Insulin dose during glucocorticoid treatment for fetal lung maturation in diabetic pregnancy: Test of analgoritm

Abstract

Objective. Poor glycemic control is often a serious clinical problem during glucocorticoid treatment for fetal lung maturation in pregnant women with diabetes. An algorithm for improved subcutaneous insulin treatment during glucocorticoid treatment in insulin-dependent diabetic women was developed and tested. Study design. The sample, divided into two cohorts, consisted of all insulin-dependent diabetic women (n = 16) receiving glucocorticoid treatment (betamethasone 12mg i.m., repeated after 24h) from 1996 to 1999. In the first cohort the increments of insulin dose were based on the level of blood glucose obtained. Based on the first cohort an algorithm to determine increments of insulin dose was developed. In the second cohort (n = 8) the insulin dose was increased by up to 40%, according to the algorithm, starting immediately after glucocorticoid treatment; prior to a detectable increase in blood glucose. Results. After betamethasone, the daily, insulin dose for the following 5 days was increased by 6, 38, 36, 27 and 17% in the first cohort vs. 27, 45, 40, 31 and 11% in the second cohort. The algorithm was used in the second cohort. The median blood glucose was 6.7, 14.3, 12.3, 7.7 and 7.7 vs. 7.7, 8.2, 9.6, 7.0 and 7.4mmol/1 (p<0.05 for day 2 and 3) in the two cohorts, respectively. None developed ketoacidosis or severe hypoglycemia. Conclusion. An algorithm with an increasing insulin dose of up to 40% shortly after glucocorticoid treatment for fetal lung maturation in diabetic women prevents severe dysregulation of metabolic control.