In the case that target blood glucose levels
cannot be achieved, insulin therapy should be
actively implemented. Although there are RCTsindicating that the oral antidiabetic, glyburide,
does not affect the fetus, its safety cannot be said
to have been established, and so as a rule treatment
is changed to insulin therapy. In the case
that a woman becomes pregnant while taking an
oral antidiabetic, it is explained to the patient
that there is no evidence that oral antidiabetics
increase the incidence of congenital malformations.
In the case of insulin therapy, due to the
need for strict blood glucose control, it is important
to keep blood insulin concentrations as close
as possible to physiological insulin secretion patterns.
That is to say, keeping in mind basal insulin
secretion and after-meals insulin secretion, intensive
insulin therapy is carried out by means of
multiple injections of intermediate-acting and
rapid-acting insulin or ultrarapid-acting insulin
analog.