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. 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

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window