Diabetic DilemmaThe nurse is caring for a woman at 37 weeks' gestation. The client was diagnosed with insulin-dependent diabetes mellitus (IDDM) at age 7. The client states, "I am so thrilled that I will be breastfeeding my baby." Which of the following responses by the nurse is BEST?
1. "You will probably need less insulin while you are breastfeeding."
2. "You will need to initially increase your insulin after the baby is born."
3. "You will be able to take an oral hypoglycemic instead of insulin after the baby is born."
4. "You will probably require the same dose of insulin that you are now taking."
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The Correct Answer to the Question above is:
(1)
Reworded question: What are the insulin requirements of the breastfeeding diabetic?
Strategy: Determine the outcome of each answer choice.
Needed Info:
Nursing care of diabetic during pregnancy: reinforce need for careful monitoring throughout pregnancy; evaluate understanding of modifications in diet/insulin coverage. Teach client and significant other: diet (eat prescribed amount of food daily at same times); home glucose monitoring; insulin (purpose, dosage, administration, action, side effects, potential change in amount needed during pregnancy as fetus grows and immediately after delivery); no oral hypoglycemics (teratogenic). Assist with stress reduction; fetal surveillance.
Category: Planning/Health Promotion and Maintenance
(1) "You will probably need less insulin while you are breastfeeding."—CORRECT: breastfeeding has an antidiabetogenic effect; less insulin is needed
(2) "You will need to initially increase your insulin after the baby is born."—insulin needs will decrease due to an antidiabetogenic effect of breastfeeding and physiological changes during immediate postpartum period (
3) "You will be able to take an oral hypoglycemic instead of insulin after the baby is born."—client has IDDM: insulin required (4) "You will probably require the same dose of insulin that you are now taking."—during third trimester insulin requirements increase due to increased insulin resistance.
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