Use 50 units soluble insulin (Human Actrapid) made up to 50 ml with NaCl 0.9% solution. Sign each time: / Name:
Nurse: date: time: / DoB:
Nurse: date: time: / Hosp No:
Nurse: date: time: / Ward:
Nurse: date: time: / Consultant:
Prescription (see notes for choice of scales)
Blood glucose
(mmol/l) / Scale A (<40Units/day) / Scale B
(41- 80units/day) / Scale C
(81-120units/day) / Scale D (>120units/day)
<6 / 0 mls / hr / 0 mls / hr / 0 mls/hr / 0 mls/hr
6.1-7.0 / 0.5 / 1 / 2 / 3
7.1-8.0 / 1 / 2 / 3 / 5
8.1-9.0 / 1.5 / 3 / 4 / 7
9.1-10.0 / 2 / 4 / 6 / 10
>10.1 / 3 / 6 / 6 / 13
Dr to cross through scale not used and sign:
Date and time:
Administration soluble insulin (Human Actrapid) 1 unit / ml
Date: / Date:
blood
glucose (mmol/l) / insulin
ml / hr / midwife
sign / blood
glucose (mmol/l) / insulin
ml / hr / midwife
sign
00.00 / 00.00
01.00 / 01.00
02.00 / 02.00
03.00 / 03.00
04.00 / 04.00
05.00 / 05.00
06.00 / 06.00
07.00 / 07.00
08.00 / 08.00
09.00 / 09.00
10.00 / 10.00
11.00 / 11.00
12.00 / 12.00
13.00 / 13.00
14.00 / 14.00
15.00 / 15.00
16.00 / 16.00
17.00 / 17.00
18.00 / 18.00
19.00 / 19.00
20.00 / 20.00
21.00 / 21.00
22.00 / 22.00
23.00 / 23.00
Total mls: / hrs: / Total mls: / hrs:
Guideline for Administration of Supplementary IV Insulin Following Betamethasone in Patients Receiving Insulin for Gestational or Pre-pregnancy Diabetes Mellitus.
· Patient will need to be cared for in an environment where the staffing levels allow hourly observation.
· Immediately prior to the first Betamethasone injection, a supplementary, variable dose intravenous insulin infusion is commenced (see chart for instructions). The hourly rate is adjusted according to hourly blood glucose measurements. The initial dosage is determined according to her current 24 hour subcutaneous insulin requirements (short + long-acting) (see Supplementary Insulin Requirement Table).
· Following administration of the first dose of Betamethasone, the patient will continue to eat and drink as normal and will continue to administer her usual subcutaneous insulin regimen, without any change in dosage.
· IV fluids are NOT co-administered if the woman is eating and drinking normally.
· The supplementary Insulin infusion is continued for at least 12 hours after the second Betamethasone injection.
· If blood glucose levels are not responding to the initial regimen (i.e. glucose >10mmol/l for 2 consecutive hours) the dosage regimen is moved up to the next level (e.g. If commenced on regimen A, move up to regimen B etc.).
· If the blood glucose level is <4mmol/l on one occasion the dosage regimen is moved down one level (e.g. If on regimen C, move down to regimen B).
Version 1 08/2011