In some cases, a doctor may prescribe insulin to help manage gestational diabetes. However, other management methods and medications are available.

Gestational diabetes (GD) is when a person experiences a high blood sugar level during pregnancy. This typically occurs due to the body undergoing many changes throughout pregnancy, one of which being how the body processes the hormone insulin.

Insulin is responsible for regulating blood sugar. Due to GD, a person may develop insulin resistance. This refers to when the body uses insulin less effectively.

Although it is possible to manage GD with diet and lifestyle changes, some people may require medication such as insulin. However, for people who cannot afford or do not want to use insulin, a doctor may be able to recommend other treatment options.

In this article, we discuss whether a person requires insulin therapy to help manage GD.

A pregnant person-1.Share on Pinterest
timnewman/Getty Images

In many cases, a person can manage their blood sugar through diet only. However, if their blood sugar remains high, a doctor may recommend trying medication, such as insulin, to manage it.

A person can refuse any medical intervention that they do not want, including insulin. However, it is important to understand that high blood sugar can lead to complications for both the pregnant person and the fetus.

If a person does not wish to use insulin, other options are available. For example, a healthcare professional may suggest a combination of non-insulin agents, such as metformin, glyburide, and lifestyle changes.

Learn more about diabetes medications.

Healthcare professionals may recommend insulin treatment for GD based on individual circumstances. Their goal is to help the person maintain stable blood sugar.

In some cases, a person with GD may need insulin treatment. Examples of circumstances include the following.

Side effects of metformin

Metformin helps to treat high blood sugar. Doctors commonly prescribe it as tablets. If a person cannot take metformin or they experience side effects, a doctor may suggest insulin instead.

Learn about taking metformin during pregnancy.

Other treatments do not lower glucose

If a person’s blood sugar remains high despite dietary modifications, exercise, and other medications, a doctor may prescribe insulin. Insulin is typically more effective at lowering blood sugar and may be necessary when other methods do not produce the desired effects.

Severe hyperglycemia

If a person’s blood sugar is consistently very high or there is a risk of severe hyperglycemia, a healthcare professional may recommend insulin. This is to help prevent potential complications for both the pregnant person and the fetus.

Insulin doses vary, and a person should work with their healthcare team to determine the necessary dosage for their needs.

One approach to working out the units of insulin a person requires is by basing it on the pregnant person’s weight and gestational week:

  • First trimester: A person’s total daily insulin requirement may be 0.7 units per kilogram of weight per day (units/kg/day).
  • Second trimester: A person’s total daily insulin requirement may be 0.8 units/kg/day.
  • Third trimester: A person’s total daily insulin requirement may be 0.9–1.0 units/kg/day.

However, it is important that a person always follows the exact dosage a doctor prescribes for them. Never take a dose that a doctor has not specifically approved or prescribed.

Insulin is a naturally occurring hormone in the body. When a person uses it appropriately, and at the dosage recommended for them by a doctor, the potential risks of side effects in the fetus are generally minimal.

The benefit of insulin therapy typically outweighs the risk of taking it. However, as with most medications, there are a few side effects that may affect the fetus. They can include a lower birth weight and childhood weight and a higher risk of admission to a neonatal intensive care unit or admission to special care baby unit.

However, it is important to highlight that GD itself also increases the risk of these side effects.

Learn about delivery with GD.

Metformin and insulin are two common medications a doctor may prescribe a person to manage GD.

Metformin is an oral medication typically prescribed as tablets or capsules. It works by reducing glucose production in the liver, improving insulin sensitivity in the body, and helping to manage blood sugar.

Insulin is an injectable medication. When a person injects insulin, it helps the body to move sugar from the blood into other body tissues.

It is important to note that the choice between metformin and insulin for GD management depends on various factors, including individual circumstances, blood sugar, and the advice of a healthcare professional.

A person should discuss treatment decisions with their healthcare team, who can provide personalized recommendations.

A person can discuss the best ways to manage GD with their healthcare team. Aside from medication, other ways to manage GD include:

Balanced, nutritious meal plans

A person should collaborate with a dietician to create an eating plan that suits them and prioritizes well-balanced foods. The plan will provide guidance on which foods to consume, meal timings, and appropriate portion sizes.

Learn about what to eat with GD.

Regular physical exercise

Regular physical activity can enhance insulin sensitivity, thereby lowering blood sugar. Pregnancy-safe activities include brisk walking, swimming, prenatal yoga, and stationary cycling. Health experts typically advise aiming for at least 30 minutes of activity on most days of the week.

Read some exercise tips for pregnancy.

Regular monitoring of blood glucose

In certain instances, a healthcare professional may recommend the use of a glucose meter to monitor a person’s glucose level. Monitoring helps determine whether glucose is within the desired range. A person should discuss target glucose ranges with a healthcare professional.

Learn about blood sugar goals and GD.

In some cases, a person with GD may require insulin. For example, if their blood sugar remains high despite dietary changes, exercise, and oral medications.

A person has the right to refuse insulin or any medical intervention. However, high blood sugar can have GD management with their healthcare team.