- Pre-conception and 1st trimester
Maintaining the best possible glucose control before and at the start of pregnancy can reduce the risk of complications for the baby. However, it is also a time of increased risk of hypoglycaemia for the mother, so insulin doses may drop later in the first trimester.
- 2nd trimester
At this point, the placenta is fully developed and hormone levels begin to rise steadily, causing insulin requirements to increase as well. In particular the pre-meal boluses may have to be increased to keep tight glucose control after meals.
- 3rd trimester
Because insulin is absorbed more slowly and can be less effective at lowering glucose in late pregnancy, you may need to give larger doses even earlier, up to 30 to 40 minutes before eating. Maintaining tight glucose control throughout the last trimester can help to enhance the baby’s final organ development, maintain a normal birth-weight and reduce the risk of hypoglycaemia for your newborn baby.
- Labour and delivery
During delivery, glucose levels will be closely monitored to ensure they remain within the target range. Small boluses of insulin may be required, with many women opting to continue insulin pump therapy during delivery.
Immediately after delivery and up to 24 hours post-delivery, insulin requirements can decrease significantly and blood glucose target levels may be changed.
- Back at home
Adjusting to life with the new baby often means unpredictable sleeping and eating schedules, which can be a challenge when also managing diabetes.
For nursing mothers glucose levels may drop quickly during and after feeding, making it important to check blood glucose levels regularly and reduce insulin doses when required.
After a month of pump therapy my HbA1c dropped from 8.3% (67 mmol/L) to 6.2% (44 mmol/L) and I also found out I was pregnant! Changing from MDI to CSII gave me better glycaemic control and also a new level of freedom I never thought I could have reached before.
REDUCED HBA1C CAN HELP REDUCE COMPLICATIONS
HbA1c: An important measure of how effectively diabetes can be managed using a measure of the amount of glucose that has attached itself to each red blood cell over the preceding 2 to 3 months to assess the level of diabetes control.
Maintaining tight blood glucose control is one of the objectives for all women with Type 1 diabetes during pregnancy. HbA1c should be monitored every 3 months with the goal of keeping it below 7% (53 mmol/L) or at the target set by your physician*.
Because of this, women often find they need to intensify their therapy to achieve their glycemic targets without hypoglycaemia. This can include:
- Small correction boluses throughout the day when out of range, requiring more injections.
- More accurate pre-meal insulin doses to help maintain tight glucose levels after meals and avoid additional corrections.
- Frequently checking blood glucose levels to help guide therapy adjustments.
So, as a woman with Type 1 diabetes who wants to become pregnant or is already pregnant, how can you better keep your glucose level under tight control when your body’s hormones are constantly changing?
- * References are kept on file and are available on request; please contact your local Medtronic representative for copies.