This document discusses the administration of insulin for gestational diabetes mellitus. It aims to lower and maintain blood glucose levels to avoid risks to the mother and fetus. The session will cover different insulin types and durations of action, dose calculation, subcutaneous injection sites, and sliding scale insulin. Sliding scale insulin regimens are used during labor and post C-section to improve glycemic control. The document provides an example dose calculation and monitoring protocol for a GDM patient. Failure to control blood sugar levels can increase risks like preeclampsia and birth injuries.

1. GESTATIONAL DIABETES
MELLITUS
“What” and “How” of Insulin administration
in susceptible pregnant population
Presented by: D. Vighnesh (34)
4th year MBBS, Dept. of Obs and Gynae,
VMC KNL

2. OBJECTIVES OF THE SESSION
● Aim of the protocols are to lower blood glucose and sustain them at a level
where no threat is posed to the pregnant mother or the foetus in terms of blood
sugar levels.
● We will be discussing several modalities on how the above specified aim is
achieved, and what are their pitfalls.
● Today’s discussion will be focussing on:
1. Different types of insulin, their onset, peak and duration of action.
2. Dose calculation of insulin for a patient of gestational diabetes mellitus.
3. Sliding scale Insulin

3. ROUTES TO ADMINISTER
INSULIN
Insulin is administered in
several ways according to the
needs and requirements of the
patient. They are as follows:
● Oral
● Nasal
● Inhaled
● Subcutaneous
● Transdermal
● Intraperitoneal

4. SITES OF SUBCUTICULAR INSULIN
INJECTION

6. ADMINISTRATION OF INSULIN
NOTE:
What is Dawn phenomenon?
It is an abnormal rise in blood sugar in early
hours (between 2 a.m to 8 a.m) in diabetic
patients.
What is Differentiate rebound?
The differential rebound, also known as the
“Somogyi effect” states that when insulin is
taken in large amounts during night, it can
trigger a rebound increase in blood sugar levels
by morning due to the concurrent release of
Cortisol and Growth hormone.
Patient is instructed to do SMBG

7. DOSE CALCULATION OF INSULIN

8. ILLUSTRATIVE EXAMPLE
Let us assume that we are looking after a GDM patient aged 30, weighing 77 kg is admitted as
an in-patient, currently in her third trimester.
The formula for calculating dose of insulin to be administered is given as:
0.9 (due to it being the third trimester) x 77 (which is her given weight) ~ 70 units
This is the dose that is to be administered to her in a whole day.
The protocol further suggests to administer ⅔ of dose in before lunch and ⅓ dose after lunch.
Therefore, in this case, the patient will receive ~ 47 units before lunch and 23 units before
dinner.
Note: In an ideal situation, it is suggested to take 7 levels of Blood sugar in a day. It comprises of
Fasting blood sugar, and preprandial and postprandial blood sugar levels for breakfast, lunch and
dinner.
However, in practice, 4 levels of blood sugar are taken in a day. They comprise of Fasting blood
sugar and all 2 hr postprandial blood sugar levels for breakfast, lunch and dinner.

9. SLIDING SCALE INSULIN
Sliding scale regimen are
defined as “a schedule of
regular insulin dosage
contingent on capillary blood
glucose measurements
generally taken 4 times daily
before meals”
Sliding scale model is used
during labour and in post-
operative care of Lower
segment cesarean section.
These regimens were effective
in improving glycemic control
in diabetic patients.

10. REPERCUSSIONS OF FAILURE

11. THANK YOU Sources:
1. Mudaliar and Menon: Clinical
Obstetrics
2. Sliding Scale Insulin - Time to
Stop Sliding , Irl B.Hirsch,
JAMA January 14, 2009, Vol
301.
3. Use of a standardized protocol to
decrease medication errors and
adverse events related to sliding
scale insulin: Donihi et al, BMJ
2006.
4. CDAPP SS Guidelines 2009.