Can Pregnancy effect an insulin dependent diabetic?

[ghurty]

Hi,

Just wondering, can being pregnant make a insulin dependent diabetic need more insulin then her regular dose? Enough to send her into DKA?

[akroeze]

Pregnancy can do pretty much anything.... including that.

[ccmedoc]

Good question, short answer is Yes it can, pregnancy is very stressful.

Another issue is DKA can be observed at lower glucose levels than in non-pregnant mothers that are diabetics. This would possibly delay the diagnosis and put the mother and fetus at high risk.

In a woman with diabetes, pregnancy has the potential for increased complications due to drastic changes in the mother's carbohydrate metabolism. A growing fetus is dependent on the mother's nutrient supply of glucose, amino acids, and lipids. This supply mostly is regulated by insulin. In the early stages of pregnancy, insulin sensitivity is normal or increased.

However, in later pregnancy, the hormonal changes associated with fetal growth such as the rise in estrogen, progesterone, HPL (a hormone similar to growth hormone), prolactin, and cortisol, are all associated with insulin resistance. The biggest contributor to this resistance is most likely the HPL as it is a known insulin antagonist. This resistance is maximized in the third trimester as maternal insulin levels reach a bit of a plateau , leading to an increase in free fatty acids, which further aggravates insulin resistance. All of these changes in insulin sensitivity and in glucose and lipid levels have the potential for adverse complications for the diabetic mother, and contribute to the aforementioned DKA potentially occurring at lower levels than in non-pregnant mothers.

[firedoc5]

I think your question has been answered quite adequately.

[captainstandup]

There are tremendous risks to mother and fetus including unexplainable in utero death, hypoglycemic newborns that are also heavily exposed to ketones along with really large babies > 90th percentile are common. A myriad of problems during the birthing process for the child and certainly for the mom.Please note this only scratches the surface of a much broader discussion of the ill effects of (GDM) gestational diabetes mellitus.