Comprehensive Nursing Pharmacology Q 31
A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has been coming for routine prenatal visits, during which diabetic teaching has been implemented. Which of the following statements indicates that the woman understands the teaching regarding her insulin needs during her pregnancy?
A. “Are you sure all this insulin won’t hurt my baby?”
B. “I’ll probably need my daily insulin dose raised.”
C. “I will continue to take my regular dose of insulin.”
D. “These finger sticks make my hand sore. Can I do them less frequently?”
Correct Answer: B. “I’ll probably need my daily insulin dose raised.”
The client starts to need increased insulin in the second trimester. As a result of placental maturation and placental production of lactogen, insulin requirements begin increasing in the second trimester and may double or quadruple by the end of pregnancy. Insulin doses depend on blood glucose levels. Extra testing can be an extreme burden on patients but may be necessary for a short time for aggressive insulin treatment to achieve glycemic goals in a timely manner. Regardless of the method of initiating or adjusting insulin, aggressive management is necessary to attain quick glucose control. Maintaining tight control throughout pregnancy will require close and frequent monitoring to prescribe appropriate doses.
Option A: This statement indicates a lack of understanding. Insulin has long been considered the standard of care to attain optimal glucose control in pregnancy, although multiple methods are available to initiate insulin. Weight-based dosing, weight plus gestational age–based dosing, and even a “one-dose-for-all” type of dosing have been used.
Option C: Insulin isophane (NPH) is a U-100, intermediate-acting insulin. It is produced in E. coli. It is identical to human insulin and is in a suspension. Its onset of action is 1–2 hours, with an average peak of 4 hours (range: 4–8 hours). Duration of action is 10–20 hours. Vials are good for 31 days at room temperature, and pens are good for 14 days.
Option D: Finger sticks for glucose levels must be continued. Accurate and timely adjustments depend on accurate blood glucose testing, type of insulin used, and consistent carbohydrate levels for meals. Fasting, preprandial, 1-hour postprandial, and bedtime blood glucose levels are all important to monitor all types of diabetes during pregnancy.