In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states
a. "I will need to increase my insulin dosage during the first 3 months of pregnancy."
b. "Insulin dosage will likely need to be increased during the second and third
trimesters."
c. "Episodes of hypoglycemia are more likely to occur during the first 3 months."
d. "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle
feeding."
A
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A Insulin needs are reduced in the first trimester due to increased insulin
production by the pancreas and increased peripheral sensitivity to insulin.
B This statement is accurate and signifies understanding. Insulin resistance begins
as early as 14 to 16 weeks of gestation and continues to rise until it stabilizes
during the last few weeks of pregnancy.
C This statement is correct. During the first trimester maternal blood glucose levels
are reduced and the insulin response to glucose is enhanced therefore this is
when an episode of hypoglycemia is most likely to occur.
D For the non-breastfeeding mother insulin levels return to normal within 7 to 10
days. Lactation utilized maternal glucose, therefore the mother's insulin
requirements will remain low during lactation. On completion of weaning the
mother's prepregnancy insulin requirement is reestablished.
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