Endocrinology Book

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Gestational Diabetes Insulin Management Intrapartum

Aka: Gestational Diabetes Insulin Management Intrapartum, Insulin Management in Labor
  1. Indication
    1. Gestational Diabetes Insulin Management in Labor
    2. Diet controlled Gestational Diabetes rarely warrants intrapartum Insulin management
  2. 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
  3. 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
  4. 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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