Obstetrics & Gynecology>>>>>Medical and Surgical Complications of Pregnancy
Question 10#

A 30-year-old G1 at 6 weeks’ gestation by last menstrual period presents for prenatal care. Her past medical history is significant for type 1 diabetes, which was diagnosed at the age of 14.

What should you tell her about her insulin requirements during pregnancy?

A. Her insulin requirement will not change during pregnancy
B. She will require less insulin due to increased sensitivity to insulin during pregnancy
C. She will require less insulin during pregnancy because she will experience decreased insulin resistance
D. As long as her glycosylated hemoglobin A1c (Hb A1c) is less than 6%, she will not require any changes in her insulin management during pregnancy
E. She should expect her insulin requirement to increase throughout the pregnancy

Correct Answer is E

Comment:

Pregnancy is characterized by both increased insulin resistance and decreased sensitivity to insulin. The increased insulin resistance is largely due to placental hormones such as human placental lactogen, progesterone, and cortisol. The management of type 1 diabetes in pregnancy focuses on glucose control, maximizing diet, engaging in exercise, and insulin therapy. Insulin requirements will increase during pregnancy, most markedly during the period between 28 and 32 weeks’ gestation.