A standardized protocol to achieve normoglycaemia during labour and delivery in women with type 1 diabetes.

Abstract Aim To evaluate a standardized protocol for maintaining near-normoglycaemia during labour and delivery in women with type 1 diabetes. Methods Over a nine-year period (1997–2005), 229 pregnancies in 174 women with type 1 diabetes were delivered at one centre. The same regimen was used for the induction of labour (group 1) and in women admitted in spontaneous labour (group 2): 10% dextrose (80ml/h) intravenous was given along with short-acting insulin, starting at 1IU/h intravenous via an infusion pump. Capillary blood glucose (CBG) was determined hourly, and the insulin infusion rate was modified accordingly. Results Labour was induced in 85 cases (37%) and spontaneous in 23 cases (10%), and an elective C-section was performed in 121 cases (53%). Maternal glycaemia during labour was 6.1±1.6 (range: 3.9–9.2)mmol/l in group 1, and 6.9±2.0 (range: 4.7–12.0)mmol/l in group 2. Maternal glycaemia at delivery was 5.8±1.5 (range: 3.4–9.4) and 6.3±1.9 (range: 4.1–11.4)mmol/l in groups 1 and 2, respectively. Women who underwent an elective C-section were not included in the standardized protocol and had higher glycaemia at delivery 7.1±2.0 (range: 2.7–13.5)mmol/l. Neonatal hypoglycaemia occurred in 30 infants (13%), and was only associated with preterm delivery. Conclusion Using a standardized simple protocol during labour, maternal glycaemia was maintained within a near-normal range in 80–85% of cases.