Endocrinology Book

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Gestational Diabetes Insulin Management

Aka: Gestational Diabetes Insulin Management, Insulin Management in Pregnancy
  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]

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