# Gestational diabetes mellitus (primary care referral & supportive care) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ADA Standards of Care 2024 · GLUCOPHAGE 500 mg film-coated tablets GLUCOPHAGE 850 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 987) · Egyptian National Drug Formulary - Endocrine System 2024 (short-acting insulin (soluble, neutral, or regular) monograph, Dosage Regimen and Pregnancy), with the basal-plus-prandial split from Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt) · Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt) · Egyptian National Drug Formulary - Endocrine System 2024 (intermediate-acting insulin (NPH) monograph, Indications and Pregnancy), with the basal half of the total daily dose and the bedtime timing from Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt), and the 0.3 to 1.0 international units/kg/day requirement from the same formulary's short-acting insulin (soluble, neutral, or regular) monograph - Verified date: 2026-08 ## Verified against - GLUCOPHAGE 500 mg film-coated tablets GLUCOPHAGE 850 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 987) - Egyptian National Drug Formulary - Endocrine System 2024 (short-acting insulin (soluble, neutral, or regular) monograph, Dosage Regimen and Pregnancy), with the basal-plus-prandial split from Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt) - Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt) - Egyptian National Drug Formulary - Endocrine System 2024 (intermediate-acting insulin (NPH) monograph, Indications and Pregnancy), with the basal half of the total daily dose and the bedtime timing from Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt), and the 0.3 to 1.0 international units/kg/day requirement from the same formulary's short-acting insulin (soluble, neutral, or regular) monograph ## Treatment metadata - Insulin neutral human — injection - Metformin — 500 mg — oral.solid - Insulin isophane protamine human — injection ## Complete treatment card ```text GESTATIONAL DIABETES MELLITUS (PRIMARY CARE REFERRAL & SUPPORTIVE CARE) Sources: ADA Standards of Care 2024 · GLUCOPHAGE 500 mg film-coated tablets GLUCOPHAGE 850 mg film- coated tablets SmPC section 4.2 Posology and method of administration (eMC product 987) · Egyptian National Drug Formulary - Endocrine System 2024 (short-acting insulin (soluble, neutral, or regular) monograph, Dosage Regimen and Pregnancy), with the basal-plus-prandial split from Gestational diabetes mellitus - disease-level clinical article (gestational- diabetes-full.txt) · Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt) · Egyptian National Drug Formulary - Endocrine System 2024 (intermediate-acting insulin (NPH) monograph, Indications and Pregnancy), with the basal half of the total daily dose and the bedtime timing from Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt), and the 0.3 to 1.0 international units/kg/day requirement from the same formulary's short-acting insulin (soluble, neutral, or regular) monograph Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (1) - Early testing at the first prenatal visit is targeted at a BMI of 30 or more plus one risk factor such as prior GDM or elevated HbA1c SIGNS - what you find (1) - Excess weight gain, obesity, or a high BMI in pregnancy can be suggestive findings [obesity · weight gain] TESTS (8) - Universal screening is recommended for all pregnant patients between 24 and 28 weeks gestation - The one-step approach uses a single fasting 2-hour 75-gram oral glucose tolerance test - The two-step approach starts with a nonfasting 1-hour 50-gram glucose challenge test at a routine visit - About 20% fail the 50-gram screen and go on to a 3-hour fasting 100-gram confirmatory test - On the 3-hour 100-gram test, at least 2 abnormal values among fasting 95, 1 hour 180, 2 hour 155, and 3 hour 140 mg/dL confirm the diagnosis - At least 2 abnormal values out of the four on the 3-hour test are required to establish the diagnosis - Postpartum screening, ideally 4 to 12 weeks after delivery, is best done with a 75-gram 2-hour OGTT rather than fasting glucose alone - Postpartum fasting glucose above 125 mg/dL or a 2-hour value above 199 mg/dL indicates diabetes on follow-up testing IF NOT THIS - what else fits (2) - Undiagnosed pre-existing (pregestational) diabetes can be hard to distinguish from this when no pre-pregnancy screening was done - Maturity-onset diabetes of the young (MODY) can likewise be mistaken for it without prior screening Source StatPearls "Gestational Diabetes" - disease-level clinical article Status traced to the source above !! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them. !! the regimen: Insulin neutral human + Insulin isophane protamine human Rx: Glycaemic control when diet and exercise do not reach target | Basal insulin at bedtime - given WITH the mealtime regular insulin GLYCAEMIC CONTROL WHEN DIET AND EXERCISE DO NOT REACH TARGET - choose one 1. INSULIN NEUTRAL HUMAN [1 of 2 - GIVE ALL TOGETHER] Adult Individualised and titrated to glucose monitoring. The formulary's figure for the individual requirement is 0.3 to 1.0 international units/kg/day; the article divides the total daily dose in half, one half as basal insulin at bedtime and the other half split between the three meals as regular insulin before each. - Until delivery Peds Adult-only condition - paediatric section not applicable Choice Sourced preference. The condition's article puts insulin first-line on the ADA's recommendation, insulin not crossing the placenta to the fetus. On the oral alternative it records substantial treatment failure - 50% of patients ended up needing insulin anyway - and allows metformin as an alternative for the woman who refuses insulin or cannot afford it. Metformin is the alternative here, and cost makes it a real one in Cairo. Source Egyptian National Drug Formulary - Endocrine System 2024 (short-acting insulin (soluble, neutral, or regular) monograph, Dosage Regimen and Pregnancy), with the basal-plus- prandial split from Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt) Why Human regular insulin is what the Egyptian formulary itself names as the standard treatment for a pregnant patient with diabetes or with gestational diabetes, so the agent here is neither a guess nor glargine. The same short-acting monograph gives the requirement: usually 0.3 to 1.0 international units/kg/day for the individual patient. The indication is the article's too - insulin does not reach the fetus across the placenta, and the ADA recommends it first-line in gestational diabetes. Caution The dose is individualised by design, not for want of a source. The formulary's own note is that what one patient needs bears little relation to what another does, so the dose is adjusted as it goes, under close medical supervision. Regimen shape, from the article: a basal insulin and a short-acting one together. The basal dose is aimed at the fasting glucose; the glucose after meals is handled by moving the short-acting dose up or down. What each patient gets is worked out from her own glucose readings. The article's split: take the total daily insulin, give half of it as basal insulin at bedtime, and divide the other half across 3 meals, with a rapid-acting or regular insulin taken before each. The formulary sanctions the pairing: regular insulin may be given alone, or before a meal or snack alongside an intermediate- or long-acting insulin. Isophane (NPH) is the intermediate-acting basal insulin registered in Egypt and its monograph carries the same gestational-diabetes pregnancy sentence. CONTRAINDICATED, from the formulary: hypersensitivity to regular insulin, or to anything else in the preparation; and hypoglycaemia. Glucose targets in pregnancy are tighter than outside it - the article gives fasting under 95 mg/dL and 1-hour postprandial 140 mg/dL or less, or 120 mg/dL at 2 hours. Insulin initiation and titration in pregnancy is shared care with obstetrics; this card is primary-care support, not a substitute for antenatal review. Egypt HUMAN INSULIN R VACSERA-BIOTON 100I.U./ML VIAL VACSERA > BIOTON CO. LTD-... 31.00 EGP INSUMAN RAPID 100 I.U./ML 10ML VIAL SANOFI > FRANCO 55.00 EGP INSULIN H BIO R 100I.U.VIAL SEDICO 77.00 EGP ACTRAPID HM 100 I.U./ML 10 ML VIAL NOVO NORDISK 130.00 EGP INSUMAN RAPID 100 I.U./ML 5*3ML PENFILLS SANOFI > FRANCO 133.00 EGP HUMAXIN RAPID 100 I.U./ML 5*3ML PENFILLS EVA PHARMA 322.00 EGP ACTRAPID HM 100 I.U./ML 5*3ML PENFILLS NOVO NORDISK 338.00 EGP HUMULIN R 100 I.U./ML 5 CARTRIDGE ELI LILLY 338.00 EGP 2. METFORMIN [1st line] Adult 500 mg or 850 mg 2 or 3 times daily given during or after meals, titrated up to max 3 g daily in 3 divided doses - until delivery Peds Adult-only condition - paediatric section not applicable Source GLUCOPHAGE 500 mg film-coated tablets GLUCOPHAGE 850 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 987) Why Oral biguanide that lowers blood glucose mainly by reducing hepatic glucose production and improving insulin sensitivity; used as an initial oral option for gestational diabetes when lifestyle measures are insufficient, always under obstetric-endocrine supervision with insulin added if targets are not met. Caution Urgent specialist obstetric-endocrine co-management is mandatory. Initiate specialist insulin therapy if glycemic targets are not achieved with Metformin. Discontinue after delivery and re-test glycemic status at 6-13 weeks postpartum. The article makes this the alternative, not the first choice: it failed often enough to matter, with 50% of women ending up on insulin anyway. Metformin is worth considering instead of insulin for a woman who refuses insulin, or cannot pay for it. Metformin crosses the placenta; the article names preterm birth, maternal abdominal pain and diarrhoea among its effects. GI side effects are common; take with meals to minimize them. Egypt METFORMIN-EL NASR 500MG 200 TAB. EL NASR 26.00 EGP (0.13/unit) DIAPHAGE 500MG 20 TAB. PHAROPHARMA 4.00 EGP (0.20/unit) AMOPHAGE 500MG 30 TAB. AMOUN 10.50 EGP (0.35/unit) CIDOPHAGE 500 MG 10 TAB. CID 11.00 EGP (1.10/unit) GLUCOPHAGE 500 MG 50 F.C.TABS. MINA PHARM > ... 60.00 EGP (1.20/unit) KELVAMET MR 500 MG 30 TABS. BIOMED 54.00 EGP (1.80/unit) ANDOGLYCEMIC XR 500MG 30 EXT. REL. TABS. ANDALOUS PHARMA 24.00 EGP METIANORMIN 500 MG 30 EXT. REL. F.C.TABS. WADI ELNEEL BENTA 54.00 EGP BASAL INSULIN AT BEDTIME - GIVEN WITH THE MEALTIME REGULAR INSULIN 3. INSULIN ISOPHANE PROTAMINE HUMAN [2 of 2 - GIVE ALL TOGETHER] Adult Individualised and titrated to fasting glucose. Half of the total daily insulin dose, given at bedtime, with the other half split across the three meals as regular insulin. The formulary's figure for the individual requirement is 0.3 to 1.0 international units/kg/day. - Until delivery Peds Adult-only condition - paediatric section not applicable Source Egyptian National Drug Formulary - Endocrine System 2024 (intermediate-acting insulin (NPH) monograph, Indications and Pregnancy), with the basal half of the total daily dose and the bedtime timing from Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt), and the 0.3 to 1.0 international units/kg/day requirement from the same formulary's short-acting insulin (soluble, neutral, or regular) monograph Why The insulin regimen is basal plus prandial, and the article splits it: half the total daily dose as basal insulin at bedtime, the other half divided across 3 meals and given before each as rapid-acting or regular insulin. Isophane (NPH) is the intermediate- acting basal insulin registered in Egypt (10 products, from 31 EGP); the formulary indicates it for managing diabetes mellitus in adults and in paediatric patients who need a depot insulin of intermediate duration, its pregnancy section addresses gestational diabetes by name, and the short-acting monograph sanctions the pairing outright. The numbers are attributed on the row: the formulary's NPH monograph itself states no numeric dose, the 0.3 to 1.0 international units/kg/day is its short-acting monograph's figure for the individual insulin requirement, and the half-and-half split is the article's. Caution GIVEN WITH the mealtime regular insulin, not instead of it. The article's regimen pairs a basal insulin with a short-acting one: the basal dose answers the fasting glucose, and the glucose after meals is managed by adjusting the short-acting dose. The formulary's NPH monograph states NO numeric dose. All its dosing entry says is that insulin requirements differ enormously from patient to patient, so the dose is adjusted under close medical supervision. The figure given above, 0.3 to 1.0 international units/kg/day, is borrowed from the same formulary's short-acting insulin monograph, which puts the usual individual requirement in that band; the half-at-bedtime split is the article's. The formulary sanctions the pairing, in its short-acting insulin monograph: regular insulin may be given alone, or before a meal or snack alongside an intermediate- or long-acting insulin. What the formulary's NPH pregnancy section actually says - and note it names REGULAR insulin, not NPH: human regular insulin is still the standard treatment in pregnancy, whether the diabetes came first or arose with the pregnancy, and the woman is monitored closely throughout. NPH appears here as the basal partner the article asks for, not as the standard agent that sentence names. CONTRAINDICATED, from the formulary: hypersensitivity to insulin NPH, or to anything else in the preparation; and hypoglycaemia. Subcutaneous only: the formulary states that insulin NPH is NOT to be given intravenously or intramuscularly. Timing matters for the bedtime dose: it starts working inside 2 hours of the subcutaneous injection, and its effect is greatest somewhere in the 4-12 hour window - so the overnight peak is what carries the fasting glucose, and it is also where nocturnal hypoglycaemia happens. Switching insulin type or adding another antidiabetic: the formulary says to think about dropping the dose by 20% at the outset, to keep the risk of hypoglycaemia down, and then to adjust it to what the patient turns out to need. Insulin initiation and titration in pregnancy is shared care with obstetrics; this card is primary-care support, not a substitute for antenatal review. Egypt INSUNIL H NPH 100IU/ML VIAL. SEDICO > EL N... 31.00 EGP INSUMAN BASAL 100 I.U./ML 10ML VIAL SANOFI > FRANCO 55.00 EGP INSUMAN BASAL 100 I.U./ML 5*3ML PENFILLS SANOFI > FRANCO 133.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)