A type 1 diabetic mother has just delivered. To maintain euglycemia, what should the nurse plan to do first?

• A. Administer prepregnancy dose of metformin.
• B. Assess her blood glucose before administering any glucose-lowering medications.
• C. Administer 20 units of long-acting insulin, as sufficient time has elapsed since delivery.
• D. Keep NPO (nothing by mouth) for an additional 4 hours to allow the blood glucose to normalize.

Answer: (B)

After delivery, insulin requirements usually fall dramatically because the placenta, which produces hormones that raise blood glucose and create insulin resistance, is no longer present. Because of this sudden change, the first and safest step is to check the mother's current blood glucose before giving any glucose-lowering medications. This provides the actual data needed to determine whether insulin should be started, reduced, held, or adjusted.

Relying on a prepregnancy dose of metformin isn’t appropriate for a type 1 diabetic in the immediate postpartum period, since type 1 diabetes requires insulin therapy and metformin has a different role. Administering a fixed long-acting insulin dose as though time since delivery guarantees nothing about her current needs and risks inappropriate glucose control. Keeping her NPO to let glucose normalize isn’t a standard or necessary approach either; treatment should be guided by actual glucose measurements.