Insulin (Aspart / Isophane)

• Type 1 DM in pregnancy
• GDM not controlled on metformin
• DKA in pregnancy

Activates insulin receptor → glucose uptake (muscle/fat), ↓ hepatic glucose output, ↓ lipolysis & ketogenesis.

• Fasting <5.3 mmol/L
• 1 h post-meal <7.8 mmol/L
• 2 h post-meal <6.4 mmol/L
• Avoid <4 mmol/L (hypoglycaemia)

Basal-bolus

Individualised; needs ↑ ~50% by T3

Sliding scale (labour)

Variable rate IV insulin + 10% dextrose

DKA

0.1 units/kg/h IV after fluid resuscitation

• AbsoluteHypoglycaemia
• CautionDrop dose 50% immediately postpartum to pre-pregnancy levels

• Hypoglycaemia
• Weight gain
• Lipohypertrophy at injection sites

• • Does not cross placenta.
• • Tight glycaemic control reduces macrosomia, neonatal hypoglycaemia, stillbirth.

• Betamethasone (lung maturation)

  Caution

  Hyperglycaemia 24–72 h — ↑ insulin requirement

• Beta-blockers

  Caution

  Mask hypoglycaemia awareness

• 💡 Always co-prescribe glucagon for severe hypo.
• 💡 Pre-conception folic acid 5 mg + tight HbA1c <48 mmol/mol.