SC v IV Insulin Intrapartum

Historically, continuous intravenous (IV) insulin infusions were established as the standard of care for pregestational diabetes (Type 1 and Type 2 DM) during labor to prevent acute intrapartum hyperglycemia and minimize the risk of neonatal hypoglycemia. Intravenous insulin offers rapid titration, immediate onset, and a short half-life, allowing precise real-time glycemic control during the physiological stress and fluctuating metabolic demands of labor. Maintaining euglycemia intrapartum is emphasized because elevated maternal blood glucose levels cross the placenta, inducing fetal hyperinsulinemia, which acutely increases the risk of severe post-delivery neonatal hypoglycemia, which can be problematic. Although IV insulin protocols are widely used and are recommended in many practice guidelines, the evidence supporting their superiority over other approaches is limited. Subcutaneous (SC) insulin administration represents a potential alternative strategy to intrapartum glucose management. Continuation of SC insulin, including insulin pump therapy, has been studied most extensively among individuals with type 1 diabetes. However, evidence guiding intrapartum insulin management remains limited for patients with gestational or type 2 diabetes, who represent the majority of pregnancies complicated by diabetes. Institutional protocols frequently default to IV insulin despite limited comparative evidence with SC insulin and the increased workflow burden associated with infusion-based management. Now, a new retrospective study published in SMFM’s PREGANCY journal (25 July 2026; Seattle, Washington) is looking to give routine intrapartum SC insulin some validity. What did the data show? Listen in for details.

1. Savitsky, L.M., Barr, C., Katz, R., Martinez, N., Henderson, J., Saleh, T., White, L. and Simmons, L. (2026), Streamlining intrapartum glycemic control: Subcutaneous insulin for intrapartum diabetes management. Pregnancy, 2: e70371. https://doi.org/10.1002/pmf2.70371