Medications

Exogenous insulin therapy is used for women with preexisting diabetes. Although certain oral antidiabetic agents are used with GDM, there are limited studies on their use in pregnancy with type 2 diabetes.

Human insulin is recommended in pregnancy, as it is less allergenic and has a quicker absorption rate than animal-based insulin. Rapid-acting insulin analogs (Lispro, Aspart) are frequently used in pregnancy, yielding results similar to short-acting insulin [44-47]. Glargine and Detemir are long-acting, peakless insulin analogs. No clinical studies have been conducted on their use during pregnancy, though case reports have not shown teratogenic effects. Injectable therapies that have not demonstrated safety in pregnancy include incretin mimetic hormones (Pramlintide and Exenatide).

Multiple daily injections of rapid-acting insulin or short-acting insulin with an intermediate acting are the most frequently used insulin administrations in pregnancy (Table 10.3). Women who were on a fixed dose of insulin before conception are often switched to multiple daily injections because of the need for frequent insulin adjustments.

A common insulin regimen is rapid-acting or short-acting insulin before breakfast and dinner, or before each meal and intermediate-acting before breakfast and at bedtime. Intermediate-acting insulin is not usually injected before dinner because of possible nocturnal hypoglycemia.

Insulin requirements change during pregnancy as fetal growth continues and insulin resistance increases. First-trimester insulin regimen varies but is usually 0.7-0.8 units/kg actual body weight/day; second trimester: 0.8-1 unit/kg actual body weight/day; and 0.9-1.2 units/kg actual body weight/day in the third trimester. [35]. The requirements for obese women may be higher (1.5-2 units/kg actual body weight/day).

Insulin injection devices include syringes, pens, and continuous subcutaneous insulin pumps (insulin pump therapy). Pump therapy requires rapid-acting insulin with 50-60% of the dose as basal for continuous insulin and 40-50% as boluses before meals and snacks. Advantages to the insulin pump are flexibility with lifestyle and meal times, and improved glucose control. The disadvantages include cost, risk of interruption in insulin delivery or infection at the infusion site.

Table 10.3 Human Insulin

Insulin type

Onset (h)

Peak action (h)

Duration (h)

Rapid-acting (Lispro, Aspart, Glulisine)

5-15 min

1-2

4-6

Short-acting (Regular)

0.5-1

2-4

6-10

Intermediate-acting (NPH)

1-2

4-8

10-18 (long-acting)

Long-acting (Glargine, Detemir)

1-2

Peakless

Up to 24

From Messing C (ed) (2006) The art and science of diabetes self-management education: a desk reference for healthcare professionals. American Association of Diabetes Educators, Chicago, 1ll., p 38

From Messing C (ed) (2006) The art and science of diabetes self-management education: a desk reference for healthcare professionals. American Association of Diabetes Educators, Chicago, 1ll., p 38

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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