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Gestational Diabetes Insulin Management Intrapartum
Aka: Gestational Diabetes Insulin Management Intrapartum, Insulin Management in Labor
- Indication
- Gestational Diabetes Insulin Management in Labor
- Diet controlled Gestational Diabetes rarely warrants intrapartum Insulin management
- Preparation
- Patient
- Use only 50% of long acting Insulin (e.g. Glargine/Lantus or Detemir/Levemir) on the day of delivery
- Insulin Drip
- Dilute 25 units Humulin Regular in 250 cc Normal Saline
- Coadminister maintenance fluids at 125 cc/hour
- Monitoring
- Intrapartum
- Fingerstick Blood Sugar every 1 to 2 hours
- Target Blood Sugars between 80 to 110 mg/dl
- Check Urine Ketones with each Void
- Postpartum
- Discontinue Insulin Drip
- Check Fingerstick Blood Sugar hourly for 2-4 hours
- Fingerstick Blood Sugar before meals and at bedtime
- Decrease monitoring to a Fasting morning Blood Sugar
-
Insulin Drip Protocol (based on Blood Sugar q1-2 hours)
- Blood Sugar <100 mg/dl
- Insulin Drip 0.5 units/hour in D5LR or D5NS
- Blood Sugar 100 to 140 mg/dl
- Insulin Drip 1.0 units/hour in NS
- Blood Sugar 141 to 180 mg/dl
- Insulin Drip 1.5 units/hour in NS
- Blood Sugar 181 to 220 mg/dl
- Insulin Drip 2.0 units/hour in NS
- Blood Sugar >220 mg/dl
- Insulin Drip 2.5 units/hour in NS