A 2026 study of 113 pregnant women with diabetes found that using subcutaneous insulin injections during labor successfully kept blood sugar levels close to target, with only 6-11% of mothers and 4-12% of newborns experiencing dangerously low blood sugar. According to Gram Research analysis, this diabetes management protocol—which combines IV glucose, adjusted insulin doses, and frequent blood sugar monitoring—appears safe and practical for managing diabetes during labor and delivery.
A new study looked at how to safely manage blood sugar in pregnant women with diabetes during labor and delivery. Researchers followed 113 women (85 with type 1 diabetes and 28 with type 2 diabetes) who used a special insulin management plan during labor. The plan involved giving glucose through an IV, adjusting insulin doses, and carefully monitoring blood sugar levels. The results showed that this approach kept blood sugar levels close to target, with very few cases of dangerously low blood sugar in either mothers or newborns. This research suggests that using subcutaneous (under-the-skin) insulin injections during labor is a safe and practical way to manage diabetes in pregnant women.
Key Statistics
A 2026 study of 113 pregnant women with diabetes (85 with type 1 and 28 with type 2) found that using subcutaneous insulin during labor kept average blood sugar at 5.9-7.1 mmol/L in type 1 diabetes and 5.6-5.8 mmol/L in type 2 diabetes, close to the target range of 4.0-7.0 mmol/L.
During active labor, only 6% of women with type 1 diabetes and 11% of women with type 2 diabetes experienced dangerously low blood sugar (below 3.9 mmol/L), according to the 2026 CopenFast trial analysis of 113 pregnant women.
In the 2026 study of 113 pregnant women with diabetes managed with subcutaneous insulin during labor, neonatal hypoglycemia occurred in only 12% of babies born to type 1 diabetic mothers and 4% of babies born to type 2 diabetic mothers.
A 2026 analysis of 113 pregnant women with diabetes found that supplemental insulin was needed in 35% of type 1 diabetic women and 18% of type 2 diabetic women during labor, showing the protocol’s flexibility in managing individual differences.
The Quick Take
- What they studied: Whether a specific insulin management plan works safely during labor and delivery for women with type 1 or type 2 diabetes
- Who participated: 113 pregnant women with diabetes (85 with type 1 diabetes and 28 with type 2 diabetes) who were having labor induced at a hospital
- Key finding: Using subcutaneous insulin injections during labor kept blood sugar levels close to target in most women, with only 6-11% experiencing dangerously low blood sugar and 4-12% of newborns experiencing low blood sugar
- What it means for you: If you have diabetes and are pregnant, this research suggests that doctors can safely manage your blood sugar during labor using insulin injections rather than more complex methods, reducing risks for both you and your baby
The Research Details
This was a secondary analysis of the CopenFast trial, meaning researchers looked at data that had already been collected from a larger study. They focused specifically on women with diabetes who were having their labor induced (started artificially with medication). The women followed a diabetes management protocol that started with their usual diet and insulin, then switched to a special plan once active labor began. During active labor, doctors aimed to keep blood sugar between 4.0-7.0 mmol/L (about 72-126 mg/dL), which is a safe range. Women received glucose through an IV at a rate of 3 grams per hour. Those using insulin pumps continued their basal (background) insulin, while those using multiple daily injections stopped their routine shots and only got insulin if needed. Blood sugar was monitored continuously in women with type 1 diabetes using special sensors, and hourly with finger-stick tests in women with type 2 diabetes.
This research approach is important because labor and delivery are stressful times when blood sugar can become unpredictable in women with diabetes. Having a clear, tested protocol helps doctors know exactly what to do to keep both mother and baby safe. The study design allowed researchers to evaluate a real-world approach that hospitals can actually use, rather than testing something theoretical in a lab.
This study included a reasonable number of participants (113 women) and used objective measurements like continuous glucose monitors and blood tests to track outcomes. The researchers looked at both maternal (mother) and neonatal (newborn) outcomes, which is important. However, this was a secondary analysis of existing data rather than a study designed specifically to test this protocol, which means some information might not have been collected as thoroughly as in a purpose-built study. The study was conducted at a single hospital system, so results may not apply everywhere.
What the Results Show
The diabetes management protocol successfully kept blood sugar levels close to target during labor. In women with type 1 diabetes, average blood sugar was 5.9 mmol/L (106 mg/dL) during the induction phase and 7.1 mmol/L (128 mg/dL) during active labor. In women with type 2 diabetes, average blood sugar was 5.6 mmol/L (101 mg/dL) during induction and 5.8 mmol/L (104 mg/dL) during active labor. These numbers are very close to the target range of 4.0-7.0 mmol/L that doctors were aiming for.
Dangerously low blood sugar (hypoglycemia) was uncommon in mothers. During active labor, only 6% of women with type 1 diabetes and 11% of women with type 2 diabetes experienced blood sugar below 3.9 mmol/L (70 mg/dL). This is important because severe low blood sugar can be dangerous during labor.
Newborn outcomes were also positive. Only 12% of babies born to mothers with type 1 diabetes and 4% of babies born to mothers with type 2 diabetes experienced low blood sugar after birth. This is a relatively low rate and suggests the protocol protects babies as well as mothers.
Supplemental insulin (extra insulin given when needed) was required in 35% of women with type 1 diabetes and 18% of women with type 2 diabetes, showing that the protocol was flexible enough to handle individual differences.
The glucose infusion (IV glucose) was given for a median of about 5 hours in both groups, which is a reasonable duration for labor and delivery. Women’s HbA1c levels (a measure of average blood sugar over 2-3 months) at 35 weeks of pregnancy were 6.0% in the type 1 diabetes group and 5.9% in the type 2 diabetes group, indicating good overall diabetes control before labor. The fact that the protocol worked well for both type 1 and type 2 diabetes suggests it’s broadly applicable to different types of diabetes.
Previous research has shown that maintaining tight blood sugar control during pregnancy and labor is important for both mother and baby health. This study builds on that knowledge by showing that subcutaneous insulin (injections under the skin) can achieve this control during the stressful period of labor and delivery. Some older approaches used intravenous insulin infusions, which require more complex equipment. This study suggests that simpler subcutaneous methods may work just as well, making diabetes management during labor more practical for hospitals.
This study was a secondary analysis, meaning it looked at data collected for another purpose, so some information may not be as complete as in a study designed specifically for this question. The study included only 113 women from one hospital system, so results may not apply to all hospitals or all populations. The study didn’t compare this protocol to other methods of managing diabetes during labor, so we can’t say definitively that this approach is better than alternatives. Additionally, the study didn’t follow babies long-term after birth, so we don’t know about outcomes beyond the immediate newborn period.
The Bottom Line
For pregnant women with type 1 or type 2 diabetes planning labor and delivery: Work with your diabetes care team and obstetric team to develop a clear diabetes management plan before labor begins. This research supports using subcutaneous insulin injections during labor as a safe approach. Discuss continuous glucose monitoring or frequent blood sugar checks during labor to catch any problems early. Confidence level: Moderate to High - this is based on a real-world study of 113 women with good outcomes.
This research is most relevant to: pregnant women with type 1 or type 2 diabetes, their doctors and nurses, and hospital staff managing labor and delivery. It’s particularly useful for hospitals developing protocols for diabetic pregnancies. Women with gestational diabetes (diabetes that develops during pregnancy) may also benefit from similar approaches, though this study didn’t specifically include them.
Blood sugar control during labor should improve immediately once the protocol is started - you should see better readings within hours. The benefits for your baby appear immediately after birth, with lower rates of newborn low blood sugar. Long-term benefits for both mother and baby depend on maintaining good diabetes control throughout pregnancy and after delivery.
Frequently Asked Questions
Is it safe to use insulin injections during labor if I have diabetes?
Research from a 2026 study of 113 pregnant women shows that subcutaneous insulin injections during labor are safe and effective. Only 6-11% of mothers experienced low blood sugar, and 4-12% of newborns had low blood sugar—both relatively low rates when blood sugar is carefully monitored.
What blood sugar level should I aim for during labor if I have diabetes?
According to the 2026 study, doctors should aim for blood sugar between 4.0-7.0 mmol/L (72-126 mg/dL) during active labor. This range balances safety for both mother and baby. The study showed this target was achieved in most women using the protocol.
Will my baby be at risk for low blood sugar after birth if I have diabetes?
The 2026 study found that when mothers’ blood sugar was carefully managed during labor using the protocol, only 4-12% of newborns experienced low blood sugar after birth. Close monitoring of your baby’s blood sugar in the first hours after birth helps catch and treat any problems quickly.
Do I need continuous glucose monitoring during labor, or can I use finger-stick tests?
The 2026 study used continuous glucose monitors for type 1 diabetes and hourly finger-stick blood tests for type 2 diabetes, and both approaches worked well. Talk with your doctor about which method is available and best for your situation during labor.
What happens to my insulin needs during labor and delivery?
According to the 2026 study, women using insulin pumps continued their background insulin, while those using multiple daily injections stopped routine shots during labor. About 35% of type 1 diabetic women and 18% of type 2 diabetic women needed extra supplemental insulin during active labor to keep blood sugar in target range.
Want to Apply This Research?
- If pregnant with diabetes: Track blood glucose readings every 1-2 hours during labor induction and active labor phases. Log insulin doses given (both routine and supplemental), glucose infusion duration, and any episodes of low blood sugar. Record neonatal blood sugar readings in the first hours after birth.
- Work with your healthcare team to pre-program your insulin pump settings for labor, or prepare a clear written plan for insulin injections during labor. Set phone reminders for blood sugar checks every hour during active labor. Create a checklist of supplies needed (glucose meter, test strips, insulin, IV supplies) and review it with your hospital team before labor begins.
- During labor: Check blood sugar hourly or use continuous monitoring if available. Track supplemental insulin doses and timing. After delivery: Monitor newborn blood sugar as directed by hospital staff. In the weeks after delivery: Continue tracking your own blood sugar and insulin needs, as they often change postpartum. Share all labor and delivery glucose data with your endocrinologist at your postpartum visit.
This research describes a specific diabetes management protocol used during labor and delivery. It is not medical advice. If you have diabetes and are pregnant or planning pregnancy, work closely with your obstetrician and endocrinologist to develop a personalized diabetes management plan. Blood sugar management during labor requires professional medical supervision. Do not change your diabetes medications or management without consulting your healthcare provider. This study was conducted at a single hospital and results may vary in different settings. Always follow your doctor’s specific recommendations for your individual situation.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.