Maternity Nursing: Postpartum Q 20
The nurse is about to give a Type 2 diabetic her insulin before breakfast on her first day postpartum. Which of the following answers best describes insulin requirements immediately postpartum?
A. Lower than during her pregnancy
B. Higher than during her pregnancy
C. Lower than before she became pregnant
D. Higher than before she became pregnant
Correct Answer: C. Lower than before she became pregnant
PP insulin requirements are usually significantly lower than pre-pregnancy requirements. Occasionally, clients may require little to no insulin during the first 24 to 48 hours postpartum. Immediately after delivery, postpartum insulin requirements decrease dramatically as a result of the rapid decrease in diabetogenic placental hormone levels and resulting dissipation of pregnancy-induced insulin resistance.
Option A: The policy specifies that women with type 1 or type 2 diabetes who require ongoing insulin administration should decrease insulin doses and undergo monitoring of preprandial blood glucose values while on the postpartum unit. Glycemic targets approximating nonpregnant targets are utilized. Among women with type 1 diabetes, insulin requirements typically return to prepregnancy levels or lower following delivery.
Option B: Women are typically advised to decrease basal and prandial insulin doses to 50 to 80% of their preconception doses, but recommendations are individualized. If preconception insulin doses are not known, one-third to one-half of the term pregnancy dose or weight-based dosing may be used as a starting point.
Option D: Among women with type 2 diabetes, postpartum medication requirements vary depending on the severity of hyperglycemia postpartum and the prepregnancy diabetes therapeutic regimen, ranging from no medical therapy to resumption of insulin therapy at reduced doses (as above) or noninsulin therapies following delivery.