Frequently more insulin than normal is needed during any infection, whatever its nature. Insulin must not be stopped merely because the person is probably eating less. This could lead to hypoglycaemic attacks, or the more serious complications of coma or ketosis.
Some patients react locally to insulin injections. These may be painful, causing red, swollen lumps that may persist for 24 – 36 hours or more. They seem to be a local allergic reaction. Changing to another brand may give relief.
Some patients develop antibodies to insulin and may require abnormally large doses, in the vicinity of 1000 units a day or even more, to control the disease. Sometimes steroids may be necessary to control the reaction and suppress the antibodies.
On the other hand, some patients who are taking steroids (cortisone like preparations) for other purposes may suddenly develop diabetes. It may be the unmasking of latent diabetes. Usually the degree is not severe, and oral medication may soon control the diabetes.
In some patients a metabolic disorder called ketosis might occur. This may be shown up by the appearance of ketone bodies in the urine, which can be detected with some of the simple dip tests. This calls for immediate, vigorous treatment, for it shows that the patient is not being adequately controlled, and the condition is getting out of hand. Mild cases may be treated at home, but the dose of insulin must be increased at once by one-quarter to one-third. Anything more serious must be treated in hospital, where full facilities are available. Soluble insulin gives the quickest and best results and regular, supervised measured amounts of glucose or carbohydrate are given.
Most well-controlled diabetics are able to undergo surgical operations if these become necessary. However, precautions are necessary, and for the period of the operation the insulin may be altered to soluble forms that give greater control.
However, although the mother does well, infants do not share the improved mortality rate. The prenatal death rate, and that from obstetrical complications, has always been high. Not long ago it fluctuated around the 40 per cent mark. With greater care, and more prenatal skill, this has been brought down in some centers to 10 – 14 per cent, still very high in relation to the normal perinatal figure.
Diabetic women are best advised to discuss the matter fully with their obstetrician before embarking on pregnancy, to ascertain the full risk factors and to have clearly in mind the course their antenatal care should take. Strict control of the diabetes is essential, and close supervision with the doctors throughout is imperative. The insulin needs vary quite a lot, and as the pregnancy progresses, they tend to increase considerably.