A patient with diabetes who is in the second trimester of pregnancy notes that the usual dose of insulin to maintain blood glucose levels has been increasing over the last few weeks. What should the nurse explain to the patient about insulin during pregnancy?

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Patients with diabetes, who become pregnant, develop insulin resistance as the pregnancy progresses, or insulin does not seem as effective during pregnancy. This phenomenon is believed to be caused by the presence of the hormone human placental lactogen and high levels of cortisol, estrogen, progesterone, and catecholamines. The increased need for insulin is not because of the fetus using insulin to maintain blood glucose level in utero. The patient's increased circulating blood volume is not deactivating insulin. The patient's change in diet might necessitate an adjustment in insulin dosage, but this would vary according to blood glucose level.

A Patient with Diabetes Who Is in the Second Trimester