DRUGS FOR

DIABETES IN
PREGNANCY

Made by –
Anushka Nigam
Management
Insulin therapy
• Drug of choice for treating diabetes in pregnancy is insulin.

When to start insulin ?

• When blood glucose levels are not reached by Medical nutrition

therapy or oral antidiabetic drugs.
Insulin injection:

• Subcutaneous route, 40 lU/ml vial, Human premix insulin (30:70) are used.

• Insulin should be stored in a refrigerator between 4-8°C (not in freezer).

• Insulin requirements increase throughout pregnancy,

1. 0.7 units/kg/day in 1st T,
2. 0.8 units/kg/day between 18-26 weeks,
3. 0.9 units/kg/day from 26-36 weeks
4. 1 units /kg/ day from 36 weeks to delievery.
Dose of Insulin :
• Starting dose is calculated as per the a hour post prandial blood
glucose level.

Blood glucose level ( 2 hr Dose of insulin

PP)

120-160 4U

160-200 6U

>=200 8U
Oral Antidiabetic drugs :
• OAD are more convenient, less expensive, do not require intensive
education.
• Among OADs,metformin a better choice then glyburide.

Indications –
• Pregnant women with gdm refuses to take insulin.
• Maybe used during 2nd and 3rd trimester instead of insulin if MNT fails.
Glyburide :

• 2nd gen long acting sulfonylurea.

• No difference in glycemic control between glyburide & insulin

treated group.

Side effects – Hypoglycemia, weight gain and Git upset

Metformin :

• Belongs to biguanide.

• Freely crosses placental barrier.

• No risk of hypoglycemia, hyperinsulinemia or weight gain.

• Side effect- Git disturbances, vit b12 malabsorbtion, metallic taste in

mouth.
Obstetrical management
• In uncomplicated cases, the patient is admitted at 34-36, weeks.

• Induction of labor :
1. Diabetic controlled women on insulin are considered for induction
of labor after 38 completed weeks.

2. Women with vascular complications (PE, eclampsia, IUGR) require

induction after 37 weeks.
Timing and mode of delievery –
Labor
• Women with GDM prone to preterm labor.
• Give antenatal steroids to mother for RDS if PTL between 24-34
weeks,with close monitoring of BG and insulin dose adjustment.
• Monitor BG 2 hourly in labor.
• Start IV infusion of normal saline, add regular insulin to keep
BG = 90-120mg/dl
Post Delievery follow up-
• Prophylaxis against infection. Insulin requirements drop rapidly after
delivery, performFBG and PPPG on 3rd post delivery day.

• Encourage & support breast feedingContraception.

• Check glycemic status by 75gm oral OGTT 6-12 weeks delivery. If

normal repeat at 6 months, then yearly.
Thank you