Insulin Management Protocol for Obstetric Patients With Gestational or Type 2 Diabetes

Abstract

Type 2 and gestational diabetes place the newborn at an increased risk of developing hypoglycemia after birth. Research has indicated that a significant reduction in neonatal hypoglycemia is linked to an intravenous insulin and dextrose protocol to control maternal blood glucose levels during labor. A multidisciplinary team at the University of Alabama at Birmingham (UAB) created a new insulin protocol with the goal to better control glucose levels during labor and birth for patients with Type 2 or gestational diabetes, thereby, positively affecting neonatal hypoglycemic episodes. Hypoglycemia was defined as a plasma glucose level less than 40 mg/dl. This value was taken from the UAB newborn nursery hypoglycemia algorithm. Data were collected from delivery logs and newborn charts 3 months before initiation of the new intravenous insulin and dextrose protocol. The new protocol was presented to all labor and delivery nurses. All nurses were given a copy of new algorithm for reference. In addition, they were given two case studies to evaluate competency in application of the new protocol. Data collection was repeated from delivery logs and newborn charts at 3-months postprotocol initiation for comparison of data. This study was Institutional Review Board–exempt. Blood glucose levels of 29 newborns were reviewed during the preinitiation period. Fourteen newborns had at least one hypoglycemic event within the first 24 hours of life (48% hypoglycemic rate). Additional breakdown revealed that average blood glucose was 58 mg/dl and average minimum blood glucose was 45 mg/dl. Glucose levels of 32 newborns were reviewed during the postinitiation period. Ten newborns had a hypoglycemic event within the first 24 hours of life (31% hypoglycemic rate). The average blood sugar was 60 mg/dl and the average minimum blood sugar was 47 mg/dl. An additional key finding was that blood glucose levels improved as gestational age increased. The findings indicate an inverse relationship of maternal blood glucose level and neonatal hypoglycemia. The postinitiation data show a decrease in neonatal hypoglycemia. Additional research is needed to determine an evidence-based protocol to maintain maternal euglycemia and decrease the risk of neonatal hypoglycemia.