Insulin

Insulin is a hormone produced in the pancreas by cells in the islets of Langerhans called beta cells. Insulin’s main job is to lower blood sugar levels. When you eat, your body digests and metabolizes the food, which causes an elevation in your blood sugar levels. This triggers the beta cells to release insulin. The circulating insulin lowers blood sugar levels by facilitating the uptake of glucose into the cells, especially muscle cells.

Gestational diabetes occurs when hormones produced during pregnancy block the effects of insulin. This blocking effect creates a condition known as insulin resistance.

If diet alone for two weeks cannot control the blood sugar level, insulin is usually prescribed. There are three sources of insulin: beef, pork, and human. Human insulin is the preferred insulin to use. NPG insulin (intermediate-acting insulin) and regular insulin (short-acting insulin) are the preferred insulins during pregnancy.It is to be noted that insulin analogs (insulin lispro, aspartame, or glargine) have not been approved by the Food and Drug Administration for use in the treatment of gestational diabetes mellitus. Insulin should be stored in the refrigerator and protected from light.

The optimum goal for a woman with gestational diabetes is a blood glucose level of 105 milligrams per deciliter (mg/dL) [5.8 mmol/L] or less at fasting or 130 mg/dL (7.2 mmol/L) or less two hours after a meal. It is very important that you monitor the post-meal blood glucose since it correlates better than pre-meal blood glucose for a large baby.

Moreover, your doctor will probably adjust your insulin dose based on post-meal, not pre-meal blood glucose since it correlates best with diabetic complications for you and your baby. There is no set blood sugar level that requires beginning insulin injections. For instance, a doctor may suggest you begin insulin if your fasting sugar level exceeds 105 mg/dL (5.8 mmol/L) or if the level exceeds 130 mg/dL (7.2 mmol/L) two hours after a meal on several occasions. It is imperative that you keep excellent track of your blood glucose level by using a blood glucose monitoring kit.

If you need insulin, your doctor will work with you to calculate the amount of insulin needed to keep blood sugar levels within the normal range. The amount of insulin needed to keep your levels of blood sugar normal may increase as your pregnancy advances. Moreover, the dose of insulin may need to be adjusted during emotional or physical stresses such as fever, infection, trauma, travel or excessive exercise.This does not mean your gestational diabetes is getting worse.

Insulin is usually given as a ]]>subcutaneous injection]]> . This means that the needle goes into the fat layer between the skin and the muscle to deliver a certain amount of medicine. Your doctor will work with you to ensure you feel comfortable with and know how to give yourself the injection by rotating jnjeciton sites and proper handling and disposal of used syringes. Some women may even require two injections each day. The goal is to maintain normal blood sugar levels with whatever dosage of insulin is needed.

Insulin should be used with caution if you have either liver or kidney disease.

Injection Sites for Gestational Diabetes

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The main possible side effect of taking insulin is hypoglycemia (low blood sugar). Symptoms of hypoglycemia include:

• Shakiness
• Hunger
• Irritability
• Dizziness
• Fast heartbeat
• Headache

Drug Interactions

The following drugs may either enhance or blunt the effect of insulin:

• Hormones: ]]>testosterone]]> , ]]>progesterone]]> , ]]>estrogen]]> , corticosteroid, ]]>octreotide]]>
• Antyhypertensives: ACE inhibitors, beta blockers, ]]>diazoxide]]> , diuretics, ]]>nifedipine]]>
• Alcohol
• Monoamine oxidase inhibitors
• Fibrates (cholesterol-lowering drug)

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

• Take them as directed—not more, not less, not at a different time.
• Do not stop taking them without consulting your doctor.
• Don’t share them with anyone else.
• Know what effects and side effects to expect, and report them to your doctor.
• If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
• Plan ahead for refills so you don’t run out.

When to Contact Your Doctor

If you experience a serious complication to the medication, such as:

• Seizures or convulsions
• Unconsciousness
• Recurrent or extreme hypoglycemia

The American Diabetes Association and the American College of Obstetricians and Gynecologists do not recommend the use of ]]>glyburide]]> or any other antidiabetic drugs to treat patients with gestational diabetes.