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Insulin To Treat Gestational Diabetes: Is It Safe?

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During pregnancy, the placenta secretes hormones that are necessary for the developing baby. However, in some, these hormones can hinder the functioning of insulin and cause gestational diabetes (GD).

Usually, a balanced diet and regular exercise might help normalize blood glucose levels. But, if your GD does not come down even after specific lifestyle changes, then your doctor might put you on insulin (1) because untreated, gestational diabetes can have adverse effects on the baby and the mother.

In this post, MomJunction gives you the safety profile of insulin tablets and injections during pregnancy. Read on to learn about the other important aspects of using insulin during pregnancy.

When Do You Need To Take Insulin During Pregnancy?

Women with gestational diabetes do not produce insulin or their body stops responding to the natural insulin, increasing the blood glucose levels. Therefore, the doctor might prescribe insulin to keep the blood glucose levels under check (2).

The mom-to-be needs to maintain the blood glucose levels from before conception until the end of the pregnancy. Glucose intolerance (the body cannot metabolize blood glucose) during or before pregnancy could lead to certain complications. Insulin treatment helps in maintaining these levels.

Is Insulin Safe To Treat Gestational Diabetes During Pregnancy?

In clinical practices, insulin is the first-line of treatment for type1 and type 2 diabetes and uncontrolled GD during pregnancy (3). According to the American Diabetes Association (ADA), insulin administered through injection, insulin pen, or through an insulin pump is safe for pregnant women (4). Your doctor will put you on insulin only if it is necessary.

Does Insulin Affect The Baby During Pregnancy?

ADA says that insulin does not cross the placenta, and so is unlikely to affect the baby. However, you should take insulin only upon prescription from your doctor.

Can Insulin Cause Miscarriage During Pregnancy?

There are no studies to prove if insulin medication itself can cause miscarriage during pregnancy. However, untreated gestational diabetes can lead to high blood glucose levels, which can increase the chance of miscarriage or stillbirth (5).

What Is The Suggested Drug Therapy For Treating Gestational Diabetes?

The guidelines of the American College of Obstetricians and Gynecologists (ACOG) recommend insulin as the first-line treatment for gestational diabetes that cannot be controlled by dietary and lifestyle changes.

The US National Institute for Health and Care Excellence (NICE) guidelines advise an initial treatment of insulin either with or without metformin for women with complications of gestational diabetes (6). Insulin is available in both injection and pills. Your doctor will suggest if you need to take oral medication or insulin shots based on your condition.

Other oral medications, such as metformin, may be prescribed to treat gestational diabetes and mild hyperglycemia. However, Glyburide, which is also an oral medication, is not recommended as a first-line of treatment if insulin or metformin is not available, as a few studies state that it crosses the placenta and may have adverse effects on the fetus (6).

The safety of pills prescribed for type 2 diabetes during pregnancy is also not established. So if you’ve taken them at the time of conception, tell your doctor about it (4).

Which Insulin Is Safe During Pregnancy?

Your doctor is the best person to determine the type of insulin for you. Also, insulin is only prescribed if the non-pharmacological treatments fail to bring down blood glucose levels. So, consult with your doctor and discuss your diabetic regime during your pregnancy.

According to an article published in the American College of Clinical Pharmacy, intermediate-acting neutral protamine Hagedorn (NPH) insulin, the long-acting NPH, long-lasting insulin glargine, and insulin detemir may be considered by the doctors for treating GD (6).

Can You Inject Insulin On The Stomach When Pregnant?

Insulin should be injected into the fatty tissue. According to a publication in the Indian Journal of Endocrinology and Metabolism, the abdomen is a safe site for insulin injection during pregnancy.

The article recommends the below techniques to follow during the various stages of pregnancy.

  • First trimester: You can inject insulin into your abdomen. If you’ve been injecting it on the abdomen before conception, there is no need to change the injection site or technique.
  • Second trimester: Lateral parts of the abdomen are suitable for injection, but avoid the skin overlying the fetus (7).
  • Third trimester: The Forum of Injection Techniques, India, suggests that insulin be injected into the abdomen but by ensuring that the skin fold is properly raised. If you are apprehensive about getting an injection on your abdomen, talk to your doctor about changing the injection site to the thigh, upper arm, or buttock (8).

Talk to your healthcare provider for initial guidance on injecting insulin. With time, you will become comfortable in safely administering insulin by yourself.

Are There Any Side Effects Of Using Insulin During Pregnancy?

Insulin is crucial to protect the mother and the growing baby from the effects of gestational diabetes. However, the injection itself might have a few side effects, such as (9):

  • Redness, swelling, and itching near the injection site
  • Skin thickening or a little depression in the skin
  • Weight gain
  • Constipation
  • Shortness of breath
  • Wheezing
  • Dizziness
  • Blurred vision
  • Sweating
  • Fast heartbeat
  • Weakness
  • Muscle cramps
  • Swelling of the arms, legs, feet, ankles and lower legs

If you experience any of the following symptoms, talk to your doctor.

Gestational diabetes could lead to serious issues for the mother and the baby. If you are diagnosed with GD, then follow your doctor’s advice and make the necessary changes in your diet and lifestyle. Also, if insulin is prescribed, talk to your doctor about your drug regime and stick to it.

Did you take insulin during your pregnancy? Let us know about it in the comments section below.

This post is for informational purposes only and is not a replacement for a doctor’s consultation. Do not use any medication without talking to your doctor.

References

1. Gestational Diabetes Information- Commencing Insulin Therapy; Department of Health; Queensland Government
2. Laura Hieronymus, and Patti Geil; Expecting the best: Diabetes, Pregnancy, and Blood Glucose Control; National Federation of the Blind
3. Alyson K. Blum; Insulin Use in Pregnancy: An Update; NCBI (2016)
4. Prenatal Care; American Diabetes Association
5. Karen L. Whalen and James R. Taylor; Gestational Diabetes Mellitus; American Academy of Clinical Pharmacy
6. Pregnancy if You Have Diabetes; National Institute of Diabetes and Digestive and Kidney Disease
7. Sanjay Kalra, et al.; Addendum: First injection technique recommendations for patients with diabetes, Forum for Injection Techniques India; NCBI (2013)
8. Nikhil Tandon, et al.; Forum for injection technique and therapy expert recommendations, India: The Indian recommendations for best practice in insulin injection technique, 2017; Indian Journal of Endocrinology and Metabolism
9. Insulin Injection; MedlinePlus; US National Library of Medicine

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