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IMPORTANCE OF NUTRITION AND ADJUSTING INSULIN DOSES BEFORE AND DU-RING PREGNANCY IN WOMEN WITH TYPE 1 DIABETES: CASE REPORT
Magdalena Pisačić
; Sveučilište Josipa Jurja Strossmayera u Osijeku, Medicinski fakultet Osijek, Josipa Huttlera 4, 31000 Osijek, Hrvatska
Tomislav Ognjenčić
; Sveučilište Josipa Jurja Strossmayera u Osijeku, Medicinski fakultet Osijek, Josipa Huttlera 4, 31000 Osijek, Hrvatska
Dunja Degmenčić
; Sveučilište Josipa Jurja Strossmayera u Osijeku, Medicinski fakultet Osijek, Josipa Huttlera 4, 31000 Osijek, Hrvatska; Klinički bolnički centar Osijek, Zavod za integrativnu psihijatriju, Klinika za psihijatriju, Josipa Huttlera 4,31000 Osijek, Hrvatska
Tatjana Bačun
; Sveučilište Josipa Jurja Strossmayera u Osijeku, Medicinski fakultet Osijek, Josipa Huttlera 4, 31000 Osijek, Hrvatska; Klinički bolnički centar Osijek, Zavod za endokrinologiju, Klinika za internu medicinu, Josipa Huttlera 4, 31000 Osijek, Hrvatska
Sažetak
In women with type 1 diabetes, it is important to achieve proper glycemic values before pregnancy and to use medications that are allowed in pregnancy. Case covers 35 year old woman who was diagnosed with type 1 diabetes in childhood. The patient is on intensive insulin therapy which consists of short-acting insulin-aspart with three main meals (15 g carbohydrates: 1.5 U at breakfast, 1 U at lunch and 1 U at dinner) and long-acting insulin degludek at 10 pm. She was admitted to the Endocrinology De-partment with fluctuating glycemic values, with hypoglycemia in the afternoon and at night (HbA1c 8.7%), to regulate blood glucose as part of pregnancy planning. Further education on a regular bal-anced diet was conducted, the dose of aspart-insulin corrected depending on blood glucose and carbo-hydrate units in the meal (15 g carbohydrates: 1U at breakfast, 0.75U at lunch and 0.75U at dinner), and continuous glucose measurements is introduced. After 4 months, control HbA1c was 6.9%. Be-cause of pregnancy planning, degludec-insulin was replaced with detemir-insulin, at two daily doses. She had nausea during her pregnancy, ate more fruits and carbohydrates and, accordingly, increased dose of aspart-insulin was applied with meals (now up to 2: 2: 2 U with main daily meals). At week 28 of pregnancy, blood glucose was 5.0-5.7 mmol / l, glucose and ketones in the urine were normal, HbA1c 6.2% and had no symptoms of hypoglycemia. It is very important to achieve proper glycemic values prior and during pregnancy. Additional education is being conducted on a regular balanced diet, self-control or continuous measurement of blood glucose, adjusting the dose of short-acting insulin to glycemic values and carbohydrate units in the meal and correcting the basal insulin dose, as well as the importance of physical activity.
Ključne riječi
type 1 diabetes; insulin therapy; hypoglycemia; pregnancy and self-monitoring blood glucose
Hrčak ID:
232985
URI
Datum izdavanja:
31.12.2019.
Posjeta: 979 *