Insulin therapy instructions:

The following notes include instructions about availiable insulin therapy choices during pregnancy. (They can be applied in both GDM and overt DM cases.)

About rapid-acting insulin:

• R 5.1c Suggest rapid acting analogs (lispro and aspart) be used in prefferance to regular insulin. (2+++)

About long-acting insulin:

• R 5.1a Suggest use of long acting analog, detemir, may be initiated during pregnancy if basal insulin is required and Neutral protamine Hagedorn (NPH) insulin resulted in or is thought that may result in problematic hypoglycemia. (2++++)
• R 5.1a Suggest use of long acting analog detemir may continue, if already successfully used before conception. (2++++)
• R 5.1b Suggest use of glargine may continue, if successfully used before pregnancy. (2++)

About continuous sc insulin infusion:

• R 5.1d Recommend use of continuous sc insulin infusion if  already initiated before pregnancy. (1+++)
• R 5.1d Suggest not to initiate continuous sc insulin infusion during pregnancy, unless other strategies, including multiple doses of insulin, have first been tried and proven unsuccessful. (2++)