Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – C2

ANSWER — Correct.

This is a reasonable recommendation. The caloric restriction in comparison with a patient without obesity is appropriate. Women who have obesity need not have a hypercaloric diet during pregnancy. Their endogenous energy reserves are satisfactory to support the energy requirements of the growing fetus. In a pregnant woman with diabetes, the carbohydrate content of a meal is an important determinant of the postprandial glucose value, which is a major determinant of glucose control as measured by the glycated hemoglobin (A1C) level, and of fetal size.

What types of insulin would you recommend and at what doses?

●Switch to glargine insulin 30 units at bedtime and aspart insulin using prandial doses and correction doses calculated by the rule of 1500 (see "Interactive diabetes case 3: Hypoglycemia in a patient with type 1 diabetes – B2"). You advise the patient to return in one week. (See "Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – D1".)

●Give NPH insulin 28 units and aspart insulin 14 units before breakfast, aspart insulin 11 units before supper, and NPH insulin 11 units at bedtime, for a total of 64 units per day. You advise the patient to return in one week. (See "Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – D2".)

●Give NPH insulin 36 units and aspart insulin 18 units before breakfast, aspart insulin 13 units before supper, and NPH insulin 13 units at bedtime, for a total of 80 units per day. You advise the patient to return in one week. (See "Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – D3".)