Insulin Glargine Use in Pregnancy

Guideline Recommendations

The American Diabetes Association guidelines note that all insulins are pregnancy category B except for glargine and glulisine, which are labeled category C, although this classification system has since been replaced 1, 2
The 2024 ADA guidelines emphasize that insulin is the preferred agent for management of type 1 and type 2 diabetes in pregnancy, with both multiple daily injections and insulin pump technology being reasonable delivery strategies 3, 4

The American Diabetes Association recommends aiming for the following targets when using insulin glargine: Fasting glucose 70-95 mg/dL, one-hour postprandial 110-140 mg/dL, two-hour postprandial 100-120 mg/dL, and A1C <6% if achievable without significant hypoglycemia 5, 6
Insulin requirements change dramatically throughout pregnancy, with decreases in the first trimester, exponential increases in the second trimester, doubling of requirements in the third trimester, and rapid drops postpartum 5, 7

Pregnant individuals with Type 1 diabetes have altered counter-regulatory responses that may decrease hypoglycemia awareness, making education about hypoglycemia prevention, recognition, and treatment essential 3, 4, 5, 7
Frequent blood glucose monitoring and insulin dose adjustments are necessary throughout pregnancy, and referral to a specialized center offering team-based care is recommended when available 5, 7
Low-dose aspirin (100-150 mg/day) should be prescribed starting at 12-16 weeks gestation to reduce preeclampsia risk 5, 7