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Please refer to your program's policies and procedures when caring for women with diabetes in pregnancy.
The following information is meant to guide current and new staff of Calgary Diabetes in Pregnancy Clinics. For referral information please visit our Calgary Diabetes Services page.
Complex metabolic changes occur in pregnancy to support fetal development and maternal nutrient needs during pregnancy as well as to create energy stores for labour and lactation. The most simple explanation of metabolic changes is that women are most senstive to insulin early in the pregnancy, followed by increasing insulin resistance as the pregnancy progresses. This poses the following clinical implications for women with pre-existing type 1 and type 2 diabetes:
- Risk for hypoglycemia is highest in the first trimester- in particular from week 9 to week 16.
- As resistance to insulin climbs from week 16 to week 37, insulin needs can increase significantly. Insulin adjustments are usually required 1-2 times/week.
- Insulin needs peak at around week 37, followed by a slight decrease in insulin needs. Decrease in insulin requirements during the 3rd trimester could be normal, or could also indicate poor placental health. A decrease in total insulin needs of greater than 15% should be discussed with the patient's endocrinologist.
- Insulin needs fall signficantly postpartum with the delivery of the placenta. The endocrinologist provides pospartum insulin doses to the patient as she nears delivery. Doses are usually slighlty less than pre-pregnant insulin doses.
For more detailed information educators can read the following optional articles: (AHS staff can request from Knowledge Resource Service):
Meltzer, S. (2005). Management of diabetes in pregnancy: Challenges and trends. Canadian Journal of Diabetes, 29(3), 246-256.
Garcia-Patterson, A., Gich, I., Amini, S.B., et al. (2010). Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction. Diabetologia, 53, 446-451.
Query- link to e text book if can get access
Educators are required to read and understand the 2018 Diabetes Canada Clinical Practice Guidelines, Chapter 36: Diabetes in Pregnancy.