IV insulin
- Monitor CBG q1h
- IV insulin
- Mix 25u Humulin R in 250 mL D5W
- D5W IV 50mL/h while on insulin IV
- if CBG > 7 x2h, notify Endo
Gestational diabetes nomogram
| CBG
|
Insulin Dose
|
Infusion Rate
|
| Less than 3.8
|
0 and follow
|
0 and follow
|
|
|
hypoglycemia protocol
|
hypoglycemia protocol
|
| 3.8-6.9
|
0
|
0
|
| 7-8.9
|
0.5
|
5
|
| 9-10.9
|
0.7
|
7
|
| 11 or greater
|
1 and notify Endo
|
10 and notify Endo
|
Low dose nomogram (less than 40 u/d)
| CBG
|
Insulin Dose
|
Infusion Rate
|
| Less than 3.8
|
0 and follow
|
0 and follow
|
|
|
hypoglycemia protocol
|
hypoglycemia protocol
|
| 3.8-6.9
|
0.5
|
5
|
| 7-8.9
|
1
|
10
|
| 9-10.9
|
1.5
|
15
|
| 11 or greater
|
2 and notify Endo
|
20 and notify Endo
|
Medium dose nomogram (40-59 u/d)
| CBG
|
Insulin Dose
|
Infusion Rate
|
| Less than 3.8
|
0 and follow
|
0 and follow
|
|
|
hypoglycemia protocol
|
hypoglycemia protocol
|
| 3.8-6.9
|
1
|
10
|
| 7.0-8.9
|
1.5
|
15
|
| 9-10.9
|
2
|
20
|
| 11 or greater
|
2.5 and notify Endo
|
25 and notify Endo
|
High dose nomogram (greater than or equal to 60 u/d)
| CBG
|
Insulin Dose
|
Infusion Rate
|
| Less than 3.8
|
0 and follow
|
0 and follow
|
|
|
hypoglycemia protocol
|
hypoglycemia protocol
|
| 3.8-6.9
|
1.5
|
15
|
| 7-8.9
|
2
|
20
|
| 9-10.9
|
2.5
|
25
|
| 11 or greater
|
3 and notify Endo
|
30 and notify Endo
|
Hypoglycemia orders
- CBG 2.2-3.7
- Suspend insulin
- 175mL juice or add 25mL D50W to a 50mL D5W bag and give immediately (total volume 75mL)
- Check CBG in 15 minutes, notify Endo if still low
- When CBG ≥3.8, restart nomogram
- CBG < 2.2
- Suspend insulin
- Give 175mL juice or add 50mL D50W to a 50mL D5W bag and give immediately (total volume 100mL)
- Notify Endo
- When CBG ≥3.8, restart nomogram
Post-procedure
- Continue IV insulin
- Once eating, start SC insulin
- Stop IV insulin and D5W 1h after first dose of SC short-acting insulin OR 4h after first dose of SC long-acting
