Insulin therapy in management of diabetes during pregnancy

Insulin is the mainstay of treatment for the pregnant mothers who are suffering from diabetes as all the other oral hypoglycemic agents are teratogenic. Research suggests that early intervention with insulin is superior to diet therapy alone.
Determine the choice of insulin and regimen based on the patient's individual glucose profile. Postprandial glucose levels become consistently above the target with diet therapy. When more than 20% of postprandial blood glucose levels exceed 130 mg/dl, administer lispro insulin (4-8 U SC initially) before meals. If more than 10 U of regular insulin is needed before the noon meal, adding 8-12 U of NPH insulin before breakfast helps achieve control. When more than 10% of fasting glucose levels exceeds 95 mg/dl, initiate 6-8 U NPH insulin.
Insulins
Insulin is essential in regulating carbohydrate, protein, and fat metabolism. Primarily affect carbohydrate homoeostasis by binding to specific cell-surface receptors on insulin-sensitive tissues (eg, liver, muscles, adipose tissue).When starting insulin consider following things;
1. Dose of the insulin: 0.5-1 U/kg/d SC in divided doses; base dose on IBW; titrate dose to maintain a premeal and bedtime glucose level of 80-110 mg/dl; combine short- and longer-acting insulin to maintain blood glucose within target.

2. Contraindications: Documented hypersensitivity; hypoglycemia


3. Interactions: Since most of the drugs are contraindicated during pregnancy, interactions are not a big problem. Medications that may decrease hypoglycemic effects include acetazolamide, AIDS antivirals, asparaginase, phenytoin, nicotine isoniazid, diltiazem, diuretics, corticosteroids, thiazide diuretics, thyroid estrogens. Medications that may increase hypoglycemic effects include calcium, ACE inhibitors, alcohol, tetracyclines, beta-blockers, lithium carbonate.