In order to keep the glucose normal, more insulin is required throughout a pregnancy, and this increase drops rapidly after giving birth. Because the goal is a blood glucose level of less than 90 mg/dl before meals and less than 120 mg/dl one hour after meals, it's necessary to test before meals, an hour after meals, and at bedtime daily. This frequency of testing gives you the opportunity to treat high blood glucose or eat for low blood glucose.
Here are a couple of exceptions to the usual increased need for insulin during pregnancy:
1 At about the 9th to 11th week of the pregnancy: At this time, the ovaries stop making progesterone and the uterus takes over. There may be a brief period (lasting eight to ten days) during which your insulin requirement falls. This is a time to do more testing, especially before bedtime and at 3 a.m. to avoid overnight hypoglycemia if you don't reduce your insulin temporarily.
1 At 37 weeks: Your uterus begins to contract, and you start to burn glucose that way. You should test your blood glucose at bedtime and at 3 a.m., and lower your bedtime insulin if the overnight glucose falls to less than 70 mg/dl.
You can use whatever method of insulin delivery you like, but one method that has been successful during pregnancy is the insulin pump (see Chapter 11). It allows for easy treatment if the blood glucose gets too high or too low. The trouble with the insulin pump is the rapid development of ketoacidosis if insulin isn't being given as a result of blockage, leakage, or some other problem with the pump.
Ketoacidosis in the mother is very dangerous for the fetus and often leads to fetal loss. If you feel nauseated, check your blood ketones. See Chapter 15 for coverage of this test.
Among the various kinds of insulin, the newer long-acting insulins (insulin glargine and insulin detemir) haven't been used in large numbers of pregnant women with T1DM, although the experience with insulin glargine is probably large enough, at this time, to recommend its use. Insulin NPH has been the standard longer-acting insulin up to now. As for rapid-acting insulin, there's plenty of experience with insulin lispro and insulin aspart use in pregnant women, and these are used commonly in this situation as the rapid-acting component of the insulin treatment.
Immediately after delivery, as a result of the drop in hormones, your insulin needs drop below what you needed before the pregnancy. However, as the pituitary gland produces prolactin to stimulate breast milk, your insulin needs increase. You may find that you need less long-acting insulin and more rapid-acting insulin when you breast-feed.
A number of insulin treatment schedules are available for controlling the blood glucose throughout and after the pregnancy. You should work with your diabetes doctor to develop the one that works for you. This isn't something that can or should be done on your own.
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Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.