Why We Use Insulin in Gestational Diabetes

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diabetes during pregnancy

Getting diagnosed with gestational diabetes can be shocking and scary, and leave you with plenty of questions. What is gestational diabetes? What does that mean for my baby? How will this change my lifestyle? How is gestational diabetes treated? If you have any of these questions, no need to worry, this article was written for you.

What is gestational diabetes?

Gestational diabetes is a condition that can happen during pregnancy where the mother develops carbohydrate intolerance leading to high blood sugar levels. Diabetes in pregnancy occurs in approximately 7% of pregnancies in the United States. All women are screened for gestational diabetes using a glucose tolerance test between 24-28 weeks of pregnancy. This test includes drinking sugar to see how your body reacts. If your blood sugar levels come back high multiple times, you will most likely get diagnosed with gestational diabetes.

Why do we treat gestational diabetes?

Women who are diagnosed with gestational diabetes are at higher risk of complications such as preeclampsia and requiring a cesarean section. Babies born to mothers who have gestational diabetes are also more likely to be large for their gestational age, which can lead to more trauma during birth. Maintaining proper blood sugar control when you have diabetes in pregnancy has been shown to reduce the risk of these complications.

How is gestational diabetes treated?

Diabetes in pregnancy can be treated in several ways. Most women will start treatment with nutrition therapy. Nutrition therapy allows the woman to keep her blood sugar within a normal range by monitoring the foods she eats and exercising. Blood sugar levels must be checked throughout the day to ensure that levels do not get too high or too low. Many women will have to monitor their blood sugar four times a day and their diet will be adjusted based on these levels.

While nutrition therapy can be very effective in many women, approximately 30% of women will require some type of medication to keep their blood sugar within a normal range. Medication options include oral medications such as metformin, glyburide, and insulin. Metformin and glyburide can be given during pregnancy but are typically reserved for women who do not tolerate insulin. So let’s take a look at why we use insulin for women with diabetes in pregnancy. 

Why do we use insulin for diabetes in pregnancy?

Insulin is a hormone that helps move glucose (aka: sugar) from the blood into the cells so that it can be used to make energy. When your body’s blood sugar levels are high it means that there is more sugar in your blood than in your cells. This is called insulin resistance which can lead to the diagnosis of diabetes during pregnancy.

We like to think of insulin resistance as a “lock and key” model. Each cell has a gate called an insulin receptor. Insulin is the key that will open the gate to let glucose into the cell to make energy. The “lock” or insulin receptor will stay locked until the “key” or insulin comes to the gate. When insulin resistance occurs, the key no longer fits into the lock so it will only open a little bit and not enough glucose can get into the cell. Giving insulin injections helps fix this issue by increasing the number of “keys” so the gates can open and let more glucose into the cell. When there is more glucose in the cell, there is less sugar in the blood.

diabetes during pregnancy

For patients with diabetes in pregnancy, insulin is often considered the first medication option for several reasons. First, it is effective at lowering blood sugar levels and has been well studied in pregnancy. Healthcare providers know that many types of insulin can be used safely in pregnancy and are approved for use in pregnancy by the U.S. Food and Drug Administration (FDA). Secondly, insulin does not cross the placenta so it is less likely to have an impact on the baby. Oral medications used for diabetes in pregnancy do cross the placenta and the influence this has on the baby long term is unknown. While oral medications can be used safely in pregnancy, the unknown risks of these therapies make them less desirable for many women. Third, insulin dosing allows for better control on blood sugar levels throughout the day and can easily be adjusted to fit the needs of each woman. Many women will use a combination of short-acting, intermediate-acting, and long-acting insulin to find the perfect insulin regimen for them.

What is the best treatment option for diabetes in pregnancy?

diabetes during pregnancy

Ultimately, the best treatment option for any woman who has diabetes in pregnancy is the treatment option that works best for her. Several women use a combination of diet, exercise, and medication treatments to get control of their blood sugar so they can have the healthiest pregnancy possible. Some women will not need medications, while others may need insulin multiple times a day. It is important to remember that if you require insulin, you did not do anything wrong. Your body is just reacting differently to being pregnant than someone else with diabetes in pregnancy. At the end of the day, what is most important is working with your healthcare team to find the safest and most effective treatment for you to bring your baby into the world.

Sierra Richard
Sierra Richard, PharmD helps women live happier, healthier lives while taking medications. She is a women’s health and pediatric clinical pharmacist who uses her time away from the hospital to create educational content about women’s health topics on social media including Instagram, YouTube and TikTok under the name Happy Pharm Life.

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