II. Indication
- Failed Gastational Diabetes Diet Management
III. Protocol: Calculate Ideal Body Weight
- Start with 100 pounds + 5 pounds per inch over 5 feet
- Add 30 pounds for pregnancy
- Convert to Kilograms: Pounds / 2.2
IV. Protocol: Calculate Total Daily Calories
- Option 1
- Calories/day = Ideal Weight (in kg) x 35 KCal/kg
- Option 2 (if BMI > 30 kg/m2)
- Calories/day = actual weight (in kg) x 25 Kcal/kg
V. Protocol: Calculate Daily Insulin Dosing
- Insulin types
-
Insulin per day (based on pre-pregnancy weight)
- Variable Insulin staring dose: 0.7 to 1.0 u/kg/day
- First half of pregnancy: 0.6 u/kg/day
- Second half of pregnancy: 0.9 u/kg/day
- Regimens (Divide Insulin Dosing over course of day)
- Lantus and Levemir regimens (standard)
- NPH Regimen (historical, older regimen and for those unable to afford other agents)
- Morning: 2/3 of Insulin
- NPH Insulin: 2/3
- Regular Insulin: 1/3
- Evening: 1/3 pf Insulin
- NPH Insulin: 1/2
- Regular Insulin: 1/2
- Morning: 2/3 of Insulin
- Reevaluate with Blood Glucose log every 3 to 14 days (depending on control)
- Adjust up to 10% of dose (typically in 2-3 unit increments) until <20% of Glucose values abnormal
- See Gestational Diabetes Management for Target Blood Sugars