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Chapter-11 Insulin Therapy in Pregnancy: Initiation, Titration, and Safety Update

BOOK TITLE: Clinical Guidelines for Management of Diabetes in Pregnancy

Author

1. Chawla Rajeev
2. Jaggi Shalini

ISBN

9789352703951

DOI

10.5005/jp/books/18049_12

Edition

1/e

Publishing Year

2018

Pages

Author Affiliations

1. North Delhi Diabetes Center, New Delhi, India, North Delhi Diabetes Centre, Delhi, India, North Delhi Diabetes Centre, New Delhi, India, RSSDI, North Delhi Diabetes Centre, Rohini, New Delhi, India, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi; Rohini, New Delhi, India, North Delhi Diabetes Centre, New Delhi
2. Dr Mohans’ Diabetes Specialities Centre, New Delhi, India, Dr Mohan Diabetes Specialities Centre, New Delhi, India, Lifecare Diabetes Centre, Kirti Nagar, New Delhi, India, Lifecare Diabetes Centre, New Delhi, India, Dr Mohans’ Diabetes Specialities, Center, New Delhi, India, Dr Mohans’ Diabetes Specialities Center, New Delhi, India, Dr Mohans’ Diabetes Specialities Center, New Delhi, India, Dr Mohans' Diabetes Specialties Centre, New Delhi, India, Dr Mohan’s Diabetes Specialities Centre, New Delhi, India, Dr Mohans' Diabetes Specialities Center, New Delhi, India, Dr Mohan’s Diabetes Specialities Center, New Delhi, India, Dr Mohans' Diabetes Specialities Centre, New Delhi, India

Chapter keywords

Pregnancy, insulin resistance, placental hormone, glycemic control, hyperglycemia, antidiabetic agent, medical nutrition therapy, MNT

Abstract

Abstract

Pregnancy is characterized by progressive insulin resistance that starts near midpregnancy and progresses through the third trimester as a result of increased placental hormones which have an established diabetogenic action. It is important to note that this insulin resistance rapidly decreases postdelivery, again suggesting a major contribution of these placental hormones in its pathogenesis. The cumulative effects of maternal adiposity and placental influences result in abnormalities in insulin signaling pathways, which lead to decreased glucose uptake and an increase in insulin resistance. This chapter covers the monitoring of glycemic control and management of diabetes in pregnancy. Besides lifestyle management and medical nutrition therapy (MNT), insulin is the treatment of choice for management of hyperglycemia in pregnancy in the absence of sufficient long-term safety data on use of other oral antidiabetic agents.

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