IMPORTANCE OF NUTRITION AND ADJUSTING INSULIN DOSES BEFORE AND DU-RING PREGNANCY IN WOMEN WITH TYPE 1 DIABETES: CASE REPORT

Autor: Magdalena Pisačić, Tomislav Ognjenčić, Dunja Degmenčić, Tatjana Bačun
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Hrana u zdravlju i bolesti : znanstveno-stručni časopis za nutricionizam i dijetetiku
Volume Specijalno izdanje
Issue 11. Štamparovi dani
ISSN: 2233-1239
2233-1220
Popis: U žena s tipom 1 šećerne bolesti važno je postići uredne vrijednosti glikemije prije trudnoće i primijeniti lijekove koji su dopušteni u trudnoći. Prikazana je 35 g. žena kojoj je tip 1 šećerne bolesti dijagnostici-ran u djetinjstvu. Pacijentica je na intenziviranoj inzulinskoj terapiji koja se sastoji od kratkodjelujućeg inzulin-asparta uz tri glavna obroka (15g ugljikohidrata: 1,5j. uz doručak, 1j. uz ručak i 1j. uz večeru) i dugodjelujućeg inzulin-degludeka u 22h. Primljena je na Endokrinološki odjel s oscilirajućim vrijed-nostima glikemije, uz hipoglikemije poslijepodne i noću (HbA1c 8,7%), radi regulacije glikemije u sklopu planiranja trudnoće. Provedena je dodatna edukacija o redovitoj i uravnoteženoj prehrani, korigirana je doza aspart-inzulina ovisno o glikemiji i ugljikohidratnim jedinicama u obroku (15g ugljikohidrata: 1j. uz doručak, 0.75j. uz ručak i 0.75j. uz večeru), te je uvedeno kontinuirano mjerenje glukoze. Nakon 4 mjeseca kontrolni HbA1c bio je 6,9%. Radi planiranja trudnoće degludec-inzulin zamijenjen je detemir-inzulinom u dvije dnevne doze. U trudnoći je imala mučnine, jela je više voća i ugljikohidrata i, sukladno tome, povišena je doza aspart-inzulina uz obroke (do 2:2:2 j. uz glavne dnevne obroke). U 28. tjednu trudnoće glikemija je bila 5,0-5,7 mmol/l, glukoza i ketoni u urinu uredni, HbA1c 6,2% te nije imala simptome hipoglikemije. Prije i za vrijeme trudnoće važno je postići uredne vrijednosti glikemije. Provodi se dodatna edukacija o redovitoj uravnoteženoj prehrani, samokontroli i kontinuiranom mjerenju glikemije, prilagođavanju doze kratkodjelujećeg inzulina vrijednostima glikemije i ugljikohidratnim jedinicama u obroku te o korigiranju doze bazalnog inzulina, kao i o važnosti tjelesne aktivnosti.
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.
Databáze: OpenAIRE
Externí odkaz: