//fpnotebook.com/
Gestational Diabetes Insulin Management
Aka: Gestational Diabetes Insulin Management, Insulin Management in Pregnancy
- See Also
- Insulin Dosing
- Gestational Diabetes Insulin Management Intrapartum
- Indication
- Failed Gastational Diabetes Diet Management
- 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
- 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
- Protocol: Calculate Daily Insulin Dosing
- Insulin types
- Short acting: Regular or Lispro
- Long acting: NPH or Ultralente
- Note that Lantus and Levemir are not recommended due to lack of data in pregnancy
- Insulin per day (based on pre-pregnancy weight)
- Some providers use start of 0.7 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)
- Long acting Insulin or basal Insulin (e.g. Glargine/Lantus or Dememir/Levemir)
- Give 50% of total daily Insulin requirements in a single dose of long acting Insulin
- Short acting Insulin or Bolus Insulin (e.g. Lispro/Humalog or Aspart/Novolog)
- Give 50% of total daily Insulin requirements divided over 3 doses of short acting Insulin at meals
- 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
- References
- (2014) Diabetes Care 37(suppl 1): S14-80 [PubMed]
- (2013) Obstet Gynecol 122(2 pt 1): 406-16 [PubMed]
- Garrison (2015) Am Fam Physician 91(7): 460-7 [PubMed]