Insulin During Pregnancy: When You Need It And Safety Measures

A pregnant lady taking an insulin injection

Image: ShutterStock

If you have developed diabetes during pregnancy, a healthy and nutritious diet and routine workout usually helps normalize blood glucose levels and maintains maternal and fetal health. However, sometimes, your doctor may prescribe insulin during pregnancy to maintain your blood glucose levels within the normal range (1). But how does one get gestational diabetes (GD) during pregnancy?

When pregnant, the placenta in a woman’s womb secretes hormones essential for the baby’s development. However, these hormones can impair insulin activity and induce GD in certain pregnant women.

Read this post to know the safety profile of oral hypoglycemic medications and injections in pregnancy.

In This Article

When Do You Need To Take Insulin During Pregnancy?

Women with diabetes do not produce insulin or their body stops responding to the natural insulin, increasing the blood glucose levels. Their endocrine system is affected as it impacts insulin production or function, resulting in high blood sugar levels. Therefore, insulin is required and may be prescribed to facilitate maternal glucose control (2).

Both fasting glucose and postprandial blood glucose levels during conception and pregnancy are important to be normal both for healthy fetal development and to maintain normal fetal growth. Glucose intolerance (the body cannot metabolize blood glucose) during or before pregnancy could lead to certain complications. Insulin treatment helps in maintaining these levels if diet and exercise do not control it sufficiently.

The presented graph depicts the variations in serum insulin levels throughout pregnancy. It reveals that in non-diabetic women, the typical insulin secretion increases from the 10th week of gestation, reaching its maximum around the 40th week, and then significantly decreases.

However, in gestational diabetes, the serum insulin levels decline from about the 20th week, taking a deep plunge at the 40th week. Consequently, this reduction in insulin levels leads to a surge in hepatic glucose production, resulting in elevated fasting blood glucose levels in the second and third trimesters.

Serum insulin variation throughout pregnancy

Source: Pregestational Diabetes in Pregnancy; Obstetrics and gynecology clinics of North America

Is Insulin Safe To Treat Gestational Diabetes During Pregnancy?

Insulin administered through an insulin pen is safe for pregnant women.

Image: IStock

In prenatal care, insulin is the first-line of treatment for type 1 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 it does not affect the baby.

Can Insulin Cause Miscarriage?

No, insulin is not known to cause miscarriage (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 pregnancy nutrition and lifestyle changes.

The US National Institute for Health and Care Excellence (NICE) guidelines advise an initial treatment of insulin resistance either with or without metformin for women with complications of gestational diabetes (6). Insulin is available in only injection and pump form.

Your doctor may prescribe oral medications, such as metformin in pregnancy, for treating gestational diabetes and mild hyperglycemia. However, this is not standard practice. (6).

Things to know

Common side effects of metformin may include nausea, stomach cramps, diarrhea, and appetite loss (10).

Which Insulin Is Safe During Pregnancy?

Doctors may suggest insulin glargine or others based on your condition.

Image: IStock

Your doctor is the best person to determine the type of insulin for you.

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 regular insulin, or short-acting insulin may be considered by the doctors for treating GD (6).

Can You Inject Insulin On The Stomach When Pregnant?

Insulin should be injected into any 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.

Inject insulin into your abdomen if you’ve been doing it before conception.

Image: IStock

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).

Image: IStock

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

Quick tip

To safely inject insulin, measure one hand width down from the shoulder and one hand width up from the elbow and inject into the fleshy outer surface. Inject into the top and outer part of the leg after measuring one hand width down from the groin and one hand width up from the knee. Inject into the upper, outer area of the buttocks (11).

Are There Any Side Effects Of Using Insulin During Pregnancy?

Weakness may be the side effect of taking insulin during pregnancy.

Image: IStock

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

Quick fact

Insulin can sometimes cause the glucose levels to fall below normal, which is known as hypoglycaemia (10).

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

Frequently Asked Questions

1. How many units of insulin is safe during pregnancy?

Units for insulin dosage taken during pregnancy can depend on factors such as body weight, blood sugar levels, and how far you are in pregnancy. The desirable insulin levels can be different for each woman and are prescribed by the doctor after a thorough evaluation (12).

2. Can I stop insulin after delivery?

For most women, healthcare providers will advise stopping insulin immediately after childbirth. However, you may have to carry on with glucose monitoring regularly (13).

3. What are some of the risks associated with insulin resistance or gestational diabetes during pregnancy?

Insulin resistance and gestational diabetes during pregnancy can increase the risk of complications such as neonatal hypoglycemia, a large baby, high blood pressure, cesarean delivery, and increased susceptibility to developing type 2 diabetes later in life (14).

4. Can insulin therapy during pregnancy have any long-term effects on the mother or baby?

Although insulin therapy is generally considered safe during pregnancy, a few studies state that it might impact placental size and function. However, there is limited research on its long-term effects on both the mother and baby. Therefore, large-scale studies are necessary to understand the potential impacts on pregnant women (15) (16).

Most women have been successful in gestational diabetes management with insulin during pregnancy. However, your doctor will suggest insulin only when your diabetes is uncontrolled with diet and exercise. You need to take the prescribed insulin dosage regularly to prevent ketoacidosis. The type and dosage of insulin will be based on the severity and stage of your pregnancy. Moreover, insulin is safe for pregnant women as no reports suggest its adverse effects in pregnancy or the fetus. However, it is crucial to be in close contact with your antenatal care provider to facilitate close monitoring and favorable pregnancy outcomes.

Infographic: Hypoglycemia During Pregnancy

An overdose of insulin or delaying meals while on insulin may cause blood glucose to fall below normal. Hypoglycemia during pregnancy may be problematic. This infographic helps you identify the symptoms of low blood sugar and suggests a few ways to deal with it.

symptoms and management of hypoglycemia during pregnancy (infographic)

Key Pointers

The placenta produces hormones that can impair insulin activity during pregnancy.
Insulin is administered through an insulin pen or pump to treat glucose intolerance.
Pregnant women should consult with their doctor regarding the type of insulin, injection site, and administration technique.
Taking insulin may result in side effects like weight gain, dizziness, blurred vision, weakness, sweating, and muscle cramps.

Illustration: Insulin During Pregnancy: When You Need It And Safety Measures

Image: Dall·E/MomJunction Design Team

Navigating pregnancy becomes even more intricate when facing gestational diabetes. Discover the potential benefits of insulin as a supportive measure through insightful video content.

References

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.

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
10. Taking medication and insulin for gestational diabetes; Tommy’s
11. Insulin use during pregnancy; University of Iowa Hospitals and Clinics
12. Eman M. Alfadhli ; Gestational diabetes mellitus; NCBI (2015)
13. Your health after birth with type 1 or type 2 diabetes; Tommys
14. Gestational Diabetes; Centers for Disease Control and Prevention.
15. Subiabre Mario et al.; Insulin therapy and its consequences for the mother, foetus, and newborn in gestational diabetes mellitus; NCBI (2018).
16. Rabia Arshad et al., Effects of insulin on placental, fetal and maternal outcomes in gestational diabetes mellitus; NCBI (2014).

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Reviewer Author Editor Fact Checker

Dr. Christian PopeDO, FACOG

Dr. Christian Pope is Board-certified in Obstetrics & Gynecology, and a Fellow of the American Academy of Obstetricians and Gynecologists. He is a long-standing medical staff member and past chairman of Obstetrics and Gynecology at St.

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shreeja pillaiMSc

Shreeja holds a postgraduate degree in Chemistry and diploma in Drug Regulatory Affairs from the University of Mumbai. Before joining MomJunction, she worked as a research analyst with a leading multinational pharmaceutical company.

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Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

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Dr. Joyani DasM.Pharm, PhD

Dr. Joyani Das did her post-graduation from Birla Institute of Technology, Mesra and PhD in Pharmacology. Previously, she worked as an associate professor, faculty of Pharmacology, for two years. With her research background in preclinical studies and a zeal for scientific writing, she joined MomJunction as a health writer.

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