Book of Medical Disorders in Pregnancy - Tintash

morning. If the blood glucose is less than
60 mgm% at 4.00 p.m. or if there is an
insulin reaction before supper or in the
evening, the dose is reduced by 10% on
the following morning. Every effort
should be made to avoid insulin reactions
in pregnant patient.
Semi Lente insulin or Toronto insulin:
This has a maximum blood glucose
lowering effect from 3 to 5 hours after
injection.
The dose can be assessed by the before
noon urine test (on the second voiding
after breakfast) and by 11.00 a.m. blood
glucose. If the blood glucose is over 145
mgm% or the urine test is over· a trace at
noon for two days, the Semi Lente dose
is increased by 2 units on the following
morning. Ii the blood glucose is below
60 mgm% at 11.00 a.m. or there is an
insulin reaction before the noon meal,
the Semi-Lente dose is reduced by 2
units the following mor-ning.
Ultra Lente insulin: It has a maxi-mum
blood glucose lowering effect from 12 to
24 hours after injection with lessening
action up to 36 hours. When given at
bedtime it serves as a "basis" for stabilizing
blood sugar throughout the day,
because of slow release.
Dose regimen: The starting dose of
insulin averages 1/10th of the blood
glucose level given as Lente or NPH
before breakfast. If the dose required is
over 20 units, a short acting insulin, such
as Semi Lente or Toronto insulin is
mixed in a 2/1 ratio and given before
breakfast.
Patient should be trained to adjust the
dose herself on the basis of her urine
tests done before meals and at bed time,
30
this however, can only be done in
educated and highly motivated patient.
Blood glucose tests are to be preferred
and should be done at 11.00 a.m. and
4.00 p.m. every one or two weeks.
Patients should be advised to contact
their doctor frequently concerning
glycosuria, hyperglycemia or insulin
reactions so that insulin dosage could be
adjusted without delay. Blood sugar
measurements are a better and preferable
method of monitoring control of diabetes
in pregnancy, since glucosuria due to
lowered renal threshold can not interfere
with this method.
Method and timing of delivery:
All diabetic gravidas should be admitted
to hospital four weeks prior to term.
Diabetics who have only abnormal glucose
tolerance curve and do not receive
insulin may be allowed to deliver normally,
unless a death in utero has occurred
during the last four weeks of a previous
pregnancy. In this case delivery at 36 to
37th week should be accomplished. All
other pregnant diabetic women should
be delivered before the date of
confinement. Even well controlled
diabetic patients should be delivered by
the 37th or even the 3Sth week of
pregnancy. If toxemia supervenes, some
diabetic patients may have to be
delivered as early as 35th week. Prior to
this time the dangers of prematurity are
too great, and may result in neonatal
death easily.
Management on day of delivery:
The mode and timing of delivery should
be determined on an individual basis,
aiming to realize a spontaneous vaginal
delivery by no later than 40 weeks of
gestation if possible induction of labour
oral feedings are with held. One quarter