The use of intravenous low-dose insulin infusion in the intrapartum management of diabetes mellitus

Abstract

The technique of combined glucose and low-dose insulin infusion devised for the treatment of diabetic ketoacidosis provided an optimal method of intrapartum blood glucose control. Initial studies of this technique have yielded satisfactory maintenance of maternal euglycemia in labour. In this study, little difficulty was encountered in maintaining blood glucose values within the optical range from 4.0 to 6.7 mmol/L employing the low-dose infusion technique. None of the mothers had biochemical or clinical evidence of hypoglycemia even two hours postpartum. Ketonuria was not encountered in the course of the labours studied. This study also showed that the low-dose infusion could adequately control blood glucose levels in most patients with less than the usual antepartum insulin dose. None of the newborn babies showed any biochemical or clinical evidence of hypoglycemia. Throughout the study, blood glucose estimations were done at the bedside with the Dextrostix-Eyetone System (DES). The DES gives the result of estimation almost within two minutes and correlation between the DES and glucose-oxidase method is highly significant. Moreover, DES allows frequent estimations to be made with little inconvenience and patient acceptance of this technique was high. This simple and versatile technique of glucose estimation was an important accompaniment of the infusion technique.