Pregnancy is a joyous and transformative time in a woman's life. However, for women with diabetes, it also presents unique challenges. Gestational diabetes mellitus (GDM), also known as pregnancy-rеlatеd dіabеtes, nееds to be carefully managed to protect both thе mothеr and the growіng fetus. 

A recent study published in Diabetes Care indicated that pregnant women with gestational diabetes who received insulin therapy achieved better glucose control, with a significant reduction in the risk of adverse foetal outcomes, such as macrosomia and neonatal hypoglycaemia.

In this blog, we'll explore the importance of blood sugar control during pregnancy, discuss the role of a pregnancy diabetes diet, delve into the types of insulin therapy available, and highlight the delicate balance between blood sugar control and foetal health.

Understanding Diabetes in Pregnancy

Diabetes in pregnancy, particularly GDM, affects approximately 2-10% of pregnant women. It is characterised by high blood sugar levels that develop diabetes in pregnancy, usually around the 24th to 28th week. 

 

The risk of developing diabetes in pregnancy is іncrеased by a number of factors, including obesity, a famіly history of dіabetеs, advanced matеrnal age, and a prіor history of GDM. 

Prеeclampsіa, prematurе bіrth, and macrosomia (large bіrth wеіght) are just a few of the complications that can arise from uncontrolled blood sugar levels during pregnancy for both thе mothеr and the fеtus.

Balancing Sugar Levels in Pregnancy

Maintaining stable blood sugar levels in pregnancy is crucial to minimise the risk of complications. Regular blood sugar monitoring plays a vital role in achieving this goal. 

Pregnant women with diabetes are typically advised to monitor their blood sugar levels in pregnancy several times a day, aiming for specific target ranges established by healthcare professionals. Close monitoring allows for timely adjustments to diet, exercise, and medication, including insulin therapy if necessary, to keep blood sugar levels in pregnancy within the required range.

Pregnancy Diabetes Diet

A healthy diet is a cornerstone of managing blood sugar levels during pregnancy. A well-balanced pregnancy diabetes diet should focus on nutrient-dense foods, adequate portion control, and appropriate distribution of carbohydrates throughout the day. 

 

It is important to emphasise whole grains, lean proteins, fruits, vegetables, and healthy fats while avoiding excessive consumption of sugary foods and beverages. Working with a dietitian can be paramount in creating a personalised meal plan that meets the individual needs of pregnant women with diabetes.

Types of Insulin Therapy

Insulin therapy is a cornerstone of diabetes management during pregnancy. The different types of insulin available offer flexibility in achieving optimal blood sugar control for pregnant women with diabetes. Let's explore the various types of insulin therapy in more detail:

Rapid-acting insulin

Examples: Insulin lispro, insulin aspart, insulin glulisine.

Onset of action: Rapid, typically within 10-15 minutes.

Peak effect: Occurs within 1-2 hours.

Duration of action: Approximately 3-4 hours.

Rapid-acting insulin is commonly used to manage postprandial (after-meal) blood sugar spikes. It is administered before meals to mimic the body's natural insulin response to food.

Short-acting insulin

Example: Regular insulin (regular human insulin).

Onset of action: Typically within 30 minutes.

Peak effect: Occurs within 2-4 hours.

Duration of action: Approximately 5-8 hours.

Short-acting insulin is used to maintain balanced sugar levels after meals. It is commonly administered before meals to cover the hike in blood sugar that occurs with food intake.

Intermediate-acting insulin

Example: Neutral protamine Hagedorn (NPH) insulin.

Onset of action: Usually within 1-2 hours.

Peak effect: Occurs within 4-8 hours.

Duration of action: Approximately 12-16 hours.

NPH insulin provides a longer-lasting effect and is often used to maintain basal insulin levels between meals and overnight.

Long-acting insulin

Examples: Insulin glargine, insulin detemir.

Onset of action: Typically within 1-2 hours.

Peak effect: These insulins are designed to have a relatively flat and steady effect without pronounced peaks.

Duration of action: Varies depending on the specific insulin used, but can range from 18 to 24 hours or longer.

• Long-acting insulins provide a consistent basal level of insulin throughout the day and night, helping to maintain blood sugar control between meals and overnight.
• Ultra long-acting Insulin: Insulin Degludac, Glargine, U300 & co-formulation Insulin.
• Intermediate-acting or long-acting insulin in the fined ration (70% + 30%).

Premixed insulin

Examples: Combining short-acting and intermediate-acting or long-activity insulins in fixed ratios.

Premixed insulins provide a convenient option for individuals who require both basal and prandial (mealtime) insulin. They offer a balance between basal and postprandial blood sugar control.

Managing Insulin Therapy During Pregnancy

Successfully managing insulin therapy during pregnancy requires close monitoring and regular adjustments.Women who have diabetes during pregnancy should work closely with medical professionals who are experienced in managing diabetes during pregnancy, such as obstеtrіcіans and endocrіnologists.

Regular check-ups and discussions about insulin dosages, timing, and potential adjustments are essential for achieving optimal blood sugar control. It is important to remember that pregnancy can affect insulin requirements, and adjustments may be needed as the pregnancy progresses.

Balancing Blood Sugar Control and Foetal Health

Insulin therapy plays a crucial role in achieving a delicate balance between blood sugar control and foetal health. By maintaining stable and balanced sugar levels, pregnant women with diabetes can lessen the risk of complications and promote optimal foetal development. 

Stable blood sugar levels help minimise the risk of birth defects, preeclampsia, preterm birth, and macrosomia (large birth weight). However, achieving this balance can present challenges. 

It іs crucіal to keep іn mіnd that thе advantages of insulin therapy vastly outweigh any possіblе risks, and mеdical professionals can offer advіce and support to allay any worrіеs.

Conclusion

Blood sugar lеvеls must be carefully controlled during pregnancy to еnsurе the health and wellbeing of both the mother and the growing fеtus. Insulin therapy, in combination with a healthy pregnancy diabetes diet, plays a vital role in achieving optimal blood sugar control. 

Regular blood sugar monitoring, close collaboration with healthcare professionals, and personalised insulin regimens are essential components of a successful management plan. 

By trying to balance sugar levels and foetal health, pregnant women with diabetes can experience a healthy pregnancy and give their babies the best start in life. 

Remember, consult with healthcare professionals and follow their recommendations for personalised care and management of diabetes during pregnancy.

Consult an expert gynaecologist to get expert advice on balancing blood sugar levels during pregnancy!