Treatment of Diabetes During Pregnancy
Although there is evidence that oral glyburide is safe in pregnancy, the current practice is
to have women control their diabetes with insulin when they are pregnant. If you have type 2 diabetes and you
are using oral agents for your diabetes, you will be switched over to insulin before you start trying to get
pregnant. Not all insulins, however, are approved for use during pregnancy. The fast-acting insulin analogs
insulin lispro and insulin aspart are safe. Currently, the only long-acting insulin used during pregnancy is
NPH. Recently, a small study of insulin glargine used in thirty-two pregnancies did not show any problems. There
is no information about using insulin detemir during pregnancy.
The goal of treatment is to get your HbA1c level into the normal range before you try to get
pregnant. The time it takes to do this varies, so you may want to plan at least three months to achieve this.
You may need to visit your diabetes team every two to three weeks during this time.
Once you have stable glucose levels in the target range, with a normal HbA1c, then you can try
to get pregnant. Once you are pregnant, your care will be transitioned to a specialty high-risk obstetrics
practice staffed by a team that consists of an obstetrician, a nutritionist, a diabetes educator, a nurse, and
an endocrinologist.
Your insulin doses will vary during the pregnancy due to the hormonal changes. At about nine
to twelve weeks you may need slightly less insulin, but then the insulin doses usually will go up until about
thirty-six weeks.
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