Introduction

Insulin, is a type of natural hormone in the body that helps to regulate sugar level in the blood. Approximately 7% of women who are pregnant may develop a condition known as gestational diabetes mellitus (GDM) during their pregnancies. In these pregnant women who are having GDM, the placenta produces hormones that can impair the action of insulin. Hence, it causes high level of sugar in blood that may affect the unborn baby’s health. Subsequently, it may also increase the risk of fetal death during the last few weeks of pregnancy.

Some women may be at higher risk of getting GDM due to several reasons. For example, a woman with family history of diabetes or personal history of GDM have a higher chance to develop GDM during pregnancy. Females who are overweight with a body mass index (BMI) more than 30 kg/m2 or having glycosuria (presence of sugar in urine) may also have an increased risk of developing GDM.

Targets for Pregnant Woman

Woman who are pregnant should have a target sugar level as below:

Types of Antidiabetics for Pregnant Mothers With GDM

A pregnant mothers with GDM are advised to do self-monitoring of blood glucose. Lifestyle modifications such as eating healthy diet as according to each individual’s caloric requirement and doing moderate physical exercise to reduce excess weight are recommended.

If the blood sugar level is still not well-controlled, one may be prescribed with antidiabetic medications in in addition to lifestyle modifications. For pregnant mothers, the use of oral antidiabetics are not recommended due to safety concern.

Therefore, insulin therapy is the most suitable and safe option to control the blood sugar level. Insulin needs to be injected subcutaneously (under the skin). The type and dose of insulin is different for each individual depending on the blood sugar control of each patient.

Listed below are a few examples of insulin that may be used in the treatment of GDM :

Risks of Antidiabetics Medicine in Pregnant Mothers

By taking insulin injection as according to instruction, patient’s blood sugar level is expected to be maintained at normal range. However, pregnant mothers are at higher risk of experiencing side effects such as :

• Low blood sugar level (hypoglycemia)
• Headache
• Increase in appetite and weight
• Flu-like symptoms

Tips for Pregnant Mothers with Diabetes

• Avoid high-calorie snack or dessert especially those with obvious high sugar content, for example cake, ice-cream, candy, chocolate and others.
• Eat more servings of fruit and vegetable. However, reduce consumption of certain fruits that are sweet (examples are durian or banana) and vegetable that are starchy (examples are potato or yam).
• Although sugar intake should be reduced, consume adequate portion of carbohydrate to ensure sufficient energy for both mother and baby.
• Take insulin injection as instructed by doctor and pharmacist.
• Discuss with your pharmacist if you are not sure of the correct technique of injecting insulin.
• Be aware of signs of low blood sugar level such as dizziness, shakiness, excessive sweating, hunger, or confusion.

References

1. Micromedex
2. MIMS Gateway Service Portal
3. Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus by Ministry of Health Malaysia, 4th Edition, May 2009
4. Gestational Diabetes Mellitus (Diabetes Care by American Diabetes Association, Volume 26, Supplement 1, January 2003)
5. Mayoclinic : Gestational Diabetes (http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/definition/con-20014854)
6. WebMD : Types of insulin (http://www.webmd.com/diabetes/guide/diabetes-types-insulin)