At what point in gestation does the need for a higher insulin dose generally arise for diabetic mothers?

The need for a higher insulin dose in diabetic mothers typically arises around 24 weeks of gestation due to physiological changes that affect insulin sensitivity and glucose metabolism during pregnancy.

During the first half of pregnancy, women generally experience increased insulin sensitivity, which may lead to a lower requirement for insulin. However, as the pregnancy progresses, especially after the second trimester, placental hormones such as human placental lactogen (hPL), cortisol, and progesterone increase. These hormones contribute to insulin resistance, necessitating an increase in insulin dosage to achieve optimal blood glucose control.

By the 24-week mark, many diabetic mothers find that their previous insulin regimen is inadequate, prompting the need for adjustments to maintain glycemic control and minimize risks to both the mother and the developing fetus. This is a crucial time for monitoring and managing blood sugar levels, as proper management can help prevent complications such as gestational hypertension and macrosomia in the newborn.

When addressing blood sugar management in diabetic pregnant women, understanding these physiological changes and timing them accurately is essential for effective treatment.