Memory Joggers: Obstetrics - Insulin Therapy During Labor
for Women with Diabetes Requiring Insulin
Goal:
Maintenance of blood glucose at 80-100 mg%
Before and During Delivery:
1. Blood glucose hourly, beginning with infusion. (Glucometer readings OK).
2. Begin infusion early AM on day of induction instead of usual insulin dose.
3. Calculation for insulin infusion:
- 50 units regular insulin in 500 ml normal saline (0.1 unit per ml)
- Calculate 3% of usual daily dose of insulin to give hourly. (Ex: If pt's usual insulin dose was 30 units NPH, 20 units regular each morning, and 20 units NPH, 10 units regular each evening, the total daily dose of insulin is 80 units. The hourly dose would be 80 X 3% = 2.4 units per hour; 2.4 units per hour would be delivered by 24 cc per hour of the insulin drip.)
- Calculate 6% of usual hourly dose of insulin. (Above example: hourly dose 80 units X 6% = 4.8 units or 48 cc per hour.)
4. Use the following table to determine IV infusions and insulin infusions:
|
Blood Glucose (Hourly)
|
IV Glucose |
IV Insulin Drip |
|
less than 60
|
D5LR 200 cc/hr |
None |
|
61-100
|
D5LR 100 cc/hr |
None |
|
101-140
|
LR 100 cc/hr |
None |
|
141-180
|
LR 100 cc/hr |
3% daily dose (ex. 24 cc/hr) |
|
more than 180
|
LR 100 cc/hr |
6% daily dose (ex. 48 cc/hr) |
Post-Delivery while NPO
1. Use sliding scale regular insulin, testing blood glucose every 6 hours.
If usual total daily insulin dose is 40 units or more,
use this scale |
|
Chemstrip
|
Insulin |
|
less than 60
|
None |
|
61-80
|
5 |
|
81-120
|
10 |
|
