gdm meds

medications

insulin, glyburide, metformin

insulin therapy

multiple daily inj, mdi
4 shots/day

rapid acting insulin

humalog
onset - 15min
peak - 1h

intermediate insulin

nph, humulin n
onset - 2-4h
peak 4-12h

metformin

inc insulin sensitivity, glucose uptake
dec glucose absorb gi

metformin dose

with food, bedtime
check bl creatinine
max 2500mg/day

glyburide

not sub for insulin, poor fetal outcomes
stim pancreas release insulin, cause hypogly

glyburide dose

1.25mg <200lb, 2.5mg >200lb
oral tabs
1h before meal or bedtime
max 20mg/day

risks and benefits for delivery

fetal size - efw >4000g, plan csec
fetal wellbeing - nst and u/s check placental perfusion
fetal lung mature - 39w-40w6d

intrapartum care plan

keep bg 80-120
bg monitor - q1 stable, q30min adjusting, q15min <70
cont fhr monitor
balance i/o
prep shoulder dystocia

insulin drip starting in labor

type 1 - start on admin
type 2, gdm - no insulin until bg >110, d/c infusion when pt delivers