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Diabetes In Pregnancy

Taking Insulin

Friday, November 8, 2013 - 13:09

Contributing Author: Guy Slowik FRCS

Women with type 1 diabetes will already be taking insulin. In women with type 2 or gestational diabetes, sometimes diet, exercise and regular monitoring fail to keep blood glucose levels in the target range.

Generally, your doctor will recommend you start taking insulin injections if:

  • Your blood sugar first thing in the morning (or "fasting" blood sugar) is over 105 mg/dl.
  • Your blood sugar two hours after a meal is over 120 mg/dl two separate times in a week

If you need insulin:

  • Your nurse will show you how to draw up and inject insulin.
  • Your dietitian will review your food plan and adjust it to match your insulin dose.
  • You will be given a daily schedule with times for insulin injections, meals and snacks.

How Much Insulin? And How Often?

There are two kinds of insulin: short acting and intermediate acting. The two types are often combined to treat gestational diabetes.

  • Short-acting insulin is effective quickly and for a short period of time.
  • Intermediate-acting insulin is effective over a longer period.

If your fasting glucose measurements are above normal, a single injection of intermediate-acting insulin before bed may be all that's needed. If your blood sugar after meals is too high as well, you may need two or more injections a day.

If both fasting and after-meal glucose levels are above normal, you may need to inject a dose of:

  • Intermediate-acting as well as short-acting insulin before breakfast
  • Short-acting insulin before dinner
  • Intermediate-acting insulin at bedtime

Your doctor will calculate how much insulin is needed to keep your blood sugar levels in the normal range. Women with type 1 or type 2 diabetes who were taking insulin before pregnancy will need two or more injections a day during pregnancy.

Need To Know:

You need more insulin as pregnancy progresses. This does not mean the diabetes is getting worse. As the placenta grows and produces more of the hormones that counteract insulin, you need to inject more insulin to overcome their effects.

Insulin Reaction

Sometimes blood sugar goes too low. This is called hypoglycemia or "insulin reaction." Hypoglycemia is caused by:

  • Not consuming enough food
  • Exercising too much without eating enough extra food
  • Injecting too much insulin

Hypoglycemia isn't dangerous to the baby, but it can be harmful to the mother-to-be. Warning signs include:

  • Sweating
  • Shakiness
  • Dizziness
  • Fast heartbeat
  • Hunger
  • Nausea

Need To Know:

Q: How can I prevent low blood sugar?

A: During pregnancy, the early warning signs can change. For example, you may find that you feel less shaky but develop drowsiness or confusion more quickly. Avoid low blood sugar by:

  • Eating meals and snacks at planned times
  • Checking your blood sugar as soon as you feel the symptoms of low blood sugar
  • Carrying a readily available form of sugar such as hard candy, raisins, or orange juice
  • Allowing 15 minutes for whatever you eat or drink to act
  • Having an extra snack when you're more active than usual

 

Diabetes In Pregnancy