When does a woman with gestational diabetes need to start insulin treatment and what regimens are followed

As mentioned above, when diet is not enough to achieve therapeutic targets, insulin therapy is required, usually after a period of a few days of self blood glucose monitoring with levels above these desired. It is usually postprandial blood glucose levels that are higher than accepted cut-offs.

The mother should be told that injected insulin does not cross the placenta and does not affect the foetus. In contrast, increased blood glucose crosses the placenta and is responsible for possible diabetic complications to the foetus (macrosomia, etc.).

Initiation of insulin treatment can be done with small doses of rapid-acting insulin before meals. However, an intensive insulin regimen with multiple injections may also be needed (combination of rapid-acting insulin before meals with medium-acting insulin for regulation of pre-meal blood glucose values) or the use of an insulin pump. Intensive insulin regimen requires self blood glucose monitoring and adjustment of insulin doses accordingly. The pregnant woman should be educated and trained in the use of insulin and the problems of hypoglycaemias (awareness, prevention, treatment).

Usually, 0.6-1.0 units of insulin per kg body weight are required, depending on the age of gestation. Insulin needs increase with progression of pregnancy, whereas at labour they decrease significantly and discontinuation of insulin treatment may be required.

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