Poster Presentation Australian Diabetes in Pregnancy Society 2018

Subcutaneous insulin protocol following antenatal steroids for women with diabetes in pregnancy (#102)

Sheng-Tsung (Dominique) Chiu 1 , Catherine Marnoch 2 , Janet Rowan 2
  1. Northland District Health Board, Whangarei, NORTHLAND REGION, New Zealand
  2. Obstetric Medicine, Auckland District Health Board, Auckland, Not in US or Canada, New Zealand

Background: The National Institute for Health and Clinical Health Excellence (NICE) guideline recommends that diabetic mothers should receive additional insulin when antenatal corticosteroid is indicated. In 2013 a modified insulin protocol was developed in Waitemata District Health Board (WDHB) in New Zealand for diabetic mothers requiring antenatal corticosteroid therapy.

Aim: This audit aims to review the effectiveness of the WDHB protocol in achieving satisfactory glycaemic control.

Methods: Diabetic women who received antenatal corticosteroid between March 2013 and March 2015 in WDHB were identified retrospectively. Through clinical records insulin prescription, glycaemic monitoring and staff adherence to protocol were recorded in three times periods: One: 0-8 hours after initial injection (11.4 mg betamethasone, im); Two: 8 hours after initial injection to 24 hours after second injection; Three: 24-36 hours after second injection. During time period two, insulin doses were doubled or initiated at 0.7-1.0 unit/kg/day.

Results: In 44 cases, no woman maintained glucose measures between 4-6 mmol/L.  In time periods one, two and three, 90%, 48% and 90% of women maintained blood sugar levels between 3.5-10 mmol/L, respectively. Hyperglycaemia of greater than 6.0 mmol/L occurred in more than half of the patients in each time period, however, an additional insulin dose was not always provided as recommended. Mild hypoglycaemia (less than 3.5 mmol/L) occurred four times.

Conclusion: Our results suggest that, for women already taking insulin, doubling the dose was safe in our population. In general, the WDHB protocol was effective although insulin doses could have been higher.