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Gestational Diabetes Insulin Dosage

The Use Of Insulin Glargine With Gestational Diabetes Mellitus

The Use Of Insulin Glargine With Gestational Diabetes Mellitus

We agree with the recent letter by Woolderink et al. (1) that insulin glargine use during pregnancy may be appropriate. In contrast to that letter, which described the use of insulin glargine in pregnant women with type 1 diabetes, we detail the use of insulin glargine in four patients with gestational diabetes mellitus (GDM). Target blood glucose levels set by the American College of Obstetricians and Gynecologists for women with GDM include fasting glucose ≤95 mg/dl and 1-h postprandial glucose ≤130–140 mg/dl or 2-h postprandial glucose ≤120 mg/dl (2). These criteria are used by the Maternal-Fetal Medicine Clinic at Wake Forest University School of Medicine to determine the need for insulin. The four women whose treatment we describe here were referred to our clinic and delivered between 1 December 2003 and 31 March 2005. The decision to initiate insulin glargine in these patients was based on postprandial self-monitored blood glucose readings <150 mg/dl. All four maintained blood glucose values that, on average, met the American College of Obstetricians and Gynecologists’ criteria for the remainder of their pregnancies using insulin glargine alone. Two of four patients had average fasting blood glucose values ≤95 mg/dl; the other two maintained average fasting blood glucose values ≤98 mg/dl. Their starting doses of insulin glargine ranged from 10 to 50 units, with an average of 29 units. Doses at delivery ranged from 18 to 78 units, with an average of 44 units. For three patients with well-documented blood glucose values before initiating insulin glargine, the average reduction in fasting blood glucose was 15 mg/dl and the average postprandial decrease was 17 mg/dl. One patient experienced an average blood glucose reduction of 30 mg/dl, including reduct Continue reading >>

Current Management Of Gestational Diabetes Mellitus

Current Management Of Gestational Diabetes Mellitus

Current Management of Gestational Diabetes Mellitus Guido Menato; Simona Bo; Anna Signorile; Marie-Laure Gallo; Ilenia Cotrino; Chiara Botto Poala; Marco Massobrio Expert Rev of Obstet Gynecol.2008;3(1):73-91. Regular insulin, which is often used in pregnancy for the treatment of diabetes, has some drawbacks: it starts its action from 30 to 60 min after subcutaneous injection and it peaks too late (2-3 h after injection) to be very effective in postprandial control; in addition, it lasts too long (duration of 8-10 h), with an increased risk of postprandial hypoglycemia.[ 48 ] Insulin molecules clump in hexamers that must be broken up to dimers and monomers before absorption, so delaying their effectiveness. Therefore, in the last few years, insulin analogues started to be used to optimize glucose control during pregnancy. Insulin Lispro. The first rapidly acting analogue developed was approved for clinical use in 1996. It is obtained by inverting of the lysine at position 28 and the proline at position 29 on the -chain of the insulin molecule: it confers a conformational change that results in a quick dissociation of hexamers into monomers in subcutaneous tissue. Insulin lispro has a very rapid action, with a peak 1 h after subcutaneous injection, and a duration of 2-4 h.[ 49 ] There are various safety issues to consider: immunogenicity, teratogenicity and embryotoxicity, and retinopathy. Immunogenicity: placental passage of insulin occurs when it complexes with immunoglobulins and forms an antigen-antibody complex. The studies on the immunologic response to insulin lispro are reported in Table 2 . A successive in vitro perfusion study confirms the result of Boskovic.[ 50 ] Teratogenicity and embryotoxicity: studies on experimental animals have not shown any embryotoxi Continue reading >>

Myth-busting Insulin For Gestational Diabetes

Myth-busting Insulin For Gestational Diabetes

Gestational diabetes is a roller coaster ride from start to finish. There is a lot of information to navigate and often at a session with your diabetes educator you don’t know what questions to ask. So we pulled together an extensive list of questions about insulin for gestational diabetes. We wanted to highlight the positives and to bust the myths. We hope that after reading this you’ll feel more informed and less anxious about insulin treatment. Written by Natasha Leader, Accredited Practising Dietitian & Credentialled Diabetes Educator Do many women with GDM have to take insulin? It tends to depend on your treatment centre and which timing and targets your health practitioners are using. For example you may be advised to check your blood glucose level at 1 hour or 2 hours after the meal. There may also be some variation in the target level of glucose that your doctor/diabetes educator uses i.e may be < 7.4 or 8.0 1hr or <6.7 or 7.0 for 2hr time point. The percentage of women who need insulin is usually between 20 and 60%. Have I failed if I end up having to take insulin? Absolutely not. The need for insulin is related to how much insulin your body is able to make and whether this is enough to process the amount of carbohydrate food you and baby need to stay well. In most cases it is not a reflection of the effort you are making with your diet. Is the insulin going to harm my baby in any way? Insulin will not harm your baby but high glucose levels may. Insulin is used because it only crosses the placenta in very small amounts (compared with oral agents) and therefore is considered the safest way to control your blood glucose levels if diet and exercise alone are not enough. Are there any long-term effects from taking insulin? No. Taking injected insulin is just in Continue reading >>

Can I

Can I "cap Out" On Insulin?

I have gestational diabetes. I am 34 weeks pregnant and I am on approximately 108 units of insulin per day. My OB has expressed concern that I am on very high doses and that I could "cap out" on insulin, meaning that I could reach the maximum dose possible. Is this true? I thought that there was no max as long as my sugar is being controlled. — Karen, Massachusetts Your doctor might be referring to the balance that you should have between good glucose control and low nighttime glucose levels. Having said this, higher than 140 units per day of total insulin dose is not usually necessary to achieve this balance. I will first explain why insulin requirements increase during pregnancy. In normal pregnancy, there is a 50 percent decline in glucose metabolism due to the secretion of specific hormones from the placenta and the fetus. This translates into a higher insulin requirement, making the body produce 200 to 300 percent more insulin. The increase in fat cells, insulin resistance, and increased fat metabolism are all factors in the increase in insulin requirement. The insulin requirement is greater among diabetic women in general, and it is also larger in those whose glucose has not been well-controlled or who are obese, regardless of glucose control. Insulin dosage during pregnancy takes into account these factors as well as your weight, the amount of carbohydrates in your diet, and how much physical activity you are getting. While it is true that you can take higher insulin doses, there is a downside to taking large amounts of insulin during pregnancy. During the long fasting state that occurs each night during sleep, the baby in the uterus will continue to require glucose, as does the mother, so higher insulin doses increases the risk of hypoglycemia (low sugar level Continue reading >>

Insulin Therapy In Pregnant Women

Insulin Therapy In Pregnant Women

1. PDA ECHO: INSULIN THERAPY IN PREGNANT WOMENCynthia Halili-Manabat, M.D., PhDInternal MedicineOctober 2010 2. abstractgoal in pregnancy complicated by diabetes is to maintain maternal glucose levels as near normal as possible throughout the pregnancy because near normal glycemia has been shown to decrease the prevalence of neonatal hypoglycaemia, macrosomia, intra-uterine death and caesarean deliverysteps to achieve normal glucose during pregnancy include medical nutrition therapy and the additional of insulin, if goals are not met 3. abstractonly human NPH insulin, regular human insulin and the rapid acting insulin analogs, lispro and aspart, are approved for use during pregnancyLispro or Aspart is preferable to regular human insulinfifty percent of the insulin is given as a basal dose using NPH insulin and the other 50% as boluses before meals with lispro or aspart. 4. abstractthe total daily insulin dose may be computed based on the current weight of the patient and stage of pregnancy as follows: prepregnancy, 0.6 U/kg/dfirst trimester (wk 1-12), 0.7 U/kg/dsecond trimester (wk 13-28), 0.8 U/kg/dthird trimester (wk 29-34), 0.9 U/kg/dterm (wk 35-39), 1.0 U/kg/dthese doses are only starting doses and need to be adjusted based on results of home glucose monitoring 5. Fetal HyperinsulinemiaLGA or macrosomia are associated with birth trauma (shoulder dystocia)0.6-1.4% in fetuses weighing 2500-4000g5-9% in fetuses weighing >4000gAssociated with neonatal hypoglycemia after infant is delivered and no longer exposed to maternal hyperglycemia 6. Management of Hyperglycemia in PregnancyCGMSmean fasting glucose 75mg/dLpeak post-prandial glucose 110mg/dLMedical Nutrition TherapyWeight controlCarbohydrate restrictionFrequent self-monitoring of blood glucoseInsulin 7. When to Star Continue reading >>

Gestational Diabetes Mellitus

Gestational Diabetes Mellitus

From the Department of Internal Medicine, Endocrine Section, Taibah University Medical College, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia From the Department of Internal Medicine, Endocrine Section, Taibah University Medical College, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia Address correspondence and reprint request to: Dr. Eman M. Alfadhli, Department of Internal Medicine, Endocrine Section, Taibah University Medical College, Aljameat Road, PO Box 344, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia. Fax. +966 (14) 8443195. E-mail: [email protected] Author information Copyright and License information Disclaimer This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. It is associated with maternal and neonatal adverse outcomes. Maintaining adequate blood glucose levels in GDM reduces morbidity for both mother and baby. There is a lack of uniform strategies for screening and diagnosing GDM globally. This review covers the latest update in the diagnosis and management of GDM. The initial treatment of GDM consists of diet and exercise. If these measures fail to achieve glycemic goals, insulin should be initiated. Insulin analogs are more physiological than human insulin, and are associated with less risk of hypoglycemia, and may provide better glycemic control. Insulin lispro, aspart, and detemir are approved to be used in pregnancy. Insulin glargine is not approved in pregnancy, but the existing studies di Continue reading >>

Gestational Diabetes - I Need The Voices Of Experience Please!

Gestational Diabetes - I Need The Voices Of Experience Please!

Gestational Diabetes - I need the voices of experience please! New Member Gestational Diabetes since February 2007 Gestational Diabetes - I need the voices of experience please! Hi, My name is Angie & I am 7 months pregnant (25 Weeks) and was diagnosed a couple of months ago with gestational diabetes. I have been following the diet that the dietitian gave me & my sugars haven't been too bad, except for my after breakfast reading. My morning sugars are usually below 5.3 mmol/L < = 95 mg/dl>(at 8:00am), but when I have breakfast (which is really more like a snack consisting of 1 carb, 1/2 Cup skim milk & 1 protein - which usually translates to cereal, 1/2 cup of milk and walnuts) my blood sugar goes up to 9's & 10'smmol/L . I take 160 units of NovoRapid (fast acting) & 6 units of NPH (slow acting) before breakfast. My blood sugar drops very rapidly and I will have a low blood sugar (in the 2's & 3's mmol/L = 36 - 54 mg/dl) if I don't eat again by 10:00am - it has actually dropped to 1.7 mmol/L or 31 mg/dl while I was eating my snack. I don't do heavy exercise after breakfast, but I do make it a point not to sit around. We (diabetes clinic @ hospital & I) have tried many different things to get the morning number down, as well as lessen the amount of rapid insulin I seem to need in the morning, but nothing seems to work. I have tried eating different things in smaller and smaller amounts, getting up at different times, using longer needles, injecting in more than one site... If anyone has any suggestions, I would love to hear them since I am out of ideas, and unfortunately, the diabetes clinic seems to be as well (don't get me wrong, though, they have been great!) I still have another 15 weeks of pregnancy left to go (my due date is August 20) and Continue reading >>

Management Of Gestational Diabetes Mellitus

Management Of Gestational Diabetes Mellitus

Gestational diabetes mellitus is a common but controversial disorder. While no large randomized controlled trials show that screening for and treating gestational diabetes affect perinatal outcomes, multiple studies have documented an increase in adverse pregnancy outcomes in patients with the disorder. Data on perinatal mortality, however, are inconsistent. In some prospective studies, treatment of gestational diabetes has resulted in a decrease in shoulder dystocia (a frequently discussed perinatal outcome), but cesarean delivery has not been shown to reduce perinatal morbidity. Patients diagnosed with gestational diabetes should monitor their blood glucose levels, exercise, and undergo nutrition counseling for the purpose of maintaining normoglycemia. The commonly accepted treatment goal is to maintain a fasting capillary blood glucose level of less than 95 to 105 mg per dL (5.3 to 5.8 mmol per L); the ambiguity (i.e., the range) is due to imperfect data. The postprandial treatment goal should be a capillary blood glucose level of less than 140 mg per dL (7.8 mmol per L) at one hour and less than 120 mg per dL (6.7 mmol per L) at two hours. Patients not meeting these goals with dietary changes alone should begin insulin therapy. In patients with well-controlled diabetes, there is no need to pursue delivery before 40 weeks of gestation. In patients who require insulin or have other comorbid conditions, it is appropriate to begin antenatal screening with nonstress tests and an amniotic fluid index at 32 weeks of gestation. Screening for gestational diabetes mellitus is widely practiced despite lack of evidence that it prevents adverse perinatal outcomes. Although the disorder affects approximately 2.5 percent of pregnant women1 and has been the subject of extensive res Continue reading >>

Patient Education: Gestational Diabetes Mellitus (beyond The Basics)

Patient Education: Gestational Diabetes Mellitus (beyond The Basics)

INTRODUCTION Insulin is a hormone whose job is to enable glucose (sugar) in the bloodstream to enter the cells of the body, where sugar is the source of energy. All fetuses (babies) and placentas (afterbirths) produce hormones that make the mother resistant to her own insulin. Most pregnant women produce more insulin to compensate and keep their blood sugar level normal. Some pregnant women cannot produce enough extra insulin and their blood sugar level rises, a condition called gestational diabetes. Gestational diabetes affects between 5 and 18 percent of women during pregnancy, and usually goes away after delivery. It is important to recognize and treat gestational diabetes to minimize the risk of complications to mother and baby. In addition, it is important for women with a history of gestational diabetes to be tested for diabetes after pregnancy because of an increased risk of developing type 2 diabetes in the years following delivery. More detailed information about gestational diabetes is available by subscription. (See "Diabetes mellitus in pregnancy: Screening and diagnosis".) GESTATIONAL DIABETES TESTING We recommend that all pregnant women be tested for gestational diabetes. Identifying and treating gestational diabetes can reduce the risk of pregnancy complications. (See "Diabetes mellitus in pregnancy: Screening and diagnosis".) Complications of gestational diabetes can include: Having a large baby (weighing more than 9 lbs or 4.1 kg), which can increase the risk of injury to the mother or baby during delivery and increase the chance of needing a cesarean section. Stillbirth (a baby who dies before being born), a complication which fortunately is now rare in women with gestational diabetes because of good control of blood sugars and careful monitoring of mo Continue reading >>

Gestational Diabetes Insulin Management

Gestational Diabetes Insulin Management

Failed Gastational Diabetes Diet Management III. Protocol: Calculate Ideal Body Weight Start with 100 pounds + 5 pounds per inch over 5 feet IV. Protocol: Calculate Total Daily Calories Calories/day = Ideal Weight (in kg) x 35 KCal/kg Calories/day = actual weight (in kg) x 25 Kcal/kg V. Protocol: Calculate Daily Insulin Dosing Note that Lantus and Levemir are not recommended due to lack of data in pregnancy Insulin per day (based on pre-pregnancy weight) Regimens (Divide Insulin Dosing over course of day) Long acting Insulin or basal Insulin (e.g. Glargine / Lantus or Dememir/ Levemir ) Give 50% of total daily Insulin requirements in a single dose of long acting Insulin Give 50% of total daily Insulin requirements divided over 3 doses of short acting Insulin at meals NPH Regimen (historical, older regimen and for those unable to afford other agents) Garrison (2015) Am Fam Physician 91(7): 460-7 [PubMed] Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Gestational Diabetes Insulin Management." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6546 interlinked topic pages divided into a tree of 31 specialty books and 722 chapters. Content is updated monthly with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by S Continue reading >>

Calculating Insulin Dose

Calculating Insulin Dose

You'll need to calculate some of your insulin doses. You'll also need to know some basic things about insulin. For example, 40-50% of the total daily insulin dose is to replace insulin overnight. Your provider will prescribe an insulin dose regimen for you; however, you still need to calculate some of your insulin doses. Your insulin dose regimen provides formulas that allow you to calculate how much bolus insulin to take at meals and snacks, or to correct high blood sugars. In this section, you will find: First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement. The basal or background insulin dose usually is constant from day to day. The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. This is called the bolus insulin replacement. Bolus – Carbohydrate coverage The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio. The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin. Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 6-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress. Bolus – High blood sugar correction (also known as insulin sensitivity factor) The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Generally, to correct a high bloo Continue reading >>

Tips From Other Journals

Tips From Other Journals

Approximately 5 percent of pregnancies are complicated by diabetes. The importance of good glycemic control before conception in diabetic women and as early as possible in women with gestational diabetes has recently been emphasized. Studies in nonpregnant patients have advocated intensive insulin regimens, often involving multiple daily injections, to optimize glycemic levels. Nevertheless, the most widely used regimens for diabetes in pregnancy depend on twice-daily dosing. Nachum and colleagues compared glycemic control and perinatal outcome in pregnant diabetic patients receiving four injections of insulin per day with the same outcomes in similar patients using two daily injections. They enrolled patients with singleton pregnancies who were beginning treatment before 35 weeks of gestation at an obstetric referral center. The standard criteria of the National Diabetes Data Group were used to define diabetes. The study included 274 women with gestational diabetes and 118 women who had pregestational diabetes. These women were randomly assigned to receive insulin two or four times daily. In the twice-daily regimen, the morning dosage contained two thirds of the calculated total daily insulin requirement and was composed of one third human regular insulin and two thirds human intermediate insulin. The afternoon dosage contained equal parts of regular and intermediate insulin. In the four-times-daily insulin regimen, the first three dosages were of regular insulin given 30 minutes before a meal, and the final dosage, given at bedtime, was of intermediate insulin. All participants received the same dietary and glycemic monitoring advice. Glucose levels were initially self-monitored seven times daily, but this changed to at least twice daily when control was established. Continue reading >>

Insulin For Gestational Diabetes - What It Is And How It Works

Insulin For Gestational Diabetes - What It Is And How It Works

Where blood sugar levels cannot be lowered and stabilised enough through dietary and lifestyle changes, or through using medication such as Metformin, some ladies will be required to use insulin for gestational diabetes. Insulin is a hormone in the body produced by the pancreas. Your body uses insulin to move the sugar (glucose) obtained from food and drink from the bloodstream into cells throughout the body. The cells are then able to use the sugar for energy. Here are the most commonly asked Q&A on insulin for gestational diabetes from our Facebook support group Why do I need to take insulin for gestational diabetes? If lower blood sugar levels cannot be reached through diet, exercise and medication such as Metformin, then many will be required insulin for gestational diabetes. If blood sugar levels remain high, then the diabetes is not controlled and can cause major complications with the pregnancy and baby. If your levels are rising out of target range, your own insulin production may need to be topped up at the meal time. You may need to take insulin at one or all of your meals. Sometimes the insulin you produce in-between your meals and overnight may also require a top up. This may mean that you require an extra slower-release insulin at bedtime and/or in the morning. Some consultants will prescribe insulin on diagnosis of gestational diabetes on the basis of your GTT results or following other complications relating to gestational diabetes. For the majority, you will be given some time to try diet and exercise changes and then medication such as Metformin before insulin is introduced as a way to help lower and control your levels. NICE guidelines for timing and use of insulin for gestational diabetes 1.2.19 Offer a trial of changes in diet and exercise to women w Continue reading >>

Insulin Changes During Pregnancy

Insulin Changes During Pregnancy

Insulin requirements tend to change constantly throughout pregnancy as different hormones take effect and your baby grows. You need to be prepared to adjust your insulin doses on a regular basis. It is not uncommon to need to make adjustments to your dose at least once a week. If you are not sure how to adjust your insulin doses, ask your diabetes in pregnancy team for advice. Adjusting insulin doses in pregnancy is more challenging than usual, so make sure you know how to get in touch with your diabetes team and be prepared to contact them more often. Early pregnancy changes Many women find it extremely challenging to maintain optimal blood glucose levels in the early stage of pregnancy with so many hormonal and physical changes occurring. For around the first six to eight weeks of pregnancy your blood glucose levels may be more unstable. Following these early pregnancy changes to your blood glucose levels, you may find that your insulin requirements decrease until the end of the first trimester. You may need to adjust your insulin doses at this time to reduce the risk of severe hypos occurring, sometimes without much (or any) warning. Preventing a hypo is better than treating one. Try not to miss any meals or snacks and check your blood glucose levels regularly. Mid to late pregnancy changes From the second trimester of pregnancy, especially after 18 weeks your insulin requirements will usually start to rise. By around 30 weeks you may need as much as two or three times your daily pre- pregnancy insulin dose. This is because the hormones made by the placenta interfere with the way your insulin normally works - as the pregnancy hormones rise, so does your need for insulin. At this stage you are likely to need more mealtime, rapid-acting insulin, compared with the long- Continue reading >>

Recommended Caloric Intake And Weight Gain Calculator

Recommended Caloric Intake And Weight Gain Calculator

perinatology.comGestational Diabetes: Calculation of Caloric Requirements and Initial Insulin Dose Recommended Caloric Intake and Weight Gain Calculator The calculator below will estimate the BMI , recommended weight gain and energy requirement for a singleton or twin pregnancy [1,5] .To use the calculator enter the patient's age , prepregnancy weight, height, trimester , whether or not the pregnancy is a twin pregnancy ,and the mother's activity level, then press the 'calculate' button. Please enable JavaScript to view all features on this site. Input age years 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Input prepregnancy weight kg lbs Input Height cm in Trimester First Second Third Twins? No Yes Activity level What's this? SedentaryLow Active Active Very Active Sedentary typical daily living activities (e.g., household tasks, walking to the bus). Low active typical daily living activities PLUS 30–60 minutes of daily moderate activity (e.g., walking at 5–7 km/h). Active typical daily living activities PLUS at least 60 minutes of daily moderate activity. Very Active typical daily living activities PLUS at least 60 minutes of daily moderate activity PLUS an additional 60 minutes of vigorous activity or 120 minutes of moderate activity. Recommended Initial Insulin Dose Calculator for Diabetic Patient The calculator below will estimate a simple insulin regimen using multiple daily injections of rapid-acting or regular insulin and NPH insulin [2-4] . To use the calculator enter the current weight, select the units /kg of insulin to give using the table below and press the 'calculate' button. Weeks of Gestation Total Daily Insulin Week 1-17 0.7 to 0.8 U/kg actual body weight Continue reading >>

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