INS and gestational diabetes: Insulin has been recommended as the first-line treatment agent for GDM in the U.S (9) while in the UK, the National Institute for Health and Care Excellence (NICE) together with Scottish and Canadian guidelines recommends that metformin, an insulin sensitizer, which reduces hepatic gluconeogenesis, and increases peripheral glucose uptake (10), may be considered as initial pharmacological glucose lowering treatment in GDM women (11).