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Pregnant Diabetic Patient Interventions

Pregnant Dyed-bead Pancreas
Picmonic
Women who become pregnant may already have diabetes (either Type 1 or 2 or pregestational [diabetes that existed before pregnancy]) or may become diabetic while pregnant, which is called gestational diabetes mellitus (GDM). Women with GDM may or may not have to take insulin. Most women with pregestational diabetes are insulin dependent during pregnancy.
10 KEY FACTS
FIRST TRIMESTER
Increase Insulin then Decrease
Insect-syringe Up-arrow Then Insect-syringe Down-arrow

During the first trimester, at 3-7 weeks insulin requirements will increase; at 7-15 weeks insulin requirements will start to dwindle.

Glyburide
Guy-bride

An oral hypoglycemic agent such as glyburide (a sulfonylurea) is usually preferred over insulin in management of gestational diabetes mellitus because only small amounts of glyburide cross the placenta.

Nutrition
Nutritional-plate

The woman should be placed on a diabetic diet with proper calories per the pregnant woman’s weight. The pregnant woman should be referred to a dietician to assist with this process.

Exercise
Treadmill

Exercise is recommended in pregnant women with diabetes in order to promote cardiac health and may decrease the need for insulin.

SECOND TRIMESTER
Increase Insulin
Insulin Up-arrow

In the second and third trimesters, insulin needs to increase exponentially due to the development of insulin resistance.

More Likely to Develop Hypoglycemia than Hyperglycemia
Hippo-glue-bottle Smashing Down Hiker-glue-bottle

Episodes of hypoglycemia can develop rapidly and should be treated with oral intake of carbohydrates or glucagon injection, if she has loss of consciousness or is unable to swallow.

THIRD TRIMESTER
Double or Quadruple Insulin
Insulin Doubled

Due to increased insulin resistance, the insulin requirements during the third semester can double or even quadruple. This significant increase requires close monitoring and frequent blood sugar assessment.

Early Delivery
Early-sun Delivery

Women with gestational or preexisting diabetes may go into early labor due to extra stress on the mother and fetus. These stresses include hypertension, poor metabolic control, or uteroplacental insufficiency causing fetal growth restriction.

POSTPARTUM
Drastically Decrease Insulin
Insulin Down-arrow

After the birth of the fetus, insulin requirements decrease significantly and may normalize very quickly due to the decrease in stress, insulin insufficiency and glucose in the body. In addition, the formation of milk uses up a higher amount of carbohydrates in the body causing maternal glucose levels to be lower.

Monitor Neonate for Hypoglycemia
Monitor Neon-natal Baby for Hippo-glue-bottle

The neonate must be monitored for hypoglycemia after birth as the fetus will have decreased sugar levels once outside of the mother. The fetus’ pancreas may have been increasing insulin production to cover the excess sugar received from the mother while in utero. After birth, there is no excess sugar coming from the mother. Remember, sugar passes through the placenta, but not insulin.

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