Microsoft word - w&chglm0025 gestational diabetes management of woman in birthing suite finalised 07-06-08.doc

Canterbury DHB
Women’s & Children’s Health
GESTATIONAL DIABETES (DIET / INSULIN / METFORMIN)
CARE OF WOMEN IN BIRTHING SUITE
DEFINITION
A disorder characterised by an impaired ability to metabolise carbohydrate, usually caused by a deficiency of insulin occurring in pregnancy and disappearing after delivery. INTRA-PARTUM CARE
Inform the Birthing Suite Clinical Co-ordinator, Obstetric Team and Neonatal Registrar For elective Caesarean Section:
Give usual evening insulin and/or metformin the day prior to delivery Withhold morning insulin and/or metformin on day of delivery. Establish i.v. access and avoid any dextrose containing i.v. fluids. Monitor capillary blood glucose 2hourly. If capillary blood glucose <4mmol/L or >7mmol/L commence i.v. dextrose/insulin infusion with hourly blood glucose monitoring (see Appendix A). For Induction of Labour (IOL) or spontaneous labour
Continue usual diet and insulin and/or metformin until labour is established.
Once labour is established
Discontinue subcutaneous insulin and/or metformin. Establish i.v. access. Take bloods for Group and Hold and FBC. Monitor capillary blood glucose levels 2 hourly. If capillary blood glucose <4mmol/L or >7mmol/L commence i.v. dextrose/insulin infusion with hourly blood glucose monitoring (see Appendix A).
Following Birth
Stop i.v. dextrose/insulin infusion immediately following birth. Antenatal treatment should not be recommenced (insulin and/or metformin).
If the woman has had her routine insulin injection shortly before birth she should eat as soon as possible after birth. If this is not possible discuss with the medical team as she may need intravenous glucose if blood glucose drops dramatically. Monitor blood glucose before breakfast and after all meals for 24 hours. If hyperglycaemia persists (fasting >7mmol/L and/or postprandial >11.1mmol/L), please advise Physician before discharge as the woman may have Type 1 or Type 2 diabetes. All women with gestational diabetes should have a glucose tolerance test at 6 weeks
postpartum to screen for residual insulin resistance. W&CH/GL/M/0025
Page 1 of 2
Issued: June 2008
Authorised by (or Developed by): Dr Ruth Hughes & Dr Peter Moore
Canterbury DHB
Women’s & Children’s Health
APPENDIX A

Dextrose/Insulin Sliding Scale
Two intravenous lines are to be sited. One for dextrose/insulin and one for oxytocin/anaesthetic/analgesic requirements. No glucose containing infusions, other than the fixed rate of dextrose, should be The intravenous line for the dextrose/insulin should be kept patent with a small amount of saline while the infusions are prepared. Prepare the prescribed dextrose/insulin infusion as follows:
The dextrose is mainlined to the woman with the insulin piggybacked to the line. o Run 10% dextrose at 1 litre 8 hourly, 125mls per hour (2mls per minute) via an o Add 100 Units Actrapid insulin to 100mls Saline and run via an infusion pump. o Run 10mls through the tubing before piggybacking the tubing to the mainline, which is connected, to the woman. This will prime the tubing and minimise subsequent binding of insulin to the plastic of the giving set. o The insulin is drawn up as directed by the Fluid and Medication Management Manual Volume 12 and checked by two staff members (one of whom must be i.v. certificated). o Run according to the Blood Glucose/Sliding Scale of Insulin Prior to Birth. Blood glucose should be checked immediately prior to starting the infusions and then hourly until the surgeon has directed the woman is ready to eat. Document blood glucose level on the Diabetes Testing and Treatment Form QMR0012. Document accurately fluid input in the Fluid Balance 24-Hour Sheet QF00372. Sliding Scale of Insulin Prior to Birth
• 0.5 unit/hr (0.5mls/hr)if blood glucose <5mmol/L • 1 unit/hr (1ml/hr) if blood glucose ≥5mmol/L <7mmol/L • 2 units/hr (2mls/hr) if blood glucose ≥7mmol/L <10mmol/L • 3 units/hr (3mls/hr) if blood glucose ≥10mmol/L <13mmol/L • 4 units/hr (4mls/hr) if blood glucose ≥13mmol/L W&CH/GL/M/0025
Page 2 of 2
Issued: June 2008
Authorised by (or Developed by): Dr Ruth Hughes & Dr Peter Moore

Source: https://www.cdhb.health.nz/Hospitals-Services/Health-Professionals/maternity-care-guidelines/Documents/GLM0025%20Gestational%20Diabetes.pdf