What are the indications for insulin therapy in patients with gestational diabetes?

The indications for insulin therapy in patients with gestational diabetes (GDM) are primarily based on blood glucose control and specific diagnostic levels NICE NG3.

• Insulin should be offered if blood glucose targets are not met with diet and exercise changes within 1 to 2 weeks, and metformin is either contraindicated or unacceptable to the woman NICE NG3.
• Insulin should also be offered if blood glucose targets are not met with diet and exercise changes in combination with metformin NICE NG3.
• For women diagnosed with gestational diabetes who have a fasting plasma glucose level of 7.0 mmol/litre or above at diagnosis, immediate treatment with insulin, with or without metformin, along with diet and exercise changes, should be offered NICE NG3.
• If a woman with gestational diabetes has a fasting plasma glucose level between 6.0 and 6.9 mmol/litre at diagnosis and presents with complications such as macrosomia or hydramnios, immediate treatment with insulin, with or without metformin, and diet and exercise changes, should be considered NICE NG3.

Rapid-acting insulin analogues (aspart and lispro) may be considered for pregnant women with diabetes due to their advantages over soluble human insulin during pregnancy NICE NG3.