Management of Gestational Diabetes Mellitus with Intravenous Insulin

Implementation of Intravenous Insulin Protocol

Initiate intensive blood glucose monitoring with capillary glucose checks every 1-2 hours after betamethasone administration, with target glucose values of fasting <95 mg/dL, 1-hour postprandial <140 mg/dL, or 2-hour postprandial <120 mg/dL, and increase total daily insulin dose by 40-60% during the peak effect period, according to the American College of Obstetricians and Gynecologists 1
Distribute insulin as 40% basal and 60% prandial to address postprandial hyperglycemia, and consider ketone monitoring in patients with unexplained hyperglycemia or symptoms of ketosis, as recommended by the American Diabetes Association 1

Increase both basal and bolus insulin components by 20-30% and 30-50% respectively, based on pre-meal glucose readings, and monitor blood glucose levels every 1-2 hours during the peak effect period, as suggested by the Endocrine Society 1
Adjust insulin doses downward by 10-20% if glucose readings normalize, and be vigilant for maternal hypoglycemia, as pregnant individuals have altered counter-regulatory responses that may decrease hypoglycemia awareness, according to the American College of Endocrinology 2, 3