South
Dakota
Gestational Diabetes Care Guidelines
Insulin Management
- Allow up to 1 week for blood glucose to improved to optimal levels in response to MNT before using insulin.
- Consider starting insulin if more than 2 elevated blood glucoses within 1 week (fasting and/or 2 hour postprandial). Example regimen 0.4 u/kg day based on current weight.
- Always use non-animal (minimally antigenic) insulin.
- Many patients with isolated elevated fasting blood sugars do well with neutral protamine hagedorn (NPH) (an intermediate-acting insulin) at bedtime.
- Patients with postprandial hyperglycemia can often be treated with a single injection of mixed insulin daily.
- Multiple injections may be required.
- Base insulin adjustments on home glucose monitoring results.
- The patient should report results of daily home glucose monitoring at least 2-3 times per week during the insulin initiation period and then at least once a week when normalized.
- Instruct patient to call physician or diabetes educator if there are 3 abnormal results between scheduled follow up visits.
- If patient is not achieving euglycemia within 2 weeks of start of insulin therapy, then she should consult with a physician with additional expertise in managing insulin in pregnant patients.
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