Insulin Management in Pregnancy Complicated by Diabetes

Recommended Insulins

The American Diabetes Association recommends the use of insulin lispro and insulin aspart (both FDA Category B) as short-acting insulins, and insulin detemir (FDA Category B) and NPH insulin as long-acting insulins, for managing pregnancy complicated by diabetes 1
The American College of Obstetricians and Gynecologists suggests that insulin glargine can be considered acceptable despite limited data, for women who require long-acting insulin coverage 1

None of the currently available human insulin preparations cross the placenta, making them inherently safe for fetal exposure 1
Insulins studied in randomized controlled trials (lispro, aspart, detemir) are preferred over those studied only in cohort studies (glargine), which are preferred over those with only case reports 1

Both multiple daily injections and continuous subcutaneous insulin infusion are acceptable delivery strategies, with neither shown to be superior during pregnancy 1, 2

The primary advantage of analogues is reduced hypoglycemia risk, which is most relevant in type 1 diabetes with frequent severe hypoglycemia 3

The American Diabetes Association recommends calculating total daily insulin dose as 0.5 units/kg/day based on current body weight, divided as 50% basal and 50% prandial insulin distributed across meals 4
The total daily insulin dose should be divided into 50% as basal insulin and 50% as prandial insulin, with prandial insulin distributed across three meals 4

The initial total daily insulin dose can be calculated based on current body weight, with 0.5 units/kg/day being a commonly recommended starting point 4