Maternity Nursing: Postpartum Q 30
Which of the following changes A. Increase described the insulin needs of a client with type 1 diabetes who has just delivered an infant vaginally without complications?
A. Increase
B. Decrease
C. Remain the same as before pregnancy
D. Remain the same as during pregnancy
Correct Answer: B. Decrease.
The placenta produces the hormone human placental lactogen, an insulin antagonist. After birth, the placenta, the major source of insulin resistance, is gone. Insulin needs decrease and women with type 1 diabetes may only need one-half to two-thirds of the prenatal insulin during the first few PP days.
Option A: After delivery, the requirement of insulin shows a sharp decline and in GDM it is advisable to continue the monitoring to see if the sugars have become normal in the postpartum period but in cases with type 1 and type 2 DM it is not prudent to stop the insulin rather the dose of insulin needs to be decreased by 20-40% of the pregnancy dose as the requirement of insulin during lactation is less.
Option C: During breast-feeding, sometimes the requirement of insulin can fall drastically and these women may develop hypoglycemia, so the dose of insulin needs to be adjusted accordingly. The monitoring of GDM women with a fasting and postprandial sugar is a good method to diagnose T2DM, about 15% of GDM remain glucose intolerant or develop type 2DM in the postpartum period and 10-50% of the women develop diabetes within 5 years of delivery.
Option D: Provision of proper obstetric and neonatal care is of prime concern after delivery. Immediate postpartum type 2 diabetes is uncommon in women with GDM. The glucose targets during the postpartum period in women who have undergone cesarean section are not very clear, but strict control is needed to prevent any infections. Patients with uncontrolled sugars have improper control and have high chances of postoperative complications.