{"id":30184,"date":"2023-05-01T23:13:18","date_gmt":"2023-05-01T16:13:18","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30184"},"modified":"2023-05-01T23:13:18","modified_gmt":"2023-05-01T16:13:18","slug":"su-dung-insulin-kiem-soat-dai-thao-duong-thai-ky-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/su-dung-insulin-kiem-soat-dai-thao-duong-thai-ky-bo-y-te\/","title":{"rendered":"S\u1eed d\u1ee5ng insulin ki\u1ec3m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai k\u1ef3 &#8211; B\u1ed9 Y t\u1ebf"},"content":{"rendered":"<p>M\u1ee5c \u0111\u00edch c\u1ee7a \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai k\u1ef3 (\u0110T\u0110TK) l\u00e0 ph\u00f2ng tr\u00e1nh c\u00e1c t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i c\u1ee7a t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft \u0111\u1ed1i v\u1edbi m\u1eb9 v\u00e0 con trong thai k\u1ef3 c\u0169ng nh\u01b0 v\u1ec1 l\u00e2u d\u00e0i sau khi m\u1eb9 sinh con, \u0111\u1ed3ng th\u1eddi v\u1eabn \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c s\u1ef1 t\u0103ng tr\u01b0\u1edfng v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng c\u1ee7a thai.<\/p>\n<h2><strong>1. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai k\u1ef3<\/strong><\/h2>\n<p><strong>B\u1ea3ng : C\u00e1c m\u1ee5c ti\u00eau \u0111\u01b0\u1eddng huy\u1ebft trong thai k\u1ef3<\/strong><\/p>\n<table width=\"100%\">\n<tbody>\n<tr>\n<td width=\"46%\"><strong>Ch\u1ec9 s\u1ed1<\/strong><\/td>\n<td width=\"53%\"><strong>M\u1ee5c ti\u00eau<a name=\"_ftnref2\"><\/a>2<sup>\u00a0<\/sup><\/strong><a name=\"_ftnref3\"><\/a><strong>3<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"46%\">HbA1c<\/td>\n<td width=\"53%\">&lt; 6%<\/td>\n<\/tr>\n<tr>\n<td width=\"46%\">\u0110\u01b0\u1eddng huy\u1ebft \u0111\u00f3i<\/td>\n<td width=\"53%\">&lt; 95 mg\/dL (5,3 mmol\/L),\u00a0<strong>V\u00c0<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"46%\">\u0110\u01b0\u1eddng huy\u1ebft sau \u0103n<\/td>\n<td width=\"53%\"><\/td>\n<\/tr>\n<tr>\n<td width=\"46%\">&#8211; \u0110\u01b0\u1eddng huy\u1ebft sau \u0103n 01 gi\u1edd<\/td>\n<td width=\"53%\">&lt; 140 mg\/dL (7,8 mmol\/L),\u00a0<strong>HO\u1eb6C<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"46%\">&#8211; \u0110\u01b0\u1eddng huy\u1ebft sau \u0103n 02 gi\u1edd<\/td>\n<td width=\"53%\">&lt; 120 mg\/dL (6,7 mmol\/L)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>1.1 \u00a0\u0110\u1ed1i v\u1edbi \u0110T\u0110TK: \u0110\u01b0\u1eddng huy\u1ebft \u1edf c\u00e1c th\u1eddi \u0111i\u1ec3m kh\u00e1c nhau trong ng\u00e0y l\u00e0 ch\u1ec9 s\u1ed1 quan tr\u1ecdng, gi\u00fap \u0111\u00e1nh gi\u00e1 s\u1edbm k\u1ebft qu\u1ea3\u00a0\u0111i\u1ec1u tr\u1ecb v\u00e0 th\u1eddi \u0111i\u1ec3m \u0111\u01b0\u1eddng huy\u1ebft ch\u01b0a \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb cho ph\u00f9 h\u1ee3p. Ch\u1ec9 s\u1ed1 HbA1c c\u00f3 gi\u00e1 tr\u1ecb th\u1ee9 y\u1ebfu v\u00ec th\u1eddi gian t\u1eeb khi ch\u1ea9n \u0111o\u00e1n \u0110T\u0110TK \u0111\u1ebfn khi thai ph\u1ee5 sinh ch\u1ec9 t\u1eeb 3 &#8211; 4 th\u00e1ng.<\/p>\n<p>1.2 \u00a0\u0110\u1ed1i v\u1edbi \u0110T\u0110 c\u00f3 t\u1eeb tr\u01b0\u1edbc mang thai: C\u1ea3 \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 HbA1c \u0111\u1ec1u c\u00f3 gi\u00e1 tr\u1ecb \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft. \u0110\u1eb7c bi\u1ec7t c\u1ea7n \u0111\u1ea3m b\u1ea3o m\u1ee9c HbA1c &lt;6,5% tr\u01b0\u1edbc mang thai \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n cho c\u1ea3 m\u1eb9 v\u00e0 thai nhi.<\/p>\n<p>1.3 \u00a0HbA1c \u0111\u01b0\u1ee3c \u0111o m\u1ed7i l\u1ea7n m\u1ed9t th\u00e1ng. L\u00fd t\u01b0\u1edfng nh\u1ea5t, m\u1ee5c ti\u00eau A1C trong thai k\u1ef3 l\u00e0, 6% (42 mmol \/ mol) m\u00e0 kh\u00f4ng c\u1ea7n b\u1ecb h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u0111\u00e1ng k\u1ec3, nh\u01b0ng m\u1ee5c ti\u00eau c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c n\u1edbi l\u1ecfng kho\u1ea3ng 7% (53mmol \/ mol) n\u1ebfu c\u1ea7n \u0111\u1ec3 ng\u0103n ng\u1eeba h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft<\/p>\n<p>1.4 \u00a0C\u00f3 th\u1ec3 \u0111\u1eb7c m\u1ee5c ti\u00eau ch\u1eb7t ch\u1ebd h\u01a1n m\u00e0 kh\u00f4ng b\u1ecb H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, \u0111\u1eb7c bi\u1ec7t khi thai to so v\u1edbi tu\u1ed5i thai, v\u00f2ng b\u1ee5ng thai nhi l\u1edbn.<\/p>\n<p>1.5 \u00a0\u0110\u01b0\u1eddng huy\u1ebft c\u1ea7n \u0111\u01b0\u1ee3c \u0111o v\u00e0o l\u00fac \u0111\u00f3i tr\u01b0\u1edbc \u0103n s\u00e1ng v\u00e0 sau 3 b\u1eefa \u0103n. C\u00f3 th\u1ec3 ch\u1ecdn glucose huy\u1ebft sau \u0103n 1 ho\u1eb7c 2 gi\u1edd t\u00f9y theo s\u1ef1 thu\u1eadn ti\u1ec7n c\u1ee7a BN. Glucose huy\u1ebft tr\u01b0\u1edbc b\u1eefa \u0103n k\u1ebf ti\u1ebfp c\u00f3 th\u1ec3 c\u1ea7n theo d\u00f5i th\u00eam \u1edf BN c\u00f3 ti\u00eam insulin nhanh tr\u01b0\u1edbc b\u1eefa \u0103n. N\u1ebfu glucose \u0111\u1ea1t m\u1ee5c ti\u00eau \u1ed5n \u0111\u1ecbnh, c\u00f3 th\u1ec3 gi\u1ea3m b\u1edbt s\u1ed1 l\u1ea7n \u0111o glucose m\u00e1u.<\/p>\n<h2><strong>2. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c<\/strong><\/h2>\n<p><strong>2.1.\u00a0Thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn s\u1eed d\u1ee5ng<\/strong><\/p>\n<p>\u1ede Vi\u1ec7t Nam c\u0169ng nh\u01b0 h\u1ea7u h\u1ebft c\u00e1c n\u01a1i kh\u00e1c tr\u00ean th\u1ebf gi\u1edbi insulin l\u00e0 duy nh\u1ea5t \u0111\u01b0\u1ee3c ch\u00ednh th\u1ee9c ch\u1ea5p thu\u1eadn cho \u0111i\u1ec1u tr\u1ecb t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft \u1edf ph\u1ee5 n\u1eef mang thai m\u1eafc \u0110T\u0110.<\/p>\n<p>C\u00e1c ch\u1ebf ph\u1ea9m insulin \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn g\u1ed3m t\u1ea5t c\u1ea3 c\u00e1c insulin ng\u01b0\u1eddi (insulin t\u00e1c d\u1ee5ng ng\u1eafn, insulin t\u00e1c d\u1ee5ng trung gian &#8211; NPH v\u00e0 insulin tr\u1ed9n), c\u00e1c insulin analog t\u00e1c d\u1ee5ng nhanh aspart v\u00e0 lispro (v\u00e0 c\u00e1c insulin tr\u1ed9n t\u01b0\u01a1ng \u1ee9ng aspart + aspart protamin, lispro + lispro protamin), insulin t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i levemir.<\/p>\n<p>&#8211; \u00a0<strong>Insulin l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng\u00a0<\/strong>\u0111\u1ec3 ki\u1ec3m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng t\u00edp 1 v\u00e0 t\u00edp 2 trong thai k\u1ef3.<\/p>\n<p>&#8211; \u00a0Ch\u1ebf \u0111\u1ed9 ti\u00eam insulin nhi\u1ec1u m\u0169i trong ng\u00e0y ho\u1eb7c b\u01a1m truy\u1ec1n insulin d\u01b0\u1edbi da li\u00ean t\u1ee5c \u0111\u1ec1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng.<\/p>\n<ul>\n<li><strong>Insulin \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ngay sau khi thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng ch\u01b0a gi\u00fap \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau \u0111\u01b0\u1eddng huy\u1ebft.<\/strong><\/li>\n<\/ul>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-30185 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Insulin-during-pregnancy-sitarambhartiahospital-delhi-1170x520@2x-300x199.webp\" alt=\"dai-thao-duong-thai-ly\" width=\"300\" height=\"199\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Insulin-during-pregnancy-sitarambhartiahospital-delhi-1170x520@2x-300x199.webp 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Insulin-during-pregnancy-sitarambhartiahospital-delhi-1170x520@2x-1024x680.webp 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Insulin-during-pregnancy-sitarambhartiahospital-delhi-1170x520@2x-768x510.webp 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Insulin-during-pregnancy-sitarambhartiahospital-delhi-1170x520@2x.webp 1393w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<p><strong>C\u00e1c lo\u1ea1i insulin \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng theo ph\u00e2n lo\u1ea1i thai k\u1ef3<\/strong><\/p>\n<table width=\"100%\">\n<tbody>\n<tr>\n<td rowspan=\"3\" width=\"44%\">Insulin\u00a0<strong>analog\u00a0<\/strong>t\u00e1c d\u1ee5ng nhanh<\/td>\n<td width=\"22%\">Aspart<\/td>\n<td width=\"33%\">B<\/td>\n<\/tr>\n<tr>\n<td width=\"22%\">Lispro<\/td>\n<td width=\"33%\">B<\/td>\n<\/tr>\n<tr>\n<td width=\"22%\">Glulisine<\/td>\n<td width=\"33%\">C<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"44%\">Insulin\u00a0<strong>analog\u00a0<\/strong>t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i<\/td>\n<td width=\"22%\">Detemir<\/td>\n<td width=\"33%\">B<\/td>\n<\/tr>\n<tr>\n<td width=\"22%\">Glargine<\/p>\n<p>Degludec<\/td>\n<td width=\"33%\">Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u tr\u00ean ph\u1ee5 n\u1eef mang thai<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>2.2. \u0110i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai k\u1ef3<\/strong><\/p>\n<p><strong><em>2.2.1.\u00a0Ch\u1ebf \u0111\u1ed9 \u0103n v\u00e0 luy\u1ec7n t\u1eadp<\/em><\/strong><\/p>\n<p><strong>80-90% thai ph\u1ee5 b\u1ecb \u0110T\u0110TK c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft b\u1eb1ng ch\u1ebf \u0111\u1ed9 \u0103n v\u00e0 luy\u1ec7n t\u1eadp.<\/strong><\/p>\n<p>C\u1ea7n tr\u00e1nh <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/muc-tang-can-hop-ly-khi-mang-thai-cho-ba-me-binh-thuong-thieu-can-thua-can\/\">t\u0103ng c\u00e2n qu\u00e1 m\u1ee9c trong th\u1eddi k\u1ef3 mang thai<\/a> \u0111\u1ed1i v\u1edbi ph\u1ee5 n\u1eef \u0110T\u0110 thai k\u1ef3. S\u1ef1 t\u0103ng c\u00e2n khi mang thai ph\u1ee5 thu\u1ed9c v\u00e0o ch\u1ec9 s\u1ed1 BMI tr\u01b0\u1edbc khi mang thai:<\/p>\n<ul>\n<li>T\u0103ng 12,5- 18 kg \u0111\u1ed1i v\u1edbi ph\u1ee5 n\u1eef nh\u1eb9 c\u00e2n (BMI &lt;18,5 kg \/ m2)<\/li>\n<li>T\u0103ng 11,5- 16 kg \u0111\u1ed1i v\u1edbi c\u00e2n n\u1eb7ng b\u00ecnh th\u01b0\u1eddng (BMI 18,5- 24,9 kg \/ m2)<\/li>\n<li>T\u0103ng 7- 11,5 kg \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi th\u1eeba c\u00e2n (BMI 25- 29,9 kg \/ m2)<\/li>\n<li>T\u0103ng 5- 9 kg \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u00e9o ph\u00ec (BMI \u226530,0 kg \/ m2)<\/li>\n<\/ul>\n<p>Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c gi\u00fap c\u1ea3i thi\u1ec7n ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft \u1edf ph\u1ee5 n\u1eef GDM. Th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn v\u1edbi khuy\u1ebfn ngh\u1ecb l\u00e0 t\u1eadp th\u1ec3 d\u1ee5c \u0111\u1ec1u \u0111\u1eb7n h\u00e0ng ng\u00e0y c\u01b0\u1eddng \u0111\u1ed9 v\u1eeba ph\u1ea3i (\u0111i b\u1ed9 30 ph\u00fat \/ ng\u00e0y ho\u1eb7c h\u01a1n \u2014 n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1ea3n khoa).<\/p>\n<p><strong>2.2.2.\u00a0Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb Insulin<\/strong><\/p>\n<p>\u0110\u01b0\u1eddng huy\u1ebft kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau: \u0110\u01b0\u1eddng huy\u1ebft kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb sau khi \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb dinh d\u01b0\u1ee1ng v\u00e0 luy\u1ec7n t\u1eadp trong 1 &#8211; 2 tu\u1ea7n khi c\u00f3 tr\u00ean 20% k\u1ebft qu\u1ea3 \u0111\u01b0\u1eddng huy\u1ebft tr\u00ean m\u1ee9c m\u1ee5c ti\u00eau.<\/p>\n<p><strong>2.2.3. Ch\u1ebf \u0111\u1ed9 v\u00e0 li\u1ec1u insulin<\/strong><\/p>\n<p>&#8211; Ch\u1ebf \u0111\u1ed9 v\u00e0 li\u1ec1u insulin c\u1ea7n \u0111\u01b0\u1ee3c c\u0103n c\u1ee9 v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m (th\u1eddi \u0111i\u1ec3m t\u0103ng) v\u00e0 m\u1ee9c t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, t\u00ecnh tr\u1ea1ng kh\u00e1ng insulin.<\/p>\n<p>&#8211; \u00a0N\u1ebfu ch\u1ec9 c\u00f3 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i bu\u1ed5i s\u00e1ng: Ch\u1ec9 d\u00f9ng insulin n\u1ec1n (NPH ho\u1eb7c detemir) v\u1edbi li\u1ec1u ban \u0111\u1ea7u 0,05- 0,1 IU\/kg\/ng\u00e0y ho\u1eb7c 2-3 UI Insulin t\u00f9y theo m\u1ee9c \u0111\u1ed9 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, t\u0103ng li\u1ec1u 1 &#8211; 2 IU m\u1ed7i 2 &#8211; 3 ng\u00e0y cho \u0111\u1ebfn khi \u0111\u1ea1t m\u1ee5c ti\u00eau.<\/p>\n<p>&#8211; \u00a0N\u1ebfu ch\u1ec9 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft sau b\u1eefa \u0103n: Ch\u1ec9 d\u00f9ng insulin nhanh (nhanh ng\u01b0\u1eddi, aspart, lispro) tr\u01b0\u1edbc c\u00e1c b\u1eefa \u0103n n\u00e0o c\u00f3 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft sau b\u1eefa \u0103n (1 &#8211; 3 m\u0169i\/ng\u00e0y). Li\u1ec1u kh\u1edfi \u0111\u1ea7u 0,05 &#8211; 0,1 IU\/kg\/b\u1eefa \u0103n ho\u1eb7c 2 &#8211; 3 UI Insulin (t\u00f9y m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 kh\u00e1ng insulin), \u0111i\u1ec1u ch\u1ec9nh t\u0103ng 1 &#8211; 2 IU m\u1ed7i 2 &#8211; 3 ng\u00e0y cho \u0111\u1ebfn khi \u0111\u1ea1t m\u1ee5c ti\u00eau.<\/p>\n<p>&#8211; \u00a0N\u1ebfu c\u00f3 t\u0103ng c\u1ea3 \u0111\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i bu\u1ed5i s\u00e1ng v\u00e0 sau b\u1eefa \u0103n: ph\u1ed1i h\u1ee3p insulin n\u1ec1n &#8211; insulin nhanh v\u00e0o b\u1eefa \u0103n nh\u01b0 tr\u00ean.<\/p>\n<p>&#8211; \u00a0N\u1ebfu c\u00f3 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft c\u1ea7n t\u00ecm nguy\u00ean nh\u00e2n v\u00e0 x\u1eed l\u00fd n\u1ebfu c\u00f3. N\u1ebfu kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n r\u00f5 r\u00e0ng, gi\u1ea3m 15-20% li\u1ec1u insulin li\u00ean quan h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n<p><strong>2.3.\u00a0\u0110i\u1ec1u tr\u1ecb insulin v\u1edbi c\u00e1c th\u1ec3 \u0110T\u0110 kh\u00e1c \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n khi mang thai<\/strong><\/p>\n<p><strong><em>2.3.1.\u00a0C\u00e1c th\u1ec3 \u0110T\u0110 kh\u00e1c \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n khi mang thai<\/em><\/strong><\/p>\n<p>&#8211; \u00a0\u0110T\u0110 mang thai (Diabetes in pregnancy) \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n theo ti\u00eau chu\u1ea9n c\u1ee7a WHO v\u1edbi glucose huy\u1ebft t\u01b0\u01a1ng l\u00fac \u0111\u00f3i \u2265 7 mmol\/L (126 mg\/dL); v\u00e0\/ho\u1eb7c glucose huy\u1ebft t\u01b0\u01a1ng 2 gi\u1edd sau u\u1ed1ng 75g glucose \u2265 11,1 mmol\/L)<\/p>\n<p>&#8211; \u00a0\u0110T\u0110 kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc mang thai (ch\u1ee7 y\u1ebfu l\u00e0 \u0110T\u0110 t\u00edp 2) c\u00f3 glucose huy\u1ebft \u0111\u1ea1t ng\u01b0\u1ee1ng ch\u1ea9n \u0111o\u00e1n \u0110T\u0110 ngo\u00e0i thai k\u1ef3.<\/p>\n<p><strong>2.3.2. \u0110i\u1ec1u tr\u1ecb insulin<\/strong><\/p>\n<p>&#8211; \u00a0C\u00e1c th\u1ec3 \u0110T\u0110 n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb insulin ngay sau khi ch\u1ea9n \u0111o\u00e1n.<\/p>\n<p>&#8211; \u00a0Th\u01b0\u1eddng ph\u1ea3i d\u00f9ng ch\u1ebf \u0111\u1ed9 insulin n\u1ec1n &#8211; b\u1eefa \u0103n ngo\u1ea1i tr\u1eeb m\u1ed9t s\u1ed1 \u00edt c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 c\u00f3 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft sau \u0103n th\u00ec ch\u1ec9 d\u00f9ng insulin nhanh tr\u01b0\u1edbc c\u00e1c b\u1eefa \u0103n nh\u01b0 \u0111i\u1ec1u tr\u1ecb \u0110T\u0110TK.<\/p>\n<p>&#8211; \u00a0T\u1ed5ng li\u1ec1u kh\u1edfi \u0111\u1ea7u: 0,2 &#8211; 0,5 IU\/kg\/ng\u00e0y, t\u00f9y m\u1ee9c \u0111\u1ed9 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 kh\u00e1ng insulin. Trong 3 th\u00e1ng \u0111\u1ea7u thai k\u1ef3 li\u1ec1u 0,7 \u0111\u01a1n v\u1ecb \/ kg \/ ng\u00e0y, trong khi 3 th\u00e1ng gi\u1eefa thai k\u1ef3 li\u1ec1u 0,8 \u0111\u01a1n v\u1ecb \/ kg \/ ng\u00e0y v\u00e0 trong 3 th\u00e1ng cu\u1ed1i thai k\u1ef3 li\u1ec1u Insulin l\u00e0 0,9- 1,0 \u0111\u01a1n v\u1ecb \/ kg \/ ng\u00e0y. Tuy nhi\u00ean li\u1ec1u n\u00e0y kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i ph\u00f9 h\u1ee3p v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c thai ph\u1ee5 c\u00f3 \u0110T\u0110.<\/p>\n<p>&#8211; \u00a0Ph\u00e2n b\u1ed1:<\/p>\n<p>&#8211;\u00a0Insulin n\u1ec1n chi\u1ebfm 40-50% t\u1ed5ng li\u1ec1u, chia 1 &#8211; 2 l\u1ea7n\/ng\u00e0y<\/p>\n<p>&#8211;\u00a0Insulin b\u1eefa \u0103n chi\u1ebfm 50 &#8211; 60% t\u1ed5ng li\u1ec1u, chia l\u00e0m 3 tr\u01b0\u1edbc 3 b\u1eefa \u0103n ch\u00ednh.<\/p>\n<p>&#8211; \u00a0Ch\u1ec9nh li\u1ec1u insulin n\u1ec1n: c\u0103n c\u1ee9 \u0111\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i bu\u1ed5i s\u00e1ng; t\u0103ng 2 &#8211; 3 IU m\u1ed7i 2 &#8211; 3 ng\u00e0y cho \u0111\u1ebfn khi \u0111\u1ea1t m\u1ee5c ti\u00eau.<\/p>\n<p>&#8211; \u00a0Ch\u1ec9nh li\u1ec1u insulin b\u1eefa \u0103n: c\u0103n c\u1ee9 \u0111\u01b0\u1eddng huy\u1ebft sau b\u1eefa \u0103n; t\u0103ng 1 &#8211; 2 IU m\u1ed7i 2 &#8211; 3 ng\u00e0y cho \u0111\u1ebfn khi \u0111\u1ea1t m\u1ee5c ti\u00eau.<\/p>\n<p>&#8211; \u00a0N\u1ebfu c\u00f3 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft c\u1ea7n t\u00ecm nguy\u00ean nh\u00e2n v\u00e0 x\u1eed l\u00fd n\u1ebfu c\u00f3. N\u1ebfu kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n r\u00f5 r\u00e0ng, gi\u1ea3m 15-20% li\u1ec1u insulin li\u00ean quan h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n<p align=\"left\">T\u00c0I LI\u1ec6U THAM KH\u1ea2O:<\/p>\n<p align=\"left\"><span lang=\"vi\">\u00a0S\u1ed1 <\/span><span lang=\"vi\">5481\/Q\u0110-BYT &#8220;<em>V\u1ec0 VI\u1ec6C BAN H\u00c0NH T\u00c0I LI\u1ec6U CHUY\u00caN M\u00d4N \u201cH\u01af\u1edaNG D\u1eaaN CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG T\u00cdP 2\u201d, 30\/12\/2020<\/em><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>M\u1ee5c \u0111\u00edch c\u1ee7a \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai k\u1ef3 (\u0110T\u0110TK) l\u00e0 ph\u00f2ng tr\u00e1nh c\u00e1c t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i c\u1ee7a t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft \u0111\u1ed1i v\u1edbi m\u1eb9 v\u00e0 con trong thai k\u1ef3 c\u0169ng nh\u01b0 v\u1ec1 l\u00e2u d\u00e0i sau khi m\u1eb9 sinh con, \u0111\u1ed3ng th\u1eddi v\u1eabn \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c s\u1ef1 t\u0103ng tr\u01b0\u1edfng v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n b\u00ecnh [&hellip;]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[80,13,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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