II. Indication

  1. Gestational Diabetes Insulin Management in Labor
  2. Diet controlled Gestational Diabetes rarely warrants intrapartum Insulin management

III. Preparation

  1. Patient
    1. Use only 50% of long acting Insulin (e.g. Glargine/Lantus or Detemir/Levemir) on the day of delivery
  2. Insulin Drip
    1. Dilute 25 units Humulin Regular in 250 cc Normal Saline
    2. Coadminister maintenance fluids at 125 cc/hour

IV. Monitoring

  1. Intrapartum
    1. Fingerstick Blood Sugar every 1 to 2 hours
    2. Target Blood Sugars between 80 to 110 mg/dl
    3. Check Urine Ketones with each Void
  2. Postpartum
    1. Discontinue Insulin Drip
    2. Check Fingerstick Blood Sugar hourly for 2-4 hours
    3. Fingerstick Blood Sugar before meals and at bedtime
    4. Decrease monitoring to a Fasting morning Blood Sugar

V. Insulin Drip Protocol (based on Blood Sugar q1-2 hours)

  1. Blood Sugar <100 mg/dl
    1. Insulin Drip 0.5 units/hour in D5LR or D5NS
  2. Blood Sugar 100 to 140 mg/dl
    1. Insulin Drip 1.0 units/hour in NS
  3. Blood Sugar 141 to 180 mg/dl
    1. Insulin Drip 1.5 units/hour in NS
  4. Blood Sugar 181 to 220 mg/dl
    1. Insulin Drip 2.0 units/hour in NS
  5. Blood Sugar >220 mg/dl
    1. Insulin Drip 2.5 units/hour in NS

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