What should the nurse explain to a client with gestational diabetes regarding insulin needs during the second trimester?

During the second trimester of pregnancy, a woman with gestational diabetes typically experiences an increase in insulin needs. This is primarily due to the physiological changes that occur as the pregnancy progresses, including increased insulin resistance caused by hormonal changes, particularly due to the placental hormones such as human placental lactogen, cortisol, and progesterone. These hormones work to ensure adequate glucose supply to the growing fetus, which can necessitate a greater amount of insulin in the mother to maintain blood glucose levels within the normal range.

As a result, rather than decreasing or remaining stable, insulin requirements often significantly increase as the second trimester progresses. This adjustment is vital for managing blood glucose levels effectively and minimizing risks to both the mother and fetus, such as the development of macrosomia or potential complications during labor.

Understanding this change in insulin needs is crucial for both the client and the healthcare provider to ensure optimal management of gestational diabetes throughout the evolving stages of pregnancy.