Gestational Diabetes Insulin Management

Aka: Gestational Diabetes Insulin Management, Insulin Management in Pregnancy

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II. Indication

  1. Failed Gastational Diabetes Diet Management

III. Protocol: Calculate Ideal Body Weight

  1. Start with 100 pounds + 5 pounds per inch over 5 feet
  2. Add 30 pounds for pregnancy
  3. Convert to Kilograms: Pounds / 2.2

IV. Protocol: Calculate Total Daily Calories

  1. Option 1
    1. Calories/day = Ideal Weight (in kg) x 35 KCal/kg
  2. Option 2 (if BMI > 30 kg/m2)
    1. Calories/day = actual weight (in kg) x 25 Kcal/kg

V. Protocol: Calculate Daily Insulin Dosing

  1. Insulin types
    1. Short acting: Regular or Lispro
    2. Long acting: NPH or Ultralente
      1. Note that Lantus and Levemir are not recommended due to lack of data in pregnancy
  2. Insulin per day (based on pre-pregnancy weight)
    1. Variable Insulin staring dose: 0.7 to 1.0 u/kg/day
    2. First half of pregnancy: 0.6 u/kg/day
    3. Second half of pregnancy: 0.9 u/kg/day
  3. Regimens (Divide Insulin Dosing over course of day)
    1. Lantus and Levemir regimens (standard)
      1. Long acting Insulin or Basal insulin (e.g. Glargine/Lantus or Dememir/Levemir)
        1. Give 50% of total daily Insulin requirements in a single dose of long acting Insulin
      2. Short acting Insulin or Bolus Insulin (e.g. Lispro/Humalog or Aspart/Novolog)
        1. Give 50% of total daily Insulin requirements divided over 3 doses of short acting Insulin at meals
    2. NPH Regimen (historical, older regimen and for those unable to afford other agents)
      1. Morning: 2/3 of Insulin
        1. NPH Insulin: 2/3
        2. Regular Insulin: 1/3
      2. Evening: 1/3 pf Insulin
        1. NPH Insulin: 1/2
        2. Regular Insulin: 1/2
  4. Reevaluate with Blood Glucose log every 3 to 14 days (depending on control)
    1. Adjust up to 10% of dose (typically in 2-3 unit increments) until <20% of Glucose values abnormal
    2. See Gestational Diabetes Management for Target Blood Sugars

VI. References

  1. (2014) Diabetes Care 37(suppl 1): S14-80 [PubMed]
  2. (2013) Obstet Gynecol 122(2 pt 1): 406-16 [PubMed]
  3. Garrison (2015) Am Fam Physician 91(7): 460-7 [PubMed]
  4. Will (2023) Am Fam Physician 108(3): 249-58 [PubMed]

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