Using insulin in pregnancy with type 1/2 diabetes

Whatever treatment you were using to control your diabetes before you became pregnant may change. If you were using tablets, you may have to start using insulin.

Much of the business of managing your diabetes in pregnancy involves checking your blood glucose levels and adjusting your treatment regime accordingly.

For some women with diabetes, the need to change treatment during pregnancy can be frustrating, especially if you have maintained good control and are settled into the treatment you were using. Learning to inject or use a pump can feel like just another thing to do. But try to stay positive. Focus on the fact that this technology is available to help you keep your glucose at safe levels for your baby. Each day that passes takes you one day closer to your baby being born. After your baby is born, your diabetes will probably return to its original patterns.

'I think it is one of the hardest things I have had to do, both times, but you just kind of keep going. It’s like running a marathon. You know that you will eventually get to the end, and it does seem really tough at the beginning but you just get through it.' Prisha, mum of two

If you were already using insulin

Your team may change your doses or suggest that you try a regimen that is more effective. You may be using a syringe, a pen or a pump.

If you are new to insulin

Insulin only works if it is injected – so if you need to take it, then this will mean injecting. If you need to start giving yourself insulin injections, your diabetes team will show you how to inject yourself, what times you need to do it, how to keep your insulin and where to put the used needles. 

Many people do not like the idea of injecting, but try not to worry – injecting insulin is not like injections you may have had in the past. You will be using either a syringe or a pen, with a very fine needle. These are not usually painful, though they may feel worse if you are anxious. Once people learn to relax, they often find injecting very straightforward.

There are various types of insulin, ranging from rapid-acting insulin, which needs to be injected at mealtimes, to long-acting insulin, which is injected at the start or end of the day. Some fast-acting types take effect quickly, while others take longer. You may be given a combination of both – a long-acting insulin to last the day plus fast-acting to take before meals.

Read more about how to inject insulin

'Before I got pregnant I was on, say, seven units of insulin for breakfast, but now I'd gone up to 40 units. Throughout the pregnancy my insulin requirements were changing constantly.' Prisha, mum of two

Another option is pump therapy, which delivers regular doses over a number of days. This may be offered if insulin injections are not bringing your glucose levels under control.

Insulin pump therapy

  • An insulin pump is a small device that delivers regular doses of rapid-acting insulin into your body over a two-to-three day period. You can activate it by simply pressing a button on a handheld device that looks much like a mobile phone, so that you receive a continuous supply rather than fewer longer-acting doses. You can then have extra doses to cover you for meals and snacks. The insulin flows through a tiny, flexible tube called a cannula, which runs under the skin and is left in place through the day. The only injecting you need to do is to replace the cannula, two or three times a week.
  • Using a pump helps you be more flexible as you can eat when you want. It also helps you have tighter blood glucose control as you can select the right insulin dose in real time. You will get detailed training to understand what doe to select, based on how much carbohydrate you have eaten, and also make adjustments based on how much exercise you do.
  • There are a number of types of pump, with a range of features. Some include blood glucose meters.

'I just couldn’t get my control as tight as the team wanted. I had a couple of appointments where I was in tears. Then I met a dietician who said I was the ideal candidate for the pump. It was a lot of hard work, but it was the best thing I ever did.' Laura, mum of one

Hypoglycaemia

While you are pregnant, you will be at much higher risk of hypoglycaemia – especially in the early weeks. At the same time, you may not have your usual early warning signs (hypo unawareness), and the symptoms may be more severe than usual.

Depending on your experience of diabetes in the past, you may already be well practised in dealing with hypos, but you may find yourself getting them more often in pregnancy.

Read more about hypoglycaemia in pregnancy

Hyperglycaemia

Hyperglycaemia is what happens when your blood sugar levels get too high and is caused by the following:

  • eating more carbohydrate than your body can handle
  • missing a dose of your insulin or other diabetes medication or having a dose that is too small
  • being stressed or unwell – for example, if you have an infection or a high temperature
  • over-treat a hypo (see above).

Read more about hyperglycaemia

Diabetes and driving

If you are taking anything for your diabetes, you need to check the regulations with the DVLA because of the risk of having low blood glucose when driving.

In general, if you are treating your diabetes through diet or tablets alone and drive a car or motorcycle, you don’t need to tell the DVLA. If you drive larger vehicles or are treated by insulin, you may need to. Either way, make sure you tell your car insurer, or your insurance may be invalid.

Read more

Also in this section

More sections on type 1 or 2 diabetes in pregnancy

Sources

  1. Diabetes UK. Insulin pumps, http://www.diabetes.org.uk/Information-for-parents/Diabetes-care/Insulin...
  2. NICE (2015) Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period, NICE guideline, National Institute for Health and Care Excellence
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Last reviewed on September 1st, 2015. Next review date September 1st, 2017.

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