Managing Blood Sugar During Labor: What Women with Type 1 Diabetes Should Know

Pregnancy and labor are times when the body's insulin needs change rapidly. For women with Type 1 diabetes, managing blood sugar during the stress of labor and delivery is critical—both for the mother's wellbeing and for the baby's health. A new study looked at how an organized insulin protocol could help keep glucose levels stable during induced labor.

The research comes from the CopenFast trial and focused on women undergoing labor induction—a common medical procedure. Researchers wanted to understand which insulin approach works best when labor begins.

The diabetes management protocol used in this study had clear steps. Before active labor began, women continued their normal diet and insulin routines. Once active labor started, the target blood sugar range was set at 4.0–7.0 mmol/L (approximately 72–126 mg/dL). A steady glucose infusion (3 grams per hour) was given through an IV to provide a baseline carbohydrate source.

Insulin dosing depended on the type of therapy each woman was using. Women on insulin pumps (nonautomated systems) kept their basal insulin running as usual. Those taking multiple daily injections stopped their routine shots and received supplemental insulin only if their blood sugar rose above the target range.

To track glucose in real time, women with Type 1 diabetes used continuous glucose monitoring (CGM), while Type 2 diabetes patients had hourly finger-stick blood glucose checks.

The study included 113 women, 85 with Type 1 diabetes and 28 with Type 2 diabetes. Before delivery (at 35 weeks), women had good overall diabetes control with HbA1c levels around 6.0% for Type 1 diabetes.

During labor and delivery, the protocol achieved its goal: blood glucose stayed close to target levels. Women with Type 1 diabetes had mean sensor glucose readings of 5.9 mmol/L during labor induction and 7.1 mmol/L during active labor—both within or near the target range. Episodes of maternal low blood sugar were managed quickly when they occurred.

Importantly, both mothers and newborns had good health outcomes. The protocol balanced the need to prevent high blood sugar (which can stress the baby) while avoiding dangerously low levels (which can affect the mother).

This research provides evidence that a structured, individualized approach to insulin during labor—rather than a one-size-fits-all approach—can work well. The study shows the importance of real-time glucose monitoring (like CGM) and flexibility in insulin dosing based on what blood sugar actually does during active labor.

If you have Type 1 diabetes and are planning pregnancy or are pregnant, these findings suggest talking with your healthcare team about how insulin will be managed during labor. Every pregnancy is different, but this protocol offers a framework that other hospitals and providers may consider using.

The key message: careful planning, close monitoring, and timely insulin adjustments during labor can help achieve stable blood sugar for both mother and baby.

Source: Diabetes technology & therapeutics. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.