145 units of insulin a day, is this dose of insulin too much?
A person without diabetes makes approximately 30 to 40 units of insulin a day. We usually think of the dose in terms of body weight and people with Type 1 diabetes (non-pregnant) use about 0.5 to 1.0 unit per kg of body weight, so about 35 to 70 units a day typically. If some one with type 1 diabetes becomes pregnant then the hormones from the placenta block how insulin works, they become insulin resistant and so need more insulin. The dose will often go up one and a half to two fold, ie if you were on 60 units a day pre pregnancy you could easily end up on 100 – 120 units a day.
In women with Type 2 diabetes they already have insulin resistance, their cells that do not respond well to insulin as they should. Pregnancy is a state of profound insulin resistance. Put the two of them together and sometimes hundreds of units of insulin will be needed to control the blood sugar. This is common with pregnant women who have type 2 diabetes and especially if they are overweight.
In women with gestational diabetes we find some need relatively small doses of insulin to control the blood sugar, 10 – 40 units a day but others are just more insulin resistant or their pancreas is really making less insulin and they may need 100 – 200 units a day.
We need to use enough insulin to control the blood sugar and not get too concerned about the dose. Metformin may help one get away with less insulin and dividing up the dose sometimes gets it to work more effectively.