Medication
Sometimes, healthy eating and physical activity alone are not enough to keep your blood glucose levels in the target range. Your doctor may suggest medication to help manage gestational diabetes.
Blood glucose levels in the target range help to lower the risk of health problems for you and your baby.
Medication for gestational diabetes
Insulin is often used to bring blood glucose levels into the target range. Insulin is given by injection. If insulin is needed, your doctor or diabetes educator will teach you how to give yourself an insulin injection.
Although most diabetes tablets are not suitable for use during pregnancy, a medication called metformin is sometimes used. Your doctor or diabetes educator will discuss whether this medication suits you.
Insulin
Insulin is given by injection using an insulin pen device (insulin pen). This device can deliver insulin at a push of a button.
The injected insulin will help lower your blood glucose level to within a range that is best for you and your baby’s growth and development. The insulin that you inject does not cross the placenta or affect your baby.
If you need insulin, your doctor or diabetes educator will teach you how to use the insulin pen and show you how and where to inject the insulin.
About 1 in every 3 of women with gestational diabetes will need to use insulin during pregnancy.
Starting insulin
Your doctor or diabetes health professional will give you information about your starting dose of insulin and timing of insulin injections.
They will continue to review your blood glucose levels and discuss with you any changes to your insulin doses that might be needed.
It is common for the insulin dose to be increased throughout the second half of pregnancy. This is due to placental hormones causing insulin resistance which can make blood glucose levels rise. Your insulin dose can continue to be increased until close to your delivery date.
You may feel worried or anxious about starting insulin. Getting used to a new treatment can take time, but your diabetes health professionals are here to help you.
Your health professional can help you with information about:
The type of insulin you need
Your insulin doses
How to give an injection
Where to inject
The equipment you need
How to store insulin
How to dispose of insulin pen needles (sharps)
What to do if you blood glucose levels drop too low
Insulin pens are easy to use and have extremely fine needles.
The injection of insulin will not harm your baby.
Low blood glucose levels
If you are taking insulin to manage your gestational diabetes, your blood glucose levels can drop too low (although this is not common).
A low blood glucose level is called hypoglycaemia or a hypo for short. This happens when your blood glucose levels drop below 4 mmol/L.
A hypo can be caused by:
- delaying or missing a meal
- not eating enough carbohydrate
- being more active than usual
- too much insulin.
Symptoms of a hypo may include:
- headache or dizziness
- trembling or shaking
- nausea
- weakness
- sweating.
If you are taking insulin to manage gestational diabetes and feel any of these symptoms, check your blood glucose level. If it is less than 4 mmol/L, treat the hypo. If you cannot check your blood glucose level, treat these symptoms as if you are having a hypo.
Hypos and staying safe
Hypos have not been shown to cause harm to the baby. But hypos can be a risk to your health, so treat hypos without delay.
Hypos can impact your ability to drive safely. If you are using insulin to manage gestational diabetes, discuss driving with your diabetes health professionals. They will review the type and doses of insulin you are using and discuss safe blood glucose targets for driving.
Always check your blood glucose before driving and carry your blood glucose monitor, hypo treatment and extra carbohydrate foods or drinks with you in case of a hypo. If you have a hypo while driving, pull over and treat the hypo immediately. It is not safe to drive if you are having a hypo (with or without symptoms).
Treating hypos
Treat hypos quickly to stop your blood glucose level from dropping even lower. To treat a hypo, have some fast-acting carbohydrates (carbs), for example:
- Glucose gel or glucose tablets equal to 15 grams (g) of carbohydrate OR
- 6–7 regular size jellybeans OR
- 3 teaspoons of sugar or honey OR
- ½ a glass (125 ml) of fruit juice OR
- ½ a can (150 ml) of regular soft drink (not ‘diet’ or ‘sugar free’ or ‘zero sugar’).
After treating a hypo, wait 10–15 minutes then recheck your blood glucose levels to make sure they are above 4 mmol/L. If symptoms continue, or if your blood glucose level is still below 4 mmol/L, repeat the treatment. If your next meal is more than 20 minutes away, you will need to have some long-acting carbs such as a piece of fruit, glass of milk or tub of yoghurt.
Myths and facts about insulin and gestational diabetes
Myths
Facts
- Insulin injections will harm my baby.
- The insulin that you inject works in the same way as the insulin made by your body. Insulin does not cross the placenta and does not harm your baby.
- Once I start insulin I will be on it forever.
- Women with gestational diabetes stop using insulin as soon as they have their baby.
- Insulin injections are painful.
- Insulin pens have extremely fine needles. The injection of insulin should not be painful.
- It is difficult to give yourself an insulin injection.
- It may take some time to get used to giving insulin injections, but insulin pens are easy to use. Your doctor or diabetes educator will teach you how to give an insulin injection.
- My insulin dose has increased so I must be doing something wrong.
- It is common for insulin doses to be increased as your pregnancy progresses. This is because hormones made by the placenta reduce how well insulin works (insulin resistance).
- Insulin injections are the only treatment option for gestational diabetes.
- Your doctor or diabetes educator will discuss the treatment options that may be suitable for you. This may include insulin injections or taking the tablet metformin.
- Needing insulin injections means I have not managed my gestational diabetes very well.
- Needing insulin just means that your body needs some extra help to keep your blood glucose levels in the target range.
- If I need insulin injections the diabetes will not go away after pregnancy.
- Diabetes will go away for most women, even if you have been using insulin.
- Insulin injections are expensive.
- Insulin pen needles are free to women with gestational diabetes registered with the National Diabetes Services Scheme (NDSS). Insulin is available on prescription from your pharmacy. You will need to pay the usual cost for a prescription. This will be the same as you pay for other medicines.
Metformin
Most diabetes tablets are not suitable for use during pregnancy, but a medication called metformin is sometimes used. Your doctor or diabetes educator will discuss whether this medication is suitable for you.
Starting Metformin
If your doctor recommends metformin, they will give you information about a starting dose and when to take it. You will need to continue to check your blood glucose levels, and your diabetes health professionals will continue to review your doses.Some women using metformin will also need insulin injections to keep blood glucose levels in the target range.
Common feelings about starting medication
When you find out that you need to start medication to manage gestational diabetes, it is common to feel many different emotions. Some women say they feel:
Concerned about what others might think
Disappointed not to manage gestational diabetes with healthy eating and exercising alone
Worried that their gestational diabetes is getting worse
Needing medication does not mean that you have failed in any way. It just means that your body needs some extra help to keep blood glucose levels in the target range.
Many women need medication to manage gestational diabetes and every woman’s experience with gestational diabetes and how it is managed will be different.
Getting support
- If starting medication is a concern for you, talk with your diabetes health professional. They will help you work out strategies for managing your worries and concerns.
Who can help you?
Managing gestational diabetes is a team effort, involving you, your partner, your family, and your health professionals. You can talk to your endocrinologist, diabetes educator or diabetes nurse practitioner, GP or dietitian for more information about medication to manage gestational diabetes.
For more information speak to your health professionals, go to ndss.com.au, or call the NDSS Helpline 1800 637 700 and ask to speak to a diabetes health professional.
