Insulin in Pregnancy: Safety, Types, Dosage, and Side Effects

Pregnancy comes with many changes, and for women managing diabetes or developing gestational diabetes, keeping blood sugar levels under control becomes especially important. One of the most trusted and effective ways to manage blood glucose during pregnancy is insulin. However, many expectant mothers have questions about its safety, the different types available, the correct dosage, and whether insulin in pregnancy can cause any side effects for them or their baby.

The good news is that insulin has been widely used during pregnancy for decades and is considered a safe option for pregnant women with diabetes when prescribed and monitored by a healthcare professional. In this article, we’ll explore everything you need to know about insulin and pregnancy.

What Is Diabetes?

Diabetes is the abnormal elevation of blood sugar and glucose levels in a person. There are times when a person’s blood sugar is higher than normal, but not high enough to be considered diabetes. This is called ‘pre-diabetes’, and a person who has this is at a higher risk of developing Type 2 diabetes (1).

There are three types of diabetes as discussed below.

1. Type 1 and Type 2 Diabetes

If your body cannot produce enough insulin, you are considered to have Type 1 Diabetes (2).

Type 2 Diabetes is more common. In this case, the body does not use insulin well as it has developed resistance towards it.

2. Gestational Diabetes

When pregnant women are diagnosed with diabetes, it is known as gestational diabetes. This is not an uncommon phenomenon and occurs due to the hormonal changes that are part of pregnancy (3).

What Is Insulin?

Insulin is actually a hormone that helps glucose (which comes from the food we consume) to get into the cells and give them energy. Basically, it helps to regulate the use of glucose in our bodies and it is produced by the pancreas (4). Too much glucose in a person’s blood can result in nerve, eye, and kidney problems if left unchecked for a long time. There are times when it could result in a stroke, heart disease, or even produce the need to amputate a limb.

When Are You Recommended to Take an Insulin Shot During Pregnancy?

If your blood sugar still does not drop after a change in diet and exercise, then your doctor is more likely to prescribe insulin shots. These shots help to keep both mother and child healthy and safe, as they are meant to regulate the glucose levels in the blood. Here are the things that will need to be considered when prescribing insulin use in pregnancy:

• The stage of the pregnancy
• The mother’s weight
• The mother’s diet
• The results of the latest blood sugar level test

Insulin Changes in Pregnancy

Insulin requirements are constantly changing during the different stages of pregnancy. This is because of all the hormonal changes that your body goes through while your baby is growing. Be prepared for adjustments in your insulin doses as these are quite common and have been known to happen at least once a week.

Early Pregnancy

All the hormonal and physical changes that take place during early pregnancy make it quite difficult to keep the ideal blood glucose levels. Your glucose levels will be unstable for the first six to eight weeks of pregnancy, and then they start to decrease for the rest of the first trimester. This is when you are most likely to need to adjust your insulin intake (5). Be very sure not to miss any meals and snacks.

Mid to Late Pregnancy

As your pregnancy hormones rise, so does your need for more insulin. By 30 weeks, your requirements may be twice as much as your pre-pregnancy dose. You will most likely need fast-acting meal-time insulin. By 36 weeks, your insulin requirement is most likely to remain steady or drop just a little, but if you start to notice your requirement dropping a lot, you are most likely having problems, so do contact your doctor.

Which Types of Insulin are Safe During Pregnancy?

Several insulin types are considered safe and effective for managing blood sugar during pregnancy. Here are a few (6):

• Rapid-Acting Insulin: Rapid-acting insulins, such as insulin lispro and insulin aspart, start working quickly after injection. They are commonly used before meals to control post-meal blood sugar spikes and are generally considered safe during pregnancy.
• Short-Acting Insulin: Regular insulin is a short-acting insulin that has been used for many years in pregnant women. It helps manage blood glucose levels around mealtimes and has a well-established safety profile.
• Intermediate-Acting Insulin: Intermediate-acting insulin, such as NPH (Neutral Protamine Hagedorn) insulin, provides longer-lasting blood sugar control between meals and overnight. It is widely used during pregnancy and is considered safe when prescribed by a healthcare provider.
• Long-Acting Insulin: Certain long-acting insulins, including insulin detemir, may be recommended during pregnancy to provide stable blood sugar control throughout the day and night. Your doctor will determine whether this option is suitable for your specific needs.

Right Dosage of Insulin for Pregnant Women

When it comes to the dosage of insulin in pregnancy, you and your doctor will need to work together, as the need for insulin will change as the baby grows.

Your blood sugar will need to be checked several times a day so that it can be established whether or not the insulin you have been prescribed is working effectively. Your dosage will be adjusted according to blood sugar levels.

1. Type 1 Diabetes

• Your glucose will need to be checked before and after meals, before bedtime, and early in the morning.

• With an increase in the levels of progesterone, there is a need for more insulin.

• After the first month of pregnancy, the levels of progesterone increases until the placenta takes over for the ovaries when it comes to producing progesterone. This is at around 10 to 12 weeks.

• At around three months, the progesterone level falls, and the need for insulin also drop. During this time, pregnant women are monitored regularly, and a lower dosage of insulin is required.

• This lasts for around eight days, after which the levels of progesterone increases and results in an increase in the dosage of insulin.

2. Type 2 Diabetes

• Your carbohydrate intake will most likely need to be reduced as Type 2 Diabetes patients often have an intolerance to it.

• Regular monitoring will be required, and the dose of insulin required will be adjusted according to the results.

How to Take Insulin When Pregnant?

Insulin while pregnant is usually injected into the fatty tissue under the skin of your upper arms, thighs or stomach. Speak to your obstetrician about where the best place to take the shot is for you. Some doctors prescribe an insulin pen, which makes taking the shot so much easier, but you can also use disposable needles and syringes. Here is how to take the shot (7):

• Prepare the area you will be taking the shot with some alcohol.
• Pinch the skin and inject the insulin, slowly pushing down the plunger.
• Release the pinched skin and slowly remove the needle from your skin.
• Do not rub; instead, hold the site of the injection for a few seconds.

Things to Remember for Making Insulin Work Best for You

Things you can do to make your insulin shots more effective (8):

• Practice taking the shot beforehand and always ensure to have the correct amount of insulin. Be extra careful about this if you are taking two different kinds in the same syringe.
• Maintain a record of which insulin type you have used and how much.
• Do your best to take the shot at the same time every day and if you feel any discomfort, always contact your doctor immediately.
• Store your insulin properly so that it is effective every time.
• Don’t change your diet, insulin or exercise without first speaking to your doctor about it.

How to Monitor Blood Sugar Levels When Taking Insulin Shots?

As you will need to keep a constant eye on your blood sugar while to take your insulin shot, you will need a glucometer so that you can monitor your levels at home. Here is how you do it (9):

• There will be a sharp needle that comes with the glucometer. This is to be used to prick your fingertip to draw some blood.
• You will get some test strips as well so put a drop of blood on it and then put it in the glucometer.
• This process will take 15 seconds after which you will get the result.
• Remember to keep track of your readings so that you can show it to your doctor at your next visit.
• Dispose of the needle and the test strip.

How Much Insulin to Take During Pregnancy?

The dosage and timing of insulin are carefully adjusted based on your blood glucose readings, overall health, and stage of pregnancy. In general, doctors aim to maintain blood sugar within the following target ranges:

• Before meals: Less than 95 mg/dL
• 1 hour after meals: Less than 140 mg/dL
• 2 hours after meals: Less than 120 mg/dL
• Fasting blood sugar: Less than 92 mg/dL

Possible Side Effects of Taking Insulin in Pregnancy

Most of the time, insulin is prescribed during pregnancy only when blood sugar levels cannot be adequately controlled through diet, exercise, and lifestyle changes alone. While insulin is generally considered safe, it is important to be aware of potential insulin injection side effects during pregnancy and monitor your health closely throughout treatment.

One of the most common side effects is low blood sugar (hypoglycemia), which can occur if insulin doses are too high, meals are skipped, or physical activity levels change unexpectedly (10). If you regularly monitor your blood glucose levels, you can significantly reduce the risk of complications.

Some symptoms that may indicate low blood sugar or an allergic reaction include:

• Dizziness
• Shaking
• Sweating
• Racing heart
• Swelling of the face
• Tingling in the tongue and lips
• Puffiness in lips, tongue, and throat

Another possible side effect of taking insulin during pregnancy is the development of small lumps or thickened skin at the injection site. This can happen when injections are repeatedly given in the same area. Rotating injection sites regularly can help prevent this issue and improve insulin absorption.

FAQs

1. How often will I need insulin injections during pregnancy?

The number of daily injections varies from person to person. Some women may need insulin once or twice a day, while others may require multiple injections depending on their blood sugar levels and treatment plan.

2. What should I do if I miss an insulin dose?

If you miss a dose, contact your healthcare provider for advice. Do not take extra insulin without medical guidance, as this could lead to dangerously low blood sugar levels.

3. Will I need insulin after delivery?

Not always. Women with gestational diabetes often stop insulin treatment after giving birth because blood sugar levels usually return to normal. However, women with pre-existing diabetes may need to continue insulin therapy as advised by their doctor.

There are many women who have to battle diabetes during their pregnancies each year, and they end with favourable results, and they have happy and healthy babies. The key is managing the levels of glucose by eating balanced and healthy meals and keeping up with your exercise. It is important for you to keep track of your blood sugar at home and not only depend on hospital visits to do so.

Also Read: 

Hypoglycemia in Pregnancy
Diabetes and Getting Pregnant
Gestational Diabetes in Pregnancy
How does Gestational Diabetes affect Mother & Baby?

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Sources References

1. Cleveland Clinic – Diabetes

2. WHO – Diabetes

3. Cleveland Clinic – Gestational Diabetes

4. Cleveland Clinic – Insulin

5. PubMed Central – Insulin Use in Pregnancy: An Update

6. The University of Iowa – Insulin Use During Pregnancy

7. Tommy’s – Injecting insulin

8. Women and Newborn Health Service – Starting insulin in pregnancy

9. U.S. Food and Drug Administration – Blood Glucose Monitoring Devices

10. Tommy’s – Using insulin in pregnancy with type 1/2 diabetes