Insulin TYPE /DOSE AND REGIMEN { SOGP} CPSP

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🌟 3.2.2: Insulin

• 💉 Insulin as Gold Standard:

  • Insulin is the gold standard treatment for women with diabetes in pregnancy. 🌟
  • When Medical Nutritional Therapy (MNT) and Oral Hypoglycemic Drugs (OHD) fail to control blood glucose (BG) values:
    • Start insulin alone or combine it with Metformin.

• 🛑 Indications for Insulin Use:

  • Start insulin as a first-line treatment for women with:
    • ⚠️ Obstetrical complications (e.g., pre-eclampsia, polyhydramnios, macrosomia).
    • FBS ≥ 126 mg/dL (≥7.0 mmol/L).
    • RBS ≥ 200 mg/dL (≥11.1 mmol/L).

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💡 3.2.2.1: Insulin Types

• 🟢 Basal Insulin:
  • Recombinant human intermediate-acting insulin (NPH).
  • Long-acting insulin analogue (Detemir).
• 🔵 Bolus Insulin:
  • Recombinant human short-acting insulin (Regular insulin).
  • Short-acting insulin analogues (Aspart and Lispro):
    • 🌟 Preferred for women with nausea and vomiting to reduce hypoglycemia and improve postprandial BG levels.
• ⚠️ Premixed Insulin Regimens:
  • Generally not recommended due to fluctuating glycemic control.
  • Women already well-controlled on premixed regimens may continue the same.
• 🚫 Restricted Use:
  • Glulisine and Degludec are not recommended due to limited safety data.

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📊 3.3: Calculation of Insulin Dosage

• 🔢 Arbitrary Guide for Starting Insulin Dosage:
  • Based on body weight (kg) and gestational period:
    • 1–13 weeks: 0.6 × weight in kg.
    • 14–26 weeks: 0.8 × weight in kg.
    • 27–37 weeks: 0.9 × weight in kg.
    • 38–40 weeks: 1.0 × weight in kg.
• 📝 Example Calculation:
  • A 60 kg woman at term (38–40 weeks):
    • Total daily insulin dose = 1.0 × 60 = 60 units.
    • Morning dose (2/3) = 40 units:
      • 1/3 Regular insulin: ~13 units.
      • 2/3 NPH: ~26 units.
    • Evening dose (1/3) = 20 units:
      • 1/2 Regular insulin: 10 units.
      • 1/2 NPH: 10 units.

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