GDM management during labor and delivery
When carrying out insulin therapy, special care is needed as the amount of insulin required during pregnancy, during delivery, and after birth differs tremendously. Thus, insulin requirements at the end of pregnancy increase by approximately two-fold. During first-stage labor the required amount decreases, while in second-stage labor it increases slightly and after birth decreases rapidly. Accordingly, attention needs to be paid to such changes in required insulin amounts during pregnancy and the amount of insulin administered reduces by half following delivery. In particular, since it becomes difficult for the patient to eat during first- and second-stage labor, especially careful management of blood glucose levels is necessary in the case that labor and delivery are prolonged. In many cases at Mie University, at the onset of labor the patient is administered an electrolyte fluid containing 5% glucose at a rate of 100–120 ml/hr, then administered insulin intravenously via an infusion pump. Depending on the individual case, blood glucose is measured at intervals of 1–2 hours. Insulin administration begins with a dosage of 0.5 units/hr and the insulin dosing rate is determined based on fluctuations in blood glucose levels.