Glucose control during pregnancy
Balancing glycemic control while minimizing the risk of severe hypoglycemic events is essential during pregnancy.However hypoglycemia is common particularly during the first trimester when where may be increased insulin sensitivity.This increased sensitivity coupled with tight glucose control places pregnant women with diabetes at increased risk for hypoglycemia.Hypoglycemia unawareness a phenomenon when there is a blunting of the body is release of glucagon and epinephrine and the classic symptoms of hypoglycemia are not recognized is also more common during pregnancy(Hawthorne 2011)
It is essential that pregnant women with diabetes and the people in their lives, recognize the signs and symptoms of hypoglycemia and are familiar with appropriate treatment including the role of glucagon. Severe hypoglycemia-defined as an episode requiring the assistance of another person and marked by altered consciousness and possible seizure is a potentially fatal complication and is associated with hypoglycemia unawareness (de Valk & Visser,2011).Because sing and symptoms may be missed or attributed to changes associated with pregnancy, increasing the frequency of self-monitoring of blood glucose to six or more time per day is recommended(Hawthorne,2011)
Individual insulin requirement vary. Two additional factors can complicate the regulation of insulin levels. After about 20 weeks gestation, insulin resistance increases and there is often a rise in blood sugar and, therefore, a rise in insulin requirements between 4 a.m. and 6 a.m. related to the release of cortisol and growth hormones(de Valk & Visser,2011). The potential hyperglycemia from this “dawn phenomenon” and the changing basal insulin requirements make the use of CSII with individualized programming of different basal insulin delivery rates especially appealing. The addition of continuous glucose