Insulin and pregnancy

Insulin and pregnancy

Department of Obstetrics and Gynaecology

Insulin

Subcutaneous	Onset (hr)	Peak (max.effect) (hr)	Duration (hr)
Regular	1	2-3	4-5
NPH	2	8	24

Regular Insulin Half-Lives: Intravenous regular insulin: 5 minute half-life

Intramuscular regular insulin: 2 hour half-life

Subcutaneous regular insulin: 4 hour half-life

If the desired level of blood sugar is not reached by diet, insulin should be added
Almost always use NPH and regular insulin in AM and PM
Usually need twice as much in AM than PM
Alternative regimen the evening dose is to administer regular insulin before dinner and NPH at bed time to avoid nocturnal hypoglycemia.
Some give regular insulin before meals and NPA at bedtime.
Some patients may require additional regular insulin before lunch to reach the goal of euglycemia state
2 weekly mild attacks of hypoglycemia are acceptable

Danish Recommendation:

4.0-6.0 mmol fasting
(3-6 before meals)
3-8 after meals
3,5-6 middle of the night
6-8 before bedtime

6-8 before bedtime
3.5-6 middle of the night

Outcome such as birthweight, correlates better with postprandial than preprandial glucose levels and correlates better to the level of HbA1C.

Sliding Scale Checking BSS every 2 hours, and give regular s.c. insulin, as below:

Blood sugar mmol/l	Action
6,6-8,0	02 IU Insulin Regular
8,1-10	04 IU Insulin Regular
10,1-12	06 IU Insulin Regular
12,1-14	08 IU Insulin Regular
14,1-15	10 IU Insulin Regular
>15	Call Physician especially if also ++ or +++ ketonuria

Steroids and Insulin: Insulin requirement is increased. The above algoritm can be used.