Sunday, November 27, 2022

When Is Insulin Prescribed For Gestational Diabetes

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Insulin For Gestational Diabetes What It Is And How It Works

Gestational Diabetes: Injecting Insulin with a Pen

Where blood sugar levels cannot be lowered and stabilised enough through dietary and lifestyle changes, or through using medication such as Metformin, some ladies will be required to use insulin for gestational diabetes.

Insulin is a hormone in the body produced by the pancreas. Your body uses insulin to move the sugar obtained from food and drink from the bloodstream into cells throughout the body. The cells are then able to use the sugar for energy.

Determining The Right Insulin And Dosage

Your health care provider will decide what kind of insulin is right for you, how much to use and when you should take it, based on:

  • your weight
  • how far along your pregnancy is
  • your meal plan
  • your most recent blood glucose levels

Sometimes, you may need more than one type of insulin. Different types of insulin work at different speeds, and your health care provider may combine insulins to achieve the best results for you.

Management Of Gestational Diabetes Mellitus

DAVID K. TUROK, M.D., M.P.H., University of Utah School of Medicine, Salt Lake City, Utah

STEPHEN D. RATCLIFFE, M.D., M.S.P.H., Lancaster General Hospital, Lancaster, Pennsylvania

ELIZABETH G. BAXLEY, M.D., University of South Carolina School of Medicine, Columbia, South Carolina

Am Fam Physician. 2003 Nov 1 68:1767-1773.

Screening for gestational diabetes mellitus is widely practiced despite lack of evidence that it prevents adverse perinatal outcomes. Although the disorder affects approximately 2.5 percent of pregnant women1 and has been the subject of extensive research, its diagnosis and management continue to be debated.

As the practice of medicine moves toward an evidence-based paradigm, the debate about gestational diabetes focuses on the absence of prospective randomized controlled trials that assess the value of screening for and treating this disorder. Several major guidelines2,3 do not recommend routine screening for gestational diabetes until more complete data become available. Proponents of screening argue that although available data are imperfect, there are biologically plausible explanations to account for adverse perinatal outcomes associated with gestational diabetes. In addition, much of medical practice is not based on results of RCTs.

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Glycemic Targets In Pregnancy

Pregnancy in women with normal glucose metabolism is characterized by fasting levels of blood glucose that are lower than in the nonpregnant state due to insulin-independent glucose uptake by the fetus and placenta and by postprandial hyperglycemia and carbohydrate intolerance as a result of diabetogenic placental hormones.

Do Take Gestational Diabetes Medication As Prescribed

Gestational Diabetes: What Pregnant Women Should Know ...

Some women with gestational diabetes will need to take medication to help control their blood sugar. Insulin is one gestational diabetes treatment option. Research thats looked at the fears and concerns of women with gestational diabetes has established that even though about 1 in 3 pregnant women with gestational diabetes might need insulin as part of their gestational diabetes treatment, women worry about the safety of insulin during pregnancy. Research published in Diabetes Care supports that even newer, long-acting insulin is thought to be safe during pregnancy.

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How Does Gd Affect Your Baby After Birth

Babies who are born to mothers with gestational diabetes should be tested for low blood sugar , even if they have no symptoms, with a simple blood test after birth. This happens immediately after delivery, while you and baby are still in the hospital.

After birth, its essential to keep the focus you had during pregnancy on a healthy lifestyle for your whole family you may find that it helps you stick to your resolutions as well.

Teach your child good eating and exercise habits early on: If you had gestational diabetes, your baby could be at a higher risk for health problems, including obesity as a child or teen and an increased risk for type 2 diabetes later in life, according to the CDC.

To help avoid a type 2 diabetes diagnosis for your child, aim to ensure that he or she:

  • Eats nutritious meals. The same diet you follow during pregnancy and beyond is good for your child, too. When he gets old enough, have him help you in the kitchen children who help prepare dishes are more likely to eat them.
  • Gets plenty of exercise as he grows. Start by taking walks. As he gets older, toddler soccer and other activities are a great way to get him interested in healthy movement.
  • Maintains a healthy weight. Talk to his pediatrician to make sure his BMI is on target, and talk openly to him about healthy weight and the increase in obesity he might notice in school.

Testing For Gestational Diabetes

Its important to be tested for gestational diabetes so you can begin treatment to protect your health and your babys health.

Gestational diabetes usually develops around the 24th week of pregnancy, so youll probably be tested between 24 and 28 weeks.

If youre at higher risk for gestational diabetes, your doctor may test you earlier. Blood sugar thats higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.

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Pregnancy And Drug Considerations

In normal pregnancy, blood pressure is lower than in the nonpregnant state. In a pregnancy complicated by diabetes and chronic hypertension, target goals for systolic blood pressure 120160 mmHg and diastolic blood pressure 80105 mmHg are reasonable . Lower blood pressure levels may be associated with impaired fetal growth. In a 2015 study targeting diastolic blood pressure of 100 mmHg versus 85 mmHg in pregnant women, only 6% of whom had GDM at enrollment, there was no difference in pregnancy loss, neonatal care, or other neonatal outcomes, although women in the less intensive treatment group had a higher rate of uncontrolled hypertension .

During pregnancy, treatment with ACE inhibitors and angiotensin receptor blockers is contraindicated because they may cause fetal renal dysplasia, oligohydramnios, and intrauterine growth restriction . Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, diltiazem, clonidine, and prazosin. Chronic diuretic use during pregnancy is not recommended as it has been associated with restricted maternal plasma volume, which may reduce uteroplacental perfusion . On the basis of available evidence, statins should also be avoided in pregnancy .

Suggested citation: American Diabetes Association. Management of diabetes in pregnancy. Sec. 13. In Standards of Medical Care in Diabetes2017. Diabetes Care 2017 40:S114S119

What To Watch For

My first insulin shot for gestational diabetes

You might get sore and have hard lumps where you inject the insulin. To prevent this, try not to give yourself the shot in the same place every time.

Insulin can also cause low blood sugar when there’s not enough glucose in your blood for your body to work right. You’re more likely to have this if you skip a meal or use too much insulin.

Be sure you know the warning signs: dizziness, sweating, shaking, and blurry vision. The best treatment is a quick-sugar food like raisins, honey, or glucose tablets or gel. Low blood sugar can be dangerous for you and your baby, so do something about it right away.

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Gestational Diabetes And Your Baby

Gestational diabetes can affect your developing baby in a couple of ways:

  • High birth weight Exposure to higher sugar levels from the maternal bloodstream can result in a larger baby and a high birth weight. The baby’s pancreas produces extra insulin in response to the higher glucose, which results in the baby storing extra fat and growing larger. A larger baby can make delivery more complicated for both mother and baby.
  • Low blood sugar If your blood sugar has been elevated during the pregnancy, your baby may have low blood sugar, called hypoglycemia, shortly after birth. The extra insulin that your baby produces when your blood sugar is high continues to bring your baby’s blood sugar down for a short time after birth. Without the continued supply of sugar from maternal blood, your baby’s blood sugar level may fall too low.This is temporary, though, and the nurses and doctors caring for your newborn will monitor your baby carefully and treat any episodes of low blood sugar that may occur.

Timing And Route Of Delivery

In gestational diabetes, shoulder dystocia is the complication most anticipated at the time of delivery. In one study,36 this complication occurred in 31 percent of neonates weighing more than 4,000 g who were delivered vaginally to unclassified mothers with diabetes. No prospective data support the use of cesarean delivery to avoid birth trauma in women who have gestational diabetes. One remaining limiting factor is the 13 percent error rate in estimating fetal weight by ultrasonography.37

A decision analysis38 that evaluated the cost and efficacy of a policy of elective cesarean delivery for an estimated fetal weight of 4,500 g in mothers with diabetes found that 443 cesarean deliveries would need to be performed to prevent one case of brachial plexus injury, at a cost of $930,000. A reasonable approach is to offer elective cesarean delivery to the patient with gestational diabetes and an estimated fetal weight of 4,500 g or more, based on the patient’s history and pelvimetry, and the patient and physician’s discussion about the risks and benefits. There are no indications to pursue delivery before 40 weeks of gestation in patients with good glycemic control unless other maternal or fetal indications are present.

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How Do I Draw Up One Kind Of Insulin

  • Wash your hands with soap and water.
  • Gather your supplies:
  • Syringe
  • Alcohol pad
  • Mix the intermediate-acting insulin by rolling the bottle gently in the palms of your hands or turn the bottle upside down at least 10 times. Do not shake the bottle. Mix it more if a white layer is still at the bottom of the bottle of insulin vial.
  • Clean the rubber stopper with the alcohol pad.
  • Pull back on the plunger to fill the barrel with air by:
  • Taking the needle cap off the syringe.
  • Pointing the needle up.
  • Pull back to your ordered dose of insulin.
  • Push the air into insulin vial by:
  • Point the needle down.
  • Push the needle straight into rubber stopper on the vial.
  • Push the plunger down until all the air has been pushed into the vial.
  • Draw up your insulin dose.
  • Keep the needle in vial.
  • Turn the vial upside down so the needle is pointed up and the rubber stopper is down.
  • Pull down on the plunger to fill the barrel with the dose your doctor ordered.
  • Make sure there are no air bubbles in syringe.
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  • Wipe the injection site with alcohol or soap and water.
  • Hold the syringe straight up and down and push the needle into the injection site at a 90 degree angle. Be sure the needle is all the way in your body.
  • Push down the plunger at a steady rate until the syringe is empty
  • Pull the needle out of your body.
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    Signs Of A Low Blood Sugar Are:

    • Shakiness
  • Retesting your blood sugar in 15 minutes.
  • Repeat step 1 if your sugar is still less than 60 mg/dl.
  • Eating a snack or meal within 30 to 60 minutes after a low blood sugar.
  • If it is going to be longer than 30 to 60 minutes until your next meal or snack, you need to eat or drink an extra 15 grams of carbohydrate and a protein.
  • Checking Your Blood Sugar Level

    You’ll be given a testing kit that you can use to check your blood sugar level.

    This involves using a finger-pricking device and putting a drop of blood on a testing strip.

    You’ll be advised:

    • how to test your blood sugar level correctly
    • when and how often to test your blood sugar most women with gestational diabetes are advised to test before breakfast and one hour after each meal
    • what level you should be aiming for this will be a measurement given in millimoles of glucose per litre of blood

    Diabetes UK has more information about monitoring your glucose levels.

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    Pregestational Type 1 And Type 2 Diabetes

    Insulin sensitivity increases with delivery of the placenta and then returns to prepregnancy levels over the following 12 weeks. In women taking insulin, particular attention is needed to hypoglycemia prevention in the setting of erratic sleep and eating schedules. If the pregnancy has motivated the adoption of a healthier diet, building on these gains to support weight loss is recommended in the postpartum period.

    Do Exercise To Improve Blood Sugar

    Insulin Injections With Gestational Diabetes | Info & How To

    Appropriate regular physical activity is often recommended during pregnancy, even without diabetes. But if you have gestational diabetes, being active is a must. Regular exercise is also beneficial to overall health and may help to improve glucose metabolism, advises Heard. Respect your pregnant status and choose exercises that wont put you at risk. For example, swimming, water aerobics, and walking are all great choices, while high-impact aerobics or activities such as basketball, which could lead to impacts or falls, should be sidelined for a while.

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    Checking Your Blood Sugar

    Your body changes as the baby grows. Because you have diabetes, these changes will affect your blood sugar level. Pregnancy can also make symptoms of low blood sugar hard to detect.

    During pregnancy, your diabetes control will require more work. The blood sugar checks you do at home are a key part of taking good care of yourself and your baby before, during, and after pregnancy.

    Blood sugar targets are designed to help you minimize the risk of birth defects and miscarriage, and help prevent your baby from getting too large. If you have trouble staying in your target range or have frequent low blood sugar levels, talk to your health care team about revising your treatment plan. Target blood sugar values may differ slightly in different care systems and with different diabetic teams. Work with your health care team on determining your specific goals before and during pregnancy.

    We suggest the following targets for women with preexisting diabetes who become pregnant. More or less stringent glycemic goals may be appropriate for each individual.

    • Before a meal and bedtime/overnight: 60-99 mg/dl
    • After a meal : 100-129 mg/dl
    • A1C: less than 6%

    *Postprandial glucose measurements should be made one to two hours after the beginning of the meal, which is generally when levels peak in people with diabetes.

    Check your blood sugar levels at the times your diabetes care team advises this may be up to eight tests daily and will probably include after-meal checks.

    Pregnancy And Antihypertensive Drugs

    In normal pregnancy, blood pressure is lower than in the nonpregnant state. In a pregnancy complicated by diabetes and chronic hypertension, target goals of systolic blood pressure 110129 mmHg and diastolic blood pressure 6579 mmHg are reasonable. Lower blood pressure levels may be associated with impaired fetal growth. In a 2015 study targeting diastolic blood pressure of 100 mmHg versus 85 mmHg in pregnant women, only 6% of whom had GDM at enrollment, there was no difference in pregnancy loss, neonatal care, or other neonatal outcomes, although women in the less intensive treatment group had a higher rate of uncontrolled hypertension .

    During pregnancy, treatment with ACE inhibitors and angiotensin receptor blockers is contraindicated, because they may cause fetal renal dysplasia, oligohydramnios, and intrauterine growth restriction. Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, diltiazem, clonidine, and prazosin. Chronic diuretic use during pregnancy is not recommended as it has been associated with restricted maternal plasma volume, which may reduce uteroplacental perfusion .

    Suggested citation: American Diabetes Association. Management of diabetes in pregnancy. Sec. 12. In Standards of Medical Care in Diabetes2016. Diabetes Care 2016 39:S94S98

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    Glycemic Targets And Control

    Blood glucose control in important in gestational diabetes because it confers the future mother a sense of disease control and validation that diet and treatment are doing their effect as the glycemic control improves, the risk of maternal and fetal complications decreases, a principle that was demonstrated by HAPO study results . The results of this landmark study and other seven randomized trials have been included in a Cochrane analysis that compared the treatment of gestational diabetes mellitus with standard care. It demonstrated a lower risk of a composite endpoint , and also a lower risk of pre-eclampsia and macrosomia , with no differences between oral and injectable treatment .

    Thereby, gestational auto monitoring and surveillance by an obstetrician in collaboration with the diabetologist, nutritionist and midwife is essential for achieving glycemic targets during pregnancy, labor and after birth. These targets are synthesized in Tables 2 and 3.

    5th International Workshop Conference Gestational Diabetes and International Association of Diabetes and Pregnancy Study Group, 2007 Capillary pre-prandial glucose < 95 mg/dl Capillary 1 hour post-prandial glucose < 140 mg/dl Capillary 2 hour post-prandial glucose < 120 mg/dl
    FIGO, 2015

    Diagnosis Of Gestational Diabetes

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    Initial screening for gestational diabetes is accomplished by performing a 50-g, one-hour glucose challenge test at 24 to 28 weeks of gestation. Patients do not have to fast for this test. To be considered normal, serum or plasma glucose values should be less than 130 mg per dL or less than 140 mg per dL . Using a value of 130 mg per dL or higher will increase the sensitivity of the test from 80 to 90 percent and decrease its specificity, compared with using a value of 140 mg per dL or higher.14 Thus, the lower screening level of 130 mg per dL identifies more patients with gestational diabetes at the cost of more false-positive results. Current recommendations from the American Diabetes Association 4 and the American College of Obstetricians and Gynecologists 15 accept either value for defining an abnormal initial screening result.

    An abnormal one-hour screening test should be followed by a 100-g, three-hour venous serum or plasma glucose tolerance test. After the patient has been on an unrestricted diet for three days, venous blood samples are obtained following an overnight fast, and then one, two, and three hours after an oral 100-g glucose load. During the test period, patients should remain seated and should not smoke. Two or more abnormal values are diagnostic for gestational diabetes.

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