as you hear the words: “You're expecting a baby.” Once you've gotten used to the amazing news, you may wonder about such things as whether the baby will be a boy or a girl, when the baby is due, and, perhaps most important, what you need to do in the meantime to make sure the baby stays healthy and develops normally. All women feel a certain amount of anxiety and sometimes even fear about how pregnancy will affect them, and whether their baby will be healthy and normal. Women with diabetes are no different, but they do have one more thing to be concerned about: maintaining control of blood glucose levels. This is true whether a woman has type 1 or type 2 diabetes before becoming pregnant, or whether she is diagnosed with a condition called gestational diabetes during pregnancy. The good news is that if a woman who has diabetes (of any type) learns as much as she can about managing her blood glucose, and puts that knowledge into practice, she can have a healthy pregnancy and a healthy baby. Blood glucose control essential Optimal blood glucose control is important throughout pregnancy, both for the mother's health and the baby's. Glucose in a mother's blood crosses the placenta to her baby, affecting the baby's blood glucose level. (The placenta, a flat circular organ, links the unborn baby to the mother's uterus, to provide oxygen, nutrients, and the elimination of wastes.) The baby begins making its own insulin around 13 weeks gestation. If the baby is constantly exposed to high levels of glucose, it is as if the baby were overeating: The baby produces more insulin to absorb the excess glucose, resulting Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

Diabetes in pregnancy There are two types of diabetes that occur in pregnancy: Gestational diabetes. This term refers to a mother who does not have diabetes before becoming pregnant but develops a resistance to insulin because of the hormones of pregnancy. Pregestational diabetes. This term describes women who already have insulin-dependent diabetes and become pregnant. With both types of diabetes, there can be complications for the baby. It is very important to keep tight control of blood sugar during pregnancy. What causes diabetes in pregnancy? The placenta supplies a growing fetus with nutrients and water. It also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can block insulin. This usually begins about 20 to 24 weeks into the pregnancy. As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results. Pregnancy also may change the insulin needs of a woman with preexisting diabetes. Insulin-dependent mothers may require more insulin as pregnancy progresses. Who is affected by diabetes in pregnancy? About 5 percent of all pregnant women in the U.S. are diagnosed with gestational diabetes. Gestational diabetics make up the vast majority of pregnancies with diabetes. Some pregnant women require insulin to treat their diabetes. Why is diabetes in pregnancy a concern? The mother's excess amounts of blood glucose are transferred to the fetus during pregnancy. This causes the baby's body to secrete increased amounts of insulin, which result Continue reading >>

Gestational Diabetes After Delivery

Gestational Diabetes After Delivery

Short-term management and long-term risks After the intensified treatment often required for treating gestational diabetes mellitus (GDM), clinicians may be tempted to relax after delivery of the baby. If it is assumed that no further management is needed, an excellent opportunity to improve the future health status of these high-risk women may be lost. There are special concerns for the early postpartum care of women with GDM. Encouragement and facilitation of exclusive breastfeeding is very important because of the profound short-term as well as long-term health benefits to the infant and the reduced risks for subsequent obesity and glucose intolerance demonstrated in many breastfeeding women. A method of contraception should be chosen that does not increase the risk of glucose intolerance in the mother. Some women with GDM will have persisting hyperglycemia in the days after delivery that will justify medical management for diabetes and perhaps for hypertension, microalbuminuria, and dyslipidemia. Treatment should be maintained according to the guidelines of the American Diabetes Association and other relevant organizations and adjusted for the needs of lactation. Treatment should be continued in adequate fashion to minimize risks to the early conceptus if there is a subsequent planned or unplanned pregnancy. Most women with GDM will not have severe hyperglycemia after delivery. This group should be followed for at least 6–12 weeks to determine their glucose status. Many studies over 3 decades on all continents of the globe demonstrate the high risk of subsequent diabetes in this female population. The degree of this risk is best assessed by glucose tolerance testing. Randomized controlled trials have proven that several interventions (diet and planned exercise 30 Continue reading >>

Gestational Diabetes And Pregnancy

Gestational Diabetes And Pregnancy

Gestational diabetes is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant. Some women have more than one pregnancy affected by gestational diabetes. Gestational diabetes usually shows up in the middle of pregnancy. Doctors most often test for it between 24 and 28 weeks of pregnancy. Often gestational diabetes can be controlled through eating healthy foods and regular exercise. Sometimes a woman with gestational diabetes must also take insulin. Problems of Gestational Diabetes in Pregnancy Blood sugar that is not well controlled in a woman with gestational diabetes can lead to problems for the pregnant woman and the baby: An Extra Large Baby Diabetes that is not well controlled causes the baby’s blood sugar to be high. The baby is “overfed” and grows extra large. Besides causing discomfort to the woman during the last few months of pregnancy, an extra large baby can lead to problems during delivery for both the mother and the baby. The mother might need a C-Section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery. C-Section (Cesarean Section) A C-section is an operation to deliver the baby through the mother’s belly. A woman who has diabetes that is not well controlled has a higher chance of needing a C-section to deliver the baby. When the baby is delivered by a C-section, it takes longer for the woman to recover from childbirth. High Blood Pressure (Preeclampsia) When a pregnant woman has high blood pressure, protein in her urine, and often swelling in fingers and toes that doesn’t go away, she might have preeclampsia. It is a serious problem that needs to be watched closely and managed by her doctor. High blood pressure can cause harm to both Continue reading >>

Inpatient Management Of Pregnancy And Type 1 Diabetes

Inpatient Management Of Pregnancy And Type 1 Diabetes

Inpatient management of pregnancy and type 1 diabetes Inpatient management of pregnancy and type 1 diabetes Inpatient management of pregnancy and type 1 diabetes A patient, aged 33 years, with a history of type 1 diabetes for 10 years, presented to the hospital. She was admitted to the hospital for induction of labor at 38 weeks gestation. The patient's pre-admission diabetes therapy was insulin pump with insulin aspart ( Novalog ). Her insulin pump settings at time of admission were as follows: 1 unit per 6 grams carbohydrate consumed (around the clock setting) Sensitivity: 1 unit will drop glucose by 55 mg/dL The patient's hemoglobin A1C value taken 1 week prior to admission and was 5.6%. Throughout her pregnancy, the patient worked closely with her outpatient endocrinology nurse practitioner for assistance with insulin dose adjustments. Read the answer and explanation for Question 1. There are some reports of lower insulin requirements during the latter part of the first trimester due to an increase in insulin sensitivity, rapid fetal growth, and reduction in oral intake associated with morning sickness. After this period, insulin requirements often increase significantly with rising hormone levels and weight gain that leads to insulin resistance. Question 1: What is known regarding insulin requirements throughout pregnancy? Answer: D. Insulin requirements often rise significantly throughout pregnancy. During pregnancy, patients will often experience a significant increase in>insulin requirements due to increases in hormone production and weight gain that lead to increased insulin resistance. Immediately after delivery, insulin requirements can decrease significantly in patients with type 1 diabetes. Some patients will experience a honeymoon phase, requiring little Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

If you have diabetes, you can still have a have a healthy pregnancy. Eating well, gaining the right amount of weight, and exercising go a long way to help you control your blood sugar level and prevent complications for both you and your baby. What is diabetes? Diabetes is a condition that affects the body's natural way of storing and using energy. It causes a high level of glucose (sugar) in the blood stream, which may lead to many health problems. Some women have diabetes before becoming pregnant; others develop diabetes during pregnancy (gestational diabetes). Either way, high blood glucose levels during pregnancy can cause the baby to grow too large, making a natural delivery difficult and causing problems for the baby. "If your blood sugars are too high in the first trimester, your baby's chance of having a birth defect is higher, so this is a very important time for good glucose control," says Kaiser Permanente doctor Anne Regenstein, MD. Gestational diabetes If your blood sugar becomes too high for the first time while you are pregnant, you have gestational diabetes. Gestational diabetes is the most common form of diabetes in pregnant women. Learn more about gestational diabetes and how to care for yourself. Type 2 diabetes Type 2 diabetes is usually diagnosed in adulthood, but has become more common in children and teens due to an increase in childhood obesity. This type of diabetes can be managed with lifestyle changes (diet and exercise) or with medications such as insulin shots or oral medication. Women with type 2 diabetes should see their doctor before they become pregnant to discuss steps they can take to ensure a safe pregnancy and a healthy baby. Women with type 2 diabetes should also be seen as soon as they find out they are pregnant, so that blood suga Continue reading >>

Diabetes In Pregnancy

Diabetes In Pregnancy

Gestational diabetes refers to diabetes that is diagnosed during pregnancy. Gestational diabetes occurs in about 7 percent of all pregnancies, usually in the second half of the pregnancy. It almost always goes away as soon as your baby is born. However, if gestational diabetes is not treated during your pregnancy, you may experience some complications. Causes Pregnancy hormones cause the body to be resistant to the action of insulin, a hormone made by your pancreas that helps your body use the fuels supplied by food. The carbohydrates you eat provide your body with a fuel called glucose, the sugar in the blood that nourishes your brain, heart, tissues and muscles. Glucose also is an important fuel for your developing baby. When gestational diabetes occurs, insulin fails to effectively move glucose into the cells that need it. As a result, glucose accumulates in the blood, causing blood sugar levels rise. Diagnosis Gestational diabetes is diagnosed with a blood test. Your blood glucose level is measured after you drink a sweet beverage. If your blood sugar is too high, you have gestational diabetes. Sometimes one test is all that is needed to make a definitive diagnosis. More often, an initial screening test is given and, if needed, a longer evaluation is performed. Gestational diabetes usually does not occur until later in pregnancy, when the placenta is producing more of the hormones that interfere with the mother's insulin. Screening for gestational diabetes usually takes place between weeks 24 to 28. However, women at high risk are usually screened during the first trimester. Risk Factors There are a number of risk factors associated with gestational diabetes, including: Being overweight Giving birth to a baby that weighed more than 9 pounds Having a parent or siblin Continue reading >>

Your Health After Giving Birth

Your Health After Giving Birth

If you have diabetes, some extra steps may be taken after giving birth to make sure you and your baby are off to a healthy start. You should find, however, that you won't need as much insulin to control your blood glucose levels. After your baby has been born, you should find that you won't need as much insulin to control your blood glucose levels. If you have Type 2 diabetes and were changed onto insulin during your pregnancy you may be able to return to the medication that you were taking before you became pregnant. Please seek advice on adjustments to insulin doses and any medication changes from your healthcare professional. If you developed gestational diabetes during your pregnancy , you may not need to continue taking medication after the birth. Your health care professional can discuss this with you and it is important to monitor your blood glucose levels on a regular basis. Having gestational diabetes increases your risk of developing it during a future pregnancy and also of developing Type 2 diabetes in the future. You can however reduce this risk by maintaining a healthy weight and by exercising regularly. You should have a postnatal check about six weeks after your baby's birth to make sure that you feel well and are recovering properly. This should include having your blood glucose levels checked to see whether your blood glucose has returned to normal. You should also be given advice on diet and exercise. After delivery, your insulin requirements will drop dramatically. Your doctor, diabetes specialist nurse or diabetes specialist midwife may put your insulin back to pre-pregnancy levels, or maybe even lower, because: You are likely to be more active than before You will be up and about during the night too You will not need to run your blood glucose leve Continue reading >>

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