Which change in treatment may a pregnant client with diabetes expect in the second half of pregnancy?

In the second half of pregnancy, particularly during the later trimesters, a pregnant client with diabetes can expect increased insulin needs. This increase is primarily due to the physiological changes that occur during pregnancy. As the placenta grows, it produces hormones such as human placental lactogen (hPL), estrogen, and cortisol, which have insulin-antagonistic effects. These hormones can lead to increased insulin resistance, meaning that more insulin is required to maintain blood glucose levels within the normal range.

The metabolic demands of the developing fetus also contribute to this increased need for insulin. As the fetus grows, it requires more glucose for energy and development, which further necessitates a rise in maternal insulin production or administration to manage blood glucose levels effectively.

While some might think that carbohydrate intake could be reduced to manage glucose levels, it's essential for pregnant women to maintain an adequate caloric intake, as both the mother and the developing fetus require sufficient nutrition. Therefore, adjusting insulin therapy in response to the increased needs is a critical aspect of managing diabetes during the second half of pregnancy.