Insulin In Pregnancy: When To Take Insulin In Pregnancy

With diabetes being a major health problem in India, the incidence rate ranges between 4.6%–14% in urban areas and 1.7%–13.2% in rural areas. Diabetes is a common pancreatic condition where the pancreas is unable to make enough insulin or the body’s cells are not able to use insulin properly. The following blog will keep more focus on insulin in pregnancy. Insulin in pregnancy can also cause some serious issues like breathing problem in babies, premature birth, etc.

Insulin is an essential hormone produced by the pancreatic cells that help convert blood glucose into energy. People with diabetes will have high glucose in the blood or hyperglycemia as the glucose-absorbed cells build up in the blood, and lack of insulin affects its energy conversion. Based on the onset of this disorder, diabetes is classified into three types.

• Type 1 diabetes: This is an autoimmune disorder. Here the body’s immune system destroys the insulin-producing cells of the pancreas. This type of diabetes starts early in childhood. 
• Type 2 diabetes: This is not an autoimmune disorder. The pancreas does not produce enough insulin, causing a requirement of insulin in the body and a build-up of glucose in the blood. The onset of this disease is majorly in the later stages of life. 
• Gestational diabetes: This type of diabetes is seen during pregnancy when the glucose levels in the blood rise. This condition subsides after pregnancy and is seen in almost 5 to 8 million pregnant women in India annually. 

This article explores the reasons for causing diabetes during pregnancy, the safe time to take insulin in pregnancy, and the side effects of insulin in pregnant women.

1. Diabetes and Pregnancy

As mentioned earlier, there are three types of diabetes, namely:

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes

DIabetes, as a condition, does not interfere with pregnancy, and women can have Type 1 or type 2 diabetes before pregnancy. This condition is called pregestational diabetes. The other is the diabetic condition caused during pregnancy or gestational diabetes. 

Pregnancy changes the way the body converts glucose due to the various hormonal changes, including the rise of pregnancy hormones. The placenta, during pregnancy, makes pregnancy hormones and helps supply nutrients and oxygen to the growing baby. The elevated pregnancy hormones such as estrogen, cortisol, and human placental lactogen can block the cells from utilizing insulin, causing insulin resistance. 

Since the cells cannot utilize insulin, glucose conversion does not occur, and the blood glucose levels increase. Thus, leading to gestational diabetes or worsening of diabetes condition in women with pregestational diabetes. 

Women who are at risk of having diabetes during pregnancy include:

• Women who are overweight
• Women with type 1 or type 2 diabetes
• Women with gestational diabetes in their previous pregnancy
• Women with a family history of diabetes
• Pregnant women having multiple gestations 

For pregnant women with diabetes, the doctor may advise insulin to help cells mediate glucose conversion and improve their energy levels.

2. When to take insulin in pregnancy?

Treatment for diabetes during pregnancy depends on the gestational age, body weight, symptoms, and associated health conditions. Generally, The treatment focuses on keeping the blood glucose levels within the reference range and includes:

• Diet with low carbohydrates and low glycemic index foods,
• Regular exercising and walking,
• Regular Blood glucose monitoring,
• Oral medicines for hypoglycemia, 
• And Insulin injections. 

You may be advised insulin during pregnancy when diet, exercise, and medication could not help reduce the blood sugar levels to the normal levels:

• Fasting blood sugar <92 mg/dl
• 1 hr post meal< 140 mg/dl
• 2 hr post meal <120 mg/dl
• premeals<95 mg/dl

Pregnant women with type 2 diabetes taking oral medications will need to switch to insulin injections, as they can cross the placenta and affect the growing baby or pregnancy. 

Experts advise readily absorbable insulin injections of different types based on how fast they act, the peak time- the time when insulin is highest in the blood, and the length or duration of time insulin lowers blood glucose levels. 

1. Rapid-acting insulin: To be taken 10-15 minutes before meals. It works within 15 minutes and peaks in 1-2 hours. The effect of this type of insulin lasts for 3-4 hours. 
2. Short-acting insulin: Can be taken half hour before meals, as it works within 30 minutes. It can reach peaks in 2-3 hours, and the effect lasts for 3-6 hours.
3. Intermediate-acting insulin: This type covers the insulin needs between meals and can work within 2-4 hours. It reaches its peak in 4-12 hours, and its effect lasts for 12-18 hours.
4. Long-acting insulin: Usually taken within 15 to 30 minutes before meals. It works after 2-3 hours. However, the effect of this type of insulin lasts for 24 hours. 

It is important to note that the dosage and type of insulin decided by the diabetes specialist highly depends on your weight, gestation period, diet, and glucose profile.

3. What to watch out for when you are on insulin in pregnancy?

While you take insulin injections during pregnancy, it is essential to monitor the glucose levels regularly and not miss or delay taking the injections. 

It is safe to administer insulin injections during pregnancy. But should be careful of not missing or delaying insulin administration/ injecting excess insulin causes low sugar levels or hypoglycemia. 

You will need to look out for some of the common symptoms of hypoglycemia or low blood sugar level (<=70 mg/dl) during pregnancy that includes:

• Excess sweating
• Feeling low in energy
• Faintness or dizziness
• Feeling shaky
• Blurred vision
• Sudden palpitations
• Feeling hungry

You will also need to take care of the site of insulin injection. Avoid areas having bruises, infections, wounds, bumps, or a nodule. If you notice rashes, allergic reactions, or infection at the injection site, do not use the area until treated and healed.

4. How to reduce insulin injection side effects during pregnancy?

During pregnancy, be wary of signs of hypoglycemia. The quickest way to treat hypoglycemia or low sugar levels in pregnancy is to have a spoon of honey, raisins, sugar filled foods, glucose gel, drinks, or sugar-filled foods that can raise blood sugar levels quickly. 

Have a glucometer at home and monitor your glucose levels at least two to three times per day. Sometimes, you may need to check the glucose levels more often, depending on your glucose profile. 

For questions like how to take insulin in pregnancy, here are the steps to use an insulin pen in pregnancy.

• Wash your hands and keep your insulin pen, needle, and alcohol swabs handy.
• Clean the top of the pen with an alcohol swab before use.
• Open the needle, place it on top of the pen and uncover it. 
• Adjust the units and dosage in the pen and push the injection button.
• The pen is ready to use when you notice the insulin moving outwards.
• Clean the injection site with an alcohol swab.
• Inject the needle at a 90-degree angle and remove it after 5 to 10 seconds.

Some tips to safely inject insulin during pregnancy

• Change insulin sites to prevent soreness.
• Taking injections in the same place every time can cause hard lumps or soreness. Move an inch or two away from the previous injection site.
• Take insulin approximately at the same time every day.
• Check with your doctor if you are unwell or have any discomfort.
• Try not to alter your diet or exercise routine. If you want to do so, check with your doctor first. 
• Keep a vial of insulin handy at room temperature. 
• If you are using two types of insulin, ensure you are using the right type. 
• Dispose of the needle carefully and keep the sharp used needle separate from the rest of the waste. 
• Avoid skipping meals and use of too much insulin during pregnancy. Take meals on time and administer only prescribed recommended doses of insulin.

Take Away

Insulin is essential to keep up the energy levels and help convert the blood sugars into energy. Lack of insulin in the body leads to a condition called diabetes. Diabetes does not interfere with pregnancy, and a diabetic woman can get pregnant. However, elevated pregnancy hormones in pregnancy can worsen diabetes or lead to gestational diabetes. In such cases, insulin injections are highly recommended depending on the gestation age, glucose profile, and weight. 

Injecting insulin in pregnancy causes no major side effects. You will need to follow certain precautionary measures and take the precise type of insulin injection in pregnancy. At Hemi Soneja Clinic, you will get appropriate suggestions and care that can help you to prevent the possible insulin injection side effects. With 18+ years of experience, the best diabetologist in Delhi, Dr. Hemi Soneja, will guide you through a smooth pregnancy with diabetes.

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