Gestational diabetes is a roller coaster ride from start to finish. There is a lot of information to navigate and often at a session with your diabetes educator you don’t know what questions to ask. So we pulled together an extensive list of questions about insulin for gestational diabetes. We wanted to highlight the positives and to bust the myths. We hope that after reading this you’ll feel more informed and less anxious about insulin treatment.
Written by Natasha Leader, Accredited Practising Dietitian & Credentialled Diabetes Educator
Do many women with GDM have to take insulin?
It tends to depend on your treatment centre and which timing and targets your health practitioners are using. For example you may be advised to check your blood glucose level at 1 hour or 2 hours after the meal. There may also be some variation in the target level of glucose that your doctor/diabetes educator uses i.e may be < 7.4 or 8.0 1hr or <6.7 or 7.0 for 2hr time point. The percentage of women who need insulin is usually between 20 and 60%.
Have I failed if I end up having to take insulin?
Absolutely not. The need for insulin is related to how much insulin your body is able to make and whether this is enough to process the amount of carbohydrate food you and baby need to stay well. In most cases it is not a reflection of the effort you are making with your diet.
Is the insulin going to harm my baby in any way?
Insulin will not harm your baby but high glucose levels may. Insulin is used because it only crosses the placenta in very small amounts (compared with oral agents) and therefore is considered the safest way to control your blood glucose levels if diet and exercise alone are not enough.
Are there any long-term effects from taking insulin?
No. Taking injected insulin is just increasing the total available amount of insulin (adds to what you are already secreting) in order to better process the carbohydrates you are eating.
Will my body get used to taking it and will I have to keep taking it after my baby is born?
No. Your body doesn’t get used to the insulin and it doesn’t affect the amount of insulin your body is still making. The majority of women who need insulin to manage their gestational diabetes will stop it at delivery or even perhaps a little before this. The need for insulin is related to the effect of the placental hormones, so once the placenta is delivered blood glucose control rapidly returns to normal for most women.
Do the needles hurt?
Insulin is injected with an extremely fine and short needle into fat tissue just under the skin. Compared to checking your blood glucose levels with fingerprick device (which is not pleasant) most women can’t believe once they try insulin that they can’t feel it as much as they anticipated. It is normal to be scared about ‘injections’ as most injections are felt – but remember those injections are needles going (deeper) into veins or muscle tissue. With insulin, you should use a new needle each time to ensure it remains super sharp. 4mm needles are the standard used these days. You will be shown how to use insulin and should have a practice go while you are with your healthcare professional.
Where do I inject the insulin?
Insulin is injected into your belly region. This is the preferred area as there is good fat coverage (even if you are slim) and it is not an area subject to variation in blood flow. If you were to inject into your leg then get up and walk around it may affect the action of the insulin, making it more unpredictable. Many women worry about the needle hurting the baby. The needle is not going to go near your baby- even towards the end of a pregnancy when you can feel a foot or elbow, the needle is going just below the skin. You have fat, then layers of muscle, then the uterine wall and amniotic fluid still below which keeps the baby quite some distance from the needle.
Isn’t there a non-injectable alternative to insulin?
No, not as yet. There is ongoing research into the possibility of inhaled insulin however there is considerable way to go with this before it might be a useful option.
Why can’t I take an oral medication instead of injecting insulin?
There are a couple of oral medications that are used by some doctors to manage glucose levels in pregnancy. These are Metformin and in the US Glibenclamide and Glyburide. Many doctors don’t feel comfortable using these as treatment options due to the potential risks to mother and/or baby for example hypoglycaemia in the baby or simply not knowing enough about the long term impact on the child (as these drugs cross the placenta in greater quantity). It is important to discuss use of any medication with your doctor.
What is insulin made from? Is it synthetic drug?
These days insulin is made synthetically from DNA material in the laboratory. It is very close in structure to human insulin and less likely to cause problems with allergy compared with when insulin was derived from animal sources.
How do I know if I’m taking the right amount? Can I overdose on insulin?
Your insulin doses are determined by reviewing your blood glucose levels. We base your insulin dose/s on the overall pattern of your results. Your results should be reviewed regularly and doses adjusted as needed. There is no ‘right amount’ in the sense that you should not worry if you are taking 30 units when your friend may only need 4 units. The right amount is the amount to keep your blood glucose level to target. Everyone’s body is different.
It is possible to take too much insulin and it is important that if you are using insulin that you keep your carbohydrate intake consistent. The difference between the injected insulin and your own is that the injected insulin can’t tell what you are eating or doing so if you eat less than usual but take your usual insulin dose, your blood glucose level may drop too low.
Likewise if you don’t usually do much activity after your meal but one day spend hours walking around the shops, you also may find you end up with a low blood glucose level. Low blood glucose levels are avoidable in most circumstances but I it is important you are taught about the causes and management for them should they occur.
If I’m taking insulin, does that mean I can go back to eating what I want, when I want? Won’t the insulin take care of my blood glucose levels for me?
If only! Insulin is an additional therapy on top of your diet and exercise. Unfortunately the placental hormones make it difficult to eat freely and merely ‘match’ your insulin dose to your carbohydrate intake. Keeping a consistent carbohydrate intake and activity level will make your diabetes much easier to manage.
Is it dangerous to exercise if I’m taking insulin? Can it bring on a hypo?
It isn’t dangerous to exercise but as exercise can reduce your blood glucose level it is important to be aware of the potential for a low blood glucose level (a hypo). It is useful to try and keep your activity regular or otherwise take any extra activity into account and perhaps discuss a lower insulin dose for those occasions. Eating a little extra carbohydrate to cover activity is also something you could discuss with your health care provider.
Do I have to wake up in the night to re-inject insulin?
No. Insulin is usually given at mealtimes (before you eat) or in the evening (ideally 930-10pm). You shouldn’t need to alter your routine in order to manage insulin. If you have a much earlier bedtime than 10pm then your doctor may prescribe a different form of insulin to ensure it is still working at the right time overnight to control your fasting glucose level.
What happens during labour if I’m on insulin?
For most women insulin is stopped for labour though it depends on the amounts and types being used. It is recommended that your treating doctor/educator discuss management for induction/caesarean section/ labour as doses may be continued or altered depending on current blood glucose level results.
Does taking insulin increase the chance of my baby being diabetic?
Taking insulin is not related to your baby’s risk of developing diabetes. In fact having GDM doesn’t mean your baby will get diabetes. However the fact that you’ve developed GDM means you are high risk of developing diabetes in the future and studies do show that if you need insulin while pregnant you are more likely to develop impaired glucose tolerance. This is not due to using insulin but rather the other way around i.e. there is more disturbance to your glucose levels hence you need insulin in the first place.
If I’m taking insulin this pregnancy, will I automatically have to take it if I get GDM again?
Every pregnancy is different and if there are modifiable risk factors for why you developed GDM that you address (such as losing excess weight) then you may even avoid developing GDM at all. However, if you do get GDM again it is not automatic that you will again need insulin just because you did the last time.
Have I damaged my pancreas and my body’s ability to naturally process the glucose in my blood? Will my body be able to function normally again even after the GDM has gone away?
No you definitely haven’t irreparably damaged your body. For most women gestational diabetes is a temporary form of diabetes and therefore the pancreas is not permanently damaged. In fact the pancreas is not damaged at all – it is the effect of the placental hormones on your muscle and liver cells causing insulin resistance that is the main problem in gestational diabetes. Around 80% of women will have normal glucose tolerance after a pregnancy. It is worth remembering that of the 20% where glucose tolerance does not return to normal some would have had undiagnosed diabetes or impaired glucose tolerance prior to their pregnancy.
Where do I get my needles and insulin? Is it expensive?
In Australia you will register with the NDSS when you are diagnosed with gestational diabetes. This will allow you to access a subsidised cost for your blood testing strips. If insulin is required your registration will be upgraded to state you need insulin. You then can access the supplies you need from your local diabetes friendly chemist. Insulin needles are free. For those holding valid Medicare registration, insulin is quite cheap! For the cost of 1 standard script (about $35) you will get 25 insulin devices!- often more than you will need the entire pregnancy. For those without Medicare in Australia you may be able to claim costs back from your private health insurer. For those of you in countries other than Australia please ask your doctor or diabetes educator for more information.
Is there anything I need to know about storing insulin?
Insulin should be kept refrigerated prior to your obtaining it. Once you are using your device it shouldn’t remain in the fridge, however the others you are not yet using should be kept in the fridge. Insulin should not be kept in hot places i.e. in the car or in direct sunlight etc.
Last updated October 2012.