In discussing management of insulin and diet with a G4P3 pregnant, type 1 diabetic woman, the nurse should:
Explanation For insulin-dependent diabetics, diet and insulin requirements vary during pregnancy. Insulin needs may decrease during the first trimester especially if the mother is unable to eat because of nausea. Glucose is also used by the growing fetus. In the second
trimester, a hormone called insulinase produced by the mother protects the fetus from hypoglycemia and acts as an insulin antagonist in the mother decreasing insulin’s effectiveness and making it necessary for the woman to increase her daily dose. By the third trimester insulin needs may double or more, but usually level off by 36 weeks. Insulin doses are titrated based on frequent
testing of blood glucose levels. Blood glucose tests are far more accurate than urine tests used for screening. Diet modifications are also necessary depending on the mother’s symptoms (nausea and vomiting), her activity level, and blood glucose levels. High parity is unrelated to insulin needs.
