Insulin and glucose treatment during labor

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With improvement in antenatal care, intra-partum events play an increasingly crucial role in the outcome of pregnancy.

The artificial beta cell may be used to maintain normoglycemia during labor and delivery, but normoglycemia can be maintained easily by subcutaneous injections. Before active labor, insulin is required, and glucose infusion is not necessary to maintain a blood glucose level of 70-90 mg/dL. With the onset of active labor, insulin requirements decrease to zero and glucose requirements are relatively constant at 2.5 mg/kg/min. From these data, a protocol for supplying the glucose needs of labor has been developed.67

The goal is to maintain the maternal plasma glucose between 70 and 90 mg/dL. In cases of the onset of active spontaneous labor, insulin is withheld and an intravenous (i.v.) dextrose infusion is begun at a rate of 2.55 mg/kg/min. If labor is latent, normal saline is usually sufficient to maintain normo-glycemia until active labor begins, at which time dextrose is infused at 2.55 mg/kg/min. Blood glucose is then monitored hourly and if it is <60 mg/dL then the infusion rate is doubled for the subsequent hour. If the blood glucose rises to >120 mg/dL, 2-4 units of regular insulin are given i.v. each hour until the blood glucose level is 70-90 mg/dL. In the case of an elective Cesarean section, the bedtime dose of NPH insulin is repeated at 8 am on the day of surgery and every 8 h if the surgery is delayed. A dextrose infusion may be started if the plasma glucose level falls to <60 mg/dL, and 2-4 units of regular insulin given i.v. every hour if the blood glucose rises to >120 mg/dL.67

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