demonstrate insulin titration after steroid administration: SOGP

an example to demonstrate insulin titration after steroid administration:

---

💉 3.4.1: Insulin Titration After Steroid Administration

Scenario:

A pregnant woman with GDM is on insulin therapy and requires corticosteroid administration to accelerate fetal lung maturity at 32 weeks gestation. Her current daily insulin dose is 50 units (30 units in the morning, 20 units in the evening).

Steps for Insulin Adjustment:

1. Increase Insulin Dosage After Corticosteroid Administration:

   • Increase by 20–40% based on SMBG (Self-Monitoring of Blood Glucose).

   • Example:

     • 20% increase: 50 × 0.2 = 10 additional units.
     • New Total Insulin Dose: 50 + 10 = 60 units/day.

   • Split the New Dose:

     • Morning dose: 2/3 of 60 units = 40 units.
       • Regular Insulin (1/3): 13 units.
       • NPH (2/3): 27 units.
     • Evening dose: 1/3 of 60 units = 20 units.
       • Regular Insulin (1/2): 10 units.
       • NPH (1/2): 10 units.

2. Maintain Increased Dose:

   • Continue the increased dose (60 units/day) from Day 1 to Day 5.
   • Monitor SMBG closely during this period and adjust further if needed.

3. Taper Insulin Dosage:

   • Gradually return to the pre-steroid dose (50 units/day) by Day 6–7:
     • Day 6: Reduce by half of the increase (e.g., 55 units/day).
     • Day 7: Return to the pre-steroid dose (50 units/day).

---

Summary Table for Adjustment:

Day	Total Insulin Dose	Morning Dose (2/3)	Evening Dose (1/3)
Pre-steroid	50 units	33 units	17 units
Day 1–5	60 units	40 units	20 units
Day 6	55 units	37 units	18 units
Day 7	50 units	33 units	17 units

---

Key Notes:

• Adjust insulin based on SMBG trends and glycemic targets:
  • Fasting: <95 mg/dL.
  • 1-hour postprandial: <140 mg/dL.
  • 2-hour postprandial: <120 mg/dL.
• Ensure frequent monitoring to prevent hypoglycemia or hyperglycemia.

---