Skip to main content
SpringerLink
Log in

Gestational Diabetes Mellitus: Insulinic Management

  • Review Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Diabetic pregnancies have attendant risks. Adverse fetal, neonatal, and maternal outcomes in a diabetic pregnancy can be avoided by optimum glycemic control. Most pregnancies with GDM can be managed with non-insulinic management, which includes medical nutrition therapy. However, many necessitate concomitant insulinic management. The new insulin analogs present undoubted advantages in reducing the risk of hypoglycemia, mainly during the night, and in promoting a more physiologic glycemic profile in pregnant women with diabetes. Rapid-acting insulin analogs seem to be safe and efficient in reducing postprandial glucose levels more proficiently than regular human insulin, with less hypoglycemia. The long-acting insulin analogs do not have a pronounced peak effect as NPH insulin, and cause less hypoglycemia, mainly during the night. The review focuses on glycemic goals in pregnancy, insulinic management of GDM, and posology of insulin and its analogs. Clear understanding of the insulinic management of GDM is essential for women’s health care providers to provide comprehensive care to women whose pregnancies are complicated with diabetes and rechristen the ‘‘diabetic capital of the world’’ to the ‘‘diabetic care capital of the world.’’

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Guariguata L, Linnenkamp U, Beagley J, et al. Global estimates of the prevalence of hyperglycaemia in pregnancy for 2013 for the IDF Diabetes Atlas. Diabetes Res Clin Pract. 2013;. doi:10.1016/j.diabres.2013.11.003.

    Google Scholar 

  2. Pedersen J. Diabetes mellitus and pregnancy: present status of the hyperglycaemia–hyperinsulinism theory and the weight of the newborn baby. Postgrad Med J. 1971;(Suppl):66–67.

  3. Magon N, Seshiah V. Gestational diabetes mellitus: noninsulin management. Indian J Endocr Metab. 2011;15:284–93.

    Article  CAS  Google Scholar 

  4. Hernandez TL, Friedman JE, Van Pelt RE, et al. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Diabetes Care. 2011;34:1660–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Metzger BE, Lowe LP, Dyer AR, et al. HAPO study cooperative research group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.

    Article  PubMed  Google Scholar 

  6. Crowther CA, Hiller JE, Moss JR, et al. Australian Carbohydrate Intolerance Study in pregnant women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477–86.

    Article  CAS  PubMed  Google Scholar 

  7. Landon MB, Spong CY, Thom E, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339–48.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Langer O. Maternal glycemic criteria for insulin therapy in GDM. Diabetes Care. 1998;21(2):B91–8.

    PubMed  Google Scholar 

  9. Diagnosis and Management of GDM: Indian Guidelines. Association of Physicians of India. Medicine Update 2013; Vol 13: Chapter 55.

  10. Gestational diabetes mellitus. Practice Bulletin No. 137. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;122:406–16

    Google Scholar 

  11. Pertot T, Molyneaux L, Tan K, et al. Can common clinical parameters be used to identify patients who will need insulin treatment in gestational diabetes mellitus? Diabetes Care. 2011;34(10):2214–6.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Magon N, Chauhan M. Pregnancy in type 1 diabetes mellitus: how special are special issues? N Am J Med Sci. 2012;4:250–6.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Lambert K, Holt RI. The use of insulin analogues in pregnancy. Diabetes Obes Metab. 2013;15(10):888–900.

    Article  CAS  PubMed  Google Scholar 

  14. Durnwald CP. Insulin analogues in the treatment of gestational diabetes mellitus. Clin Obstet Gynecol. 2013;56(4):816–26.

    Article  PubMed  Google Scholar 

  15. Singh C, Jovanovic L. Insulin analogues in the treatment of diabetes in pregnancy. Obstet Gynecol Clin N Am. 2007;34:275–91.

    Article  Google Scholar 

  16. Mathiesen ER, Kinsley B, Amiel SA, et al. Maternal glycemic control and hypoglycemia in type 1 diabetic pregnancy: a randomized trial of insulin aspart versus human insulin in 322 pregnant women. Diabetes Care. 2007;30(4):771–6.

    Article  CAS  PubMed  Google Scholar 

  17. Zhou L, Fan L. Efficacy and safety of insulin aspart versus regular human insulin for women with gestational diabetes mellitus. Zhonghua Yi Xue Za Zhi. 2012;92(19):1334–6.

    PubMed  Google Scholar 

  18. Heller S, Damm P, Mersebach H, et al. Hypoglycemia in type 1 diabetic pregnancy: role of preconception insulin aspart treatment in a randomized study. Diabetes Care. 2010;33(3):473–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Lloyd A, Townsend C, Munro V, et al. Cost-effectiveness of insulin aspart compared to human insulin in pregnant women with type 1 diabetes in the UK. Curr Med Res Opin. 2009;25(3):599–605.

    Article  CAS  PubMed  Google Scholar 

  20. Hod M, Damm P, Kaaja R, et al. Fetal and perinatal outcomes in type 1 diabetes pregnancy: a randomized study comparing insulin aspart with human insulin in 322 subjects. Am J Obstet Gynecol. 2008;98(2):186e.1–7.

    Google Scholar 

  21. Pettitt DJ, Ospina P, Howard C, et al. Efficacy, safety and lack of immunogenicity of insulin aspart compared with regular human insulin for women with gestational diabetes mellitus. Diabet Med. 2007;24(10):1129–35.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Di Cianni G, Torlone E, Lencioni C, et al. Perinatal outcomes associated with the use of glargine during pregnancy. Diabet Med. 2008;25(8):993–6.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Pettitt DJ, Ospina P, Kolaczynski JW, et al. Comparison of an insulin analog, insulin aspart, and regular human insulin with no insulin in gestational diabetes mellitus. Diabetes Care. 2003;26(1):183–6.

    Article  CAS  PubMed  Google Scholar 

  24. Lindholm A, Jensen LB, Home PD, et al. Immune responses to insulin aspart and biphasic insulin aspart in people with type 1 and type 2 diabetes. Diabetes Care. 2002;25(5):876–82.

    Article  CAS  PubMed  Google Scholar 

  25. Durnwald CP, Landon MB. A comparison of lispro and regular insulin for the management of type 1 and type 2 diabetes in pregnancy. J Matern Fetal Neonataled. 2008;21(5):309–13.

    Article  CAS  Google Scholar 

  26. Colatrella A, Visalli N, Abbruzzese S, et al. Comparison of insulin lispro protamine suspension with NPH insulin in pregnant women with type 2 and gestational diabetes mellitus: maternal and perinatal outcomes. Int J Endocrinol. 2013; doi:10.1155/2013/151975.

    PubMed Central  PubMed  Google Scholar 

  27. Cypryk K, Sobczak M, Pertynska-Marczewska M, et al. Pregnancy complications and perinatal outcome in diabetic women treated with humalog (insulin lispro) or regular human insulin during pregnancy. Med Sci Monit. 2004;10(2):PI29–32.

    PubMed  Google Scholar 

  28. Persson B, Swahn ML, Hjertberg R, et al. Insulin lispro therapy in pregnancies complicated by type 1 diabetes mellitus. Diabetes Res Clin Pract. 2002;58(2):115–21.

    Article  CAS  PubMed  Google Scholar 

  29. Bhattacharyya A, Brown S, Hughes S, et al. Insulin lispro and regular insulin in pregnancy. QJM. 2001;94:255–60.

    Article  CAS  PubMed  Google Scholar 

  30. Jovanovic L, Ilic S, Pettitt DJ, et al. The metabolic and immunologic effects of insulin lispro in gestational diabetes. Diabet Care. 1999;22:1422–6.

    Article  CAS  Google Scholar 

  31. Price N, Bartlett C, Gillmer M. Use of insulin glargine during pregnancy: a case-control pilot study. Br J Obstet Gynecol. 2007;114(4):453–7.

    Article  CAS  Google Scholar 

  32. Lapolla A, Di Cianni G, Bruttomesso D, et al. Use of insulin detemir in pregnancy: a report on 10 Type 1 diabetic women. Diabet Med. 2009;26(11):1181–2.

    Article  CAS  PubMed  Google Scholar 

  33. Sciacca L, Marotta V, Insalaco F, et al. Use of insulin detemir during pregnancy. Nutr Metab Cardiovasc Dis. 2010;20(4):e15–6.

    Article  CAS  PubMed  Google Scholar 

  34. Hod M, Mathiesen ER, Jovanovič L, et al. A randomized trial comparing perinatal outcomes using insulin detemir or neutral protamine Hagedorn in type 1 diabetes. J Matern Fetal Neonatal Med. 2014;27(1):7–13.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Callesen NF, Damm J, Mathiesen JM, et al. Treatment with the long-acting insulin analogues detemir or glargine during pregnancy in women with type 1 diabetes: comparison of glycaemic control and pregnancy outcome. J Matern Fetal Neonatal Med. 2013;26(6):588–92.

    Article  CAS  PubMed  Google Scholar 

  36. Mathiesen ER, Hod M, Ivanisevic M, et al. Detemir in pregnancy study group maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. Diabetes Care. 2012;35(10):2012–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Shenoy VV, Cook SJ, Parry AF, et al. Audit of insulin detemir in pregnancy: a retrospective case series. Diabet Med. 2012;29(7):958–9.

    Article  CAS  PubMed  Google Scholar 

  38. Paes AH, Bakker A, Soe-Agnie CJ. Impact of dosage frequency on patients compliance. Diabete Care. 1997;20:1512–7.

    Article  CAS  Google Scholar 

  39. Balaji V, Balaji MS, Alexander C, et al. Premixed insulin aspart 30 (BIAsp 30) versus premixed human insulin 30 (BHI 30) in gestational diabetes mellitus: a randomized open-label controlled study. Gynecol Endocrinol. 2012;28(7):529–32.

    Article  CAS  PubMed  Google Scholar 

  40. Seshiah V, Balaji V. Insulin therapy during pregnancy. J Assoc Phys India. 2007;55(Suppl):44–6.

    Google Scholar 

  41. Magon N. Fetal origins of adult disease: the diabetic charkravyuh. AOGD Bulletin. 2013;13(3):11–4.

    Google Scholar 

  42. Magon N. Gestational diabetes mellitus: get, set, go. From diabetes capital of the world to diabetes care capital of the world. Indian J Endocr Metab. 2011;15:161–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Head, Department of Obstetrics & Gynecology, Air Force Hospital, Jorhat, Assam, India

    Navneet Magon (Obstetrician-Gynaecologist & Endoscopic Surgeon)

  2. Dr. V. Seshiah Diabetes Research Institute & Dr. Balaji Diabetes Care Centre, Chennai, Tamil Nadu, India

    Veerasamy Seshiah (Chairman DIPSI)

Authors
  1. Navneet Magon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Veerasamy Seshiah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Navneet Magon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Magon, N., Seshiah, V. Gestational Diabetes Mellitus: Insulinic Management. J Obstet Gynecol India 64, 82–90 (2014). https://doi.org/10.1007/s13224-014-0525-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-014-0525-4

Keywords

Search

Navigation