MEDizzy - A 30-year-old multigravid client at 8 weeks’ gestation has a

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The Pregnant Client with Diabetes Mellitus and Heart Disease

A 30-year-old multigravid client at 8 weeks’ gestation has a history of insulin-dependent diabetes since age 20. When explaining the importance of blood glucose control during pregnancy, the nurse should tell the client which of the following will occur regarding the client’s insulin needs during the first trimester?

ExplanationDuring the first trimester, it is not unusual for insulin needs to decrease, commonly as a result of nausea and vomiting. Progressive insulin resistance is characteristic of pregnancy, particularly in the second half of pregnancy. It is not unusual for insulin needs to increase by as much as four times the nonpregnant dose after about the 24th week of gestation. This resistance is caused by the production of human placental lactogen, also called human chorionic somatotropin, by the placenta and by other hormones, such as estrogen and progesterone, which are insulin antagonists.