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Insulin Requirements During Pregnancy Type 1 Diabetes

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 >>

Pregnancy With Type 1 Or Type 2 Diabetes

Pregnancy With Type 1 Or Type 2 Diabetes

This next section is for women who wish to become pregnant, or are already pregnant, and are living with type 1 or type 2 diabetes. You can have a healthy baby if you have type 1 or type 2 diabetes. The key is to obtain optimal blood glucose levels before and during pregnancy. This will require more work on your part but every new mother we've talked to says it's worth it! Planning with your doctor before you become pregnant is vital. Speak to your doctor about your plans at least 3 months before trying to conceive. A team approach is used at our Centre, where you can see a nurse and dietitian at each preconception visit. With the support of a team, the right formula for your healthy pregnancy will be developed. Most women do not know that they are pregnant until approximately 5-6 weeks into the pregnancy. During this time the fetus' organs and spinal cord are developing and ideal blood glucose control is important to reduce the baby's risk for birth defects. Rates of spontaneous abortion and stillbirth are similar to women without diabetes but rise in women whose diabetes is poorly controlled. For these reasons, it is best to start working on the following goals about 3 months before conception: Achieve an A1C below 7 percent, and, if possible, below 6 percent. This blood test determines your average blood glucose for the past 2-3 months. A1C levels above this are associated with increased risks of miscarriages and fetal abnormalities. Obtain an "ideal" blood glucose level On a day-to-day basis, obtaining "ideal" blood glucose levels is your goal. Your doctor or diabetes educator will work closely with you to help you attain this goal. For most women, this means focusing more than ever on their diabetes management to achieve a successful balance between insulin, food a Continue reading >>

Insulin Requirements In Type 1 Diabetic Pregnancy

Insulin Requirements In Type 1 Diabetic Pregnancy

Insulin Requirements in Type 1 Diabetic Pregnancy Do twin pregnant women require twice as much insulin as singleton pregnant women? 1Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark 2Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark 1Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark 2Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark 1Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark 3Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark 4Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark 1Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark 2Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark 3Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark 1Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark 2Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark 3Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark 4Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark Corresponding author: Nicoline F. Callesen, [email protected] . Received 2011 Dec 19; Accepted 2012 Feb 16. Copyright 2012 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. To evaluate the insulin requirements in women with type 1 diabetes during twin pregnancy compared with singleton pregnancy. At 8, 14, 21, 27, and 33 gestational weeks, insulin requirements and HbA1c were compared between 15 twin pregnant women from 2000 to 2011 and 108 singleton p Continue reading >>

Insulin Therapy For The Treatment Of Type 1 Diabetes During Pregnancy

Insulin Therapy For The Treatment Of Type 1 Diabetes During Pregnancy

Pregnancies affected by type 1 diabetes (T1D) carry a major risk for poor fetal, neonatal and maternal outcomes. Achieving normoglycemia while minimizing the risk of hypoglycemia is a major goal in the management of T1D as this can greatly reduce the risk of complications. However, maintaining optimal glucose levels is challenging because insulin requirements are not uniform throughout the course of the pregnancy. Over the past decade, there has been significant improvement in the methods for glucose monitoring and insulin administration, accompanied by an increase in the number of treatment options available to pregnant patients with T1D. Through study of the scientific literature and accumulated evidence, we review advances in the management of T1D in pregnancy and offer advice on how to achieve optimal care for the patient. Introduction Diabetes is one of the most common chronic diseases among women of reproductive age, observed in about 10% of pregnancies in the US and approximately 0.2–0.5% of these are in women with type 1 diabetes (T1D). T1D pregnancies are associated with an increased rate of complications, including late intrauterine death or major congenital malformations, which can lead to increased fetal morbidity and mortality compared to non-diabetic pregnancies. Maternal complications are also more frequent, with increased rates of preeclampsia, cesarean section and maternal mortality. Poor glycemic control at the time of conception and organogenesis during the first trimester is a major cause for an increased risk of birth defects and pregnancy complications. It has been recognized that a positive correlation exists between hemoglobin A1c (HbA1c) levels during early pregnancy and the incidence of fetal malformations. Therefore, good glycemic control co Continue reading >>

Third Trimester With Type 1 Or 2 Diabetes

Third Trimester With Type 1 Or 2 Diabetes

Many women with diabetes have to take three or four times the normal dose of insulin at this point in the pregnancy. In fact, if your insulin needs start to drop at this stage rather than increasing, you should contact your diabetes team as this may show that your placenta is not working well. From 28 weeks you will have regular ultrasound scans to monitor your baby’s growth and the amount of amniotic fluid around your baby, checking for polyhydramnios (too much amniotic fluid). If your previous eye checks were clear, you will be given another test. If they were not, you will already be receiving treatment. Colostrum harvesting From about 36 weeks you can start manually expressing colostrum (the nutrient-rich fluid that comes from your breasts before your milk comes in. When your baby is born, if he isn’t able to breastfeed, or if he needs some extra milk because his blood glucose level is low, the team can then give him your colostrum rather than formula. Some healthcare teams may not actively promote this approach but may be happy to help you if you ask. If you would like to know more, ask your team how to do it, and how to store it. 'Expressing and storing colostrum in the weeks leading up to birth helped me feel empowered and proactive. My stored colostrum was invaluable when baby was mildly hypo for 24 hrs after birth.' Zoe, mum of one Planning your labour and birth By 36 weeks your team should be working with you to plan your delivery. This may have begun far sooner as some women with diabetes will have delivered their babies by 37 weeks. You can expect to talk about: what type of birth will be best for you – vaginal or caesarean ways to control your blood glucose levels during the birth contraception and follow-up care. If you feel unclear about any of thes Continue reading >>

Assessing Insulin Requirements In Pregnant Women With Type 1 Diabetes

Assessing Insulin Requirements In Pregnant Women With Type 1 Diabetes

Assessing Insulin Requirements in Pregnant Women with Type 1 Diabetes Women with type 1 diabetes mellitus (T1DM) whose insulin requirements decrease during their pregnancy may not suffer from any adverse neonatal outcomes, according to a study. Since pregnancy in women with T1DM is usually linked with an increase in insulin requirements, researchers in Australia were interested in determining the frequency of decreasing insulin requirements in pregnant women, as well as the effects on newborns. The study, Insulin requirements in late pregnancy in women with type 1 diabetes mellitus: A retrospective review, was conducted by researchers at the Royal Brisbane and Womens Hospital in Queensland, Australia. It was published online ahead of print in October 2012 in the journal Diabetes Research and Clinical Practice. The researchers collected data on 54 women who were seen at their hospital between 2006 and 2010. All of the women had a diagnosis of T1DM prior to their pregnancy. The study authors collected information on demographic factors, changes in insulin dose during pregnancy, and the womens pregnancy outcomes. Women who had a 15% difference in insulin dosage between 30 weeks gestation and delivery were considered to have significant increases or decreases in insulin requirements. The results of the study showed that 9.3% of the women (5 out of 54) had a decrease in insulin requirements of 15% or more. Approximately 42% of the participants (23 out of 54) had a rise of more than 15%. The researchers found that neonatal intensive care admissions were fewer in women who had a decrease in insulin requirements, but these women were also more likely to have infants with low APGAR newborns scores (at 5 minutes). However, these results were not seen when further statistical mod 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 >>

Pregnant And Pumping

Pregnant And Pumping

Great Expectations A healthy pregnancy with diabetes is a challenge, but consider this: Less than 100 years ago, before the discovery of insulin, many young women with Type 1 diabetes didn’t even live to reach childbearing age. And less than 30 years ago, physicians routinely told young women with Type 1 diabetes that pregnancy was far too dangerous for both mother and child. Today, thanks to advances in diabetes treatment, plus improvements in medical care for infants, there has never been a better time for you to have a healthy baby. Insulin pump therapy is one of the options available to women today for managing diabetes during pregnancy. Challenges of pregnancy Pregnancy with diabetes presents a variety of challenges for you and your diabetes management team far beyond the routine morning sickness, fatigue, and strange food cravings experienced by many women who are expecting. The length of time you’ve had diabetes as well as the course of your disease influences the seriousness of medical risks during your pregnancy. For example, if you have mild retinopathy, it may progress during pregnancy. Your kidney status could worsen. Women with diabetes are at higher risk for frequent and severe hypoglycemia (low blood glucose) during pregnancy because glucose crosses the placenta to provide nutrition for the growing baby. The pregnancy state also tends to allow diabetic ketoacidosis — a dangerous condition usually accompanied by very high blood glucose — to develop quickly. Having a thorough medical evaluation prior to pregnancy is extremely important for determining your individual situation and management solutions. Good blood glucose control before and during pregnancy will minimize all risks to the mother. Risks to the baby are also a consideration when a woman 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 >>

Insulin Requirements Throughout Pregnancy In Women With Type 1 Diabetes Mellitus: Three Changes Of Direction

Insulin Requirements Throughout Pregnancy In Women With Type 1 Diabetes Mellitus: Three Changes Of Direction

, Volume 53, Issue3 , pp 446451 | Cite as Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction The aim of the study was to analyse the insulin requirements of women with type 1 diabetes mellitus throughout pregnancy. We have examined the weekly mean blood glucose (mmol/l), insulin requirements (Ukg1day1) and total insulin requirements (U/day) in 65 women with type 1 diabetes mellitus and tight metabolic control since before pregnancy (HbA1c 6.0%). Both insulin requirement and total insulin requirement displayed a peak in week 9, a nadir in week 16 and a second peak in week 37. For the change in insulin requirement (4.08% per week) and in total insulin requirement (5.19% per week), the sharpest slope was observed from week 16 to week 37. However, two changes of direction took place in the first 11weeks and eight out of nine episodes of severe hypoglycaemia requiring treatment with glucagon or i.v. glucose took place in the first 16weeks. Pregnant women with type 1 diabetes mellitus and tight metabolic control since before pregnancy displayed changes in insulin requirement and total insulin requirement with successive changes of direction. The sharpest slope was observed between 16 and 37weeks, but insulin requirements were more unstable in the first 16weeks. This information could help patients and physicians to react to changes in glycaemic pattern in a prompt and adequate way. Insulin requirementsPregnancyType 1 diabetes mellitus The online version of this article (doi: 10.1007/s00125-009-1633-z ) contains supplementary material, which is available to authorised users. In women with diabetes mellitus, tight metabolic control is important both before and during pregnancy in order to reduce pregnancy complications. 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 >>

Parity Increases Insulin Requirements In Pregnant Women With Type 1 Diabetes

Parity Increases Insulin Requirements In Pregnant Women With Type 1 Diabetes

Parity increases insulin requirements in pregnant women with type 1 diabetes Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark Danish Diabetes Academy, Odense University Hospital, Odense, Denmark Correspondence: Gitte skov Skajaa, Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark, Tel +4553679850, Email [email protected] Search for other works by this author on: Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark Search for other works by this author on: Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Danish Diabetes Academy, Odense University Hospital, Odense, Denmark Search for other works by this author on: Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, jc.2018-00094, Gitte O Skajaa, Jens Fuglsang, Ulla Kampmann, Per G Ovesen; Parity increases insulin requirements in pregnant women with type 1 diabetes, The Journal of Clinical Endocrinology & Metabolism, Tight glycemic control throughout type 1 diabetes pregnancies is crucial and knowledge about which factors that affect insulin sensitivity could improve the outcome for both mother and offspring. The purpose of the study was to evaluate insulin requirements in women with type 1 diabetes during pregnancy and test whether parity affects insulin requirements. We conducted an observational cohort study consisting of women with type 1 diabetes who gave birth at Aarhus University Hospital, Denmark from 2004-2014. Daily insulin requirement. The hypothesis that parity could affect insulin resistance wa Continue reading >>

Lowered Insulin Requirements In Late Stage Pregnancy And Placental Complications

Lowered Insulin Requirements In Late Stage Pregnancy And Placental Complications

A fall in insulin dose requirement in patients with preexisting diabetes can lead to increased risk of placental dysfunction… Women with preexisting diabetes typically experience an increased need for insulin during the later stages of pregnancy due to an increase in insulin resistance during this time. A drop in insulin need late in pregnancy is often associated with placental complications. Previous studies have not shown a clear association between falling insulin requirements and placental compromise. Previous studies have also never included type 2 diabetes patients when examining this possible association. This retrospective study followed 139 pregnancies with preexisting type 1, type 2 or overt diabetes to examine the association between falling insulin needs late in pregnancy and placental complications. The primary outcome for this study was a composite on clinical outcomes associated with placental dysfunction that included preeclampsia, small for gestational age, preterm delivery and placental abruption. Cohorts were grouped into either a case or control group depending on their insulin requirement. Case subjects saw their insulin requirement fall greater than 15% while control subjects never had requirements fall more than 15%. Of the 139 pregnancies followed in this study, 35 met the requirements to be considered case subjects while the other 104 were control subjects. Results showed an increased risk for placental dysfunction determined by the composite of clinical markers in the mothers with falling insulin requirements (OR 4.4, 95% CI 1.73-11.26, P=0.002). Risk of preeclampsia was also greater in this group (OR 3.47, 95%CI 1.1-11.8, P=0.045). While the majority of subjects in this study required increased insulin during the later stages of pregnancy, t 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 >>

Pregnancy With Type 1 Diabetes: 2nd Trimester Insulin Resistance

Pregnancy With Type 1 Diabetes: 2nd Trimester Insulin Resistance

If you’re not a type 1 diabetic, the 2nd trimester of pregnancy is promised to be a wonderfully energetic phase during which you are no longer hindered by 1st trimester nausea and exhaustion. Instead, there is a promised boost of energy and that wonderful pregnancy “glow” that everyone notices…except you as the one carrying the adorable mini bowling-ball behind your belly button. If you are a type 1 diabetic, the 2nd trimester will hopefully bring all the described benefits mentioned above, but it also comes with an extra workload of blood sugar management. For those of us with very “confused” immune systems, the 2nd trimester begins the gradual climb of insulin resistance. But this form of insulin resistance is actually a very healthy sign of a very normal pregnancy because it’s the result of your increasing hormone levels as baby grows and grows in your belly! At the same time, it means we have to pre-bolus our insulin for meals more carefully and keep a watchful eye on our gradually increasing blood sugars so we know when to increase our background/basal insulin doses. My Personal 2nd Trimester Experience (with Baby #2, so far) For me, this rise in background insulin came on heartily in this past month (January). In December, I’d seen a steep drop in my insulin needs because of not being able to eat very much food for two weeks due to Super Pregnancy Stomach Acid Woe in addition to the marvelous phase of producing insulin during pregnancy! Now that I’m on the right cocktail of antacids, I can eat a full day’s worth of calories instead of barely 1,000 calories! My pre-pregnancy background insulin dose (Tresiba insulin): 11 units total My 1st trimester insulin dose (Tresiba insulin): 10 units total My current background insulin dose at 21 weeks preg Continue reading >>

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