goto Indian Health Service home page  Indian Health Service:  The Federal Health Program for American Indians and Alaska Natives

 
IHS HOME ABOUT IHS SITE MAP HELP
goto Health and Human Services home page goto Health and Human Services home page

Diabetes in Pregnancy - Part 2 Management, Delivery and Postpartum

Contact Us

MCH Website Administrator

Required Plugins

These plug-ins
may be required
for the content
on this page:


Link to Adobe Acrobat Plug-in Acrobat
Link to MicroSoft Word Plug-in MS Word

IHS Plug-in Page

Use site contact
if unable to view
a particular file

Maternal Child

Maternal Child HealthPerinatologist Corner ‹ C.E.U./C.M.E. Modules

Perinatologist Corner - C.E.U/C.M.E. Modules

Diabetes In Pregnancy Series

Sponsored by The Indian Health Service Clinical Support Center

PART 2: Management, delivery, and postpartum

4. Insulin Therapy

Case continued

Ms Kanulie returns the following week and presents this glucose log (ranges reported for simplicity):

Day
FBS
breakfast
2-hr PPG
lunch
2-hr PPG
dinner
2-hr PPG
8-15
98-121
131-203
103-129
92-118

Insulin Therapy

Despite two weeks of MNT, the fasting and the post breakfast glucose values remain out of range, but the other post-prandial sugars are good. On the basis of the elevated fasting sugars one might again suspect that she may actually be a pre-gestational diabetic (“class B”). (See White Classification) Nevertheless, the interventions are essentially the same at this point.

You decide to start Ms Kanulie on split dose insulin. She is now classified as “GDM, class A-2”, no longer diet-controlled. How should you decide on an insulin dose for her? There are several ways to do this, and most will be successful in individuals who are not type I diabetics.

One way would be to administer a small dose of short acting (regular or lispro) insulin before each meal to control the post-prandial sugars, and a small dose of longer acting insulin (usually NPH) at bedtime to control the fasting glucose.

Another way would be to give NPH and regular insulin together twice a day, before breakfast and again before dinner. A third way would be to give lispro three times a day at each meal and give NPH twice a day, on arising and at bedtime.

Type I diabetics often need Ultralente insulin or one of the newer analogs, in order to provide them 24-hour basal insulinization. The short acting insulin should control the glucose excursions after eating, and the NPH should both smooth out the daytime control, and work during the night to result in a target range FBS.

The advantage of lispro is that it is conveniently given as the patient sits down to eat, not 30 minutes before the meal, as is appropriate for regular insulin. There can be some difficulty mixing Lispro and insulins from other manufacturers, but it is OK to mix Lispro with other insulins made by the same manufacturer.

3. Monitoring: glucose, renal, eye ‹ Previous | Next › 5. How to start Insulin Therapy

up arrow Return to top of page

This file last modified: Friday July 6, 2007  1:49 PM