How do insulin requirements typically change during pregnancy for a woman with a history of diabetes?

During pregnancy, a woman's body undergoes significant physiological changes, particularly in relation to hormonal levels and metabolic processes which directly affect insulin requirements. For a woman with a history of diabetes, insulin requirements typically increase throughout the course of the pregnancy. This is primarily due to the influence of pregnancy hormones such as human placental lactogen, estrogen, and progesterone, which lead to increased insulin resistance as the pregnancy progresses.

As the placenta develops and grows, it secretes hormones that antagonize insulin action, making it necessary for the mother to produce and use more insulin to maintain appropriate blood glucose levels. This increased insulin resistance, coupled with the increased energy demands of the growing fetus, results in higher insulin requirements to effectively manage blood glucose concentrations. Therefore, monitoring and adjusting insulin doses becomes essential for these patients to ensure both maternal health and fetal well-being throughout the pregnancy.