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 pregnancyPregnancy 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.