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Am J Perinatol 1985; 2(4): 271-275
DOI: 10.1055/s-2007-999968
ORIGINAL ARTICLE

© 1985 by Thieme Medical Publishers, Inc.

Changes in Insulin Therapy During Pregnancy

William Rayburn1 , Evelyn Piehl1 , Eric Lewis2 , Anthony Schork3 , Susan Sereika3 , Karen Zabrensky1
  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Upjohn Center for Clinical Pharmacology, University of Michigan Medical Center, Ann Arbor, Michigan
  • 2Division of Endocrinology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
  • 3Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Publication History

Publication Date:
04 March 2008 (online)

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ABSTRACT

Care of the diabetic pregnant woman requires a proper understanding of anticipated changes in insulin therapy as a guide for establishing and maintaining strict glucose control. Changes in daily insulin doses were reviewed for 58 pregnancies of 50 insulin-dependent women who were followed for 26 ± 3 weeks (mean ± 1 SD) before delivery. By late gestation, insulin was administered on two or three occasions each day using a combination of regular-and intermediate-acting preparations in 55 (95%) pregnancies. Regardless of the metabolic control and duration of diabetes, averaged daily insulin requirements increased twofold from earlier in pregnancy. Following initial hospitalization, insulin requirements often decreased before increasing almost linearly between 2 and 9 months gestation. Fluctuations in insulin requirements were greatest during the last trimester. Insulin demand dropped precipitously after delivery and was two-thirds the averaged prepregnancy insulin dose or one-third the dose at 9 months gestation by the third postpartum day. The total average insulin dose was the same as that before pregnancy by the end of the first postpartum week. Explanations for these changes in prescribing insulin are described.

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