Gestational Diabetes Insulin Management

1. See Also
   1. Insulin Dosing
   2. Gestational Diabetes Insulin Management Intrapartum
2. Indication
   1. Failed Gastational Diabetes Diet Management
3. 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
4. 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
5. 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. Some providers use start of 0.7 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
6. 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]