Gestational diabetes (GDM) is becoming more prevalent, with the rate of women with GDM in NSW increasing from 8.3% in 2015, to 13.9% in 2019. There has been a simultaneous increase in number of women requiring induction of labour, and pre-term deliveries. As such, there has been a corresponding rise in the number of women who require corticosteroids for fetal lung maturity. Optimising the glycaemic control in women with GDM who receive corticosteroids can sometimes be difficult.
In the tertiary unit where the authors practice, the obstetric team have to contact the Endocrine team for advice on optimising glycaemic control. This doesn’t always happen in a timely fashion due to competing demands, or minimal staffing, especially after hours and overnight. Anecdotally we have noticed that patients are currently running hyperglycaemic following steroid doses suspected due to an insufficient increase in insulin doses being charted.
In order to streamline this process and optimise glycaemic control, we implemented a protocol that can be followed by all staff members with ease. The protocol assumes that a 40-50% increase in insulin is required post Celestone administration. The required insulin doses can then be fine-tuned by the Endocrinology Registrar within office hours.
We looked at a total of 42 women who delivered between an 18 month time period. Of these women, 26 received Celestone prior to implementation of the protocol, and 16 were managed with the new protocol.
Analysis of the glycaemic control in these women suggests that the protocol was effective in treating post-prandial blood glucose levels (BGLs), but was inadequate in treating fasting BGLs. Most women reverted back to pre-Celestone glycaemic control within 72 hrs from time of 1st Celestone administered. Often instances of elevated post-prandial BGLs was because the BGL was not measured pre-meal, or a supplemental dose of insulin was not administered.
Implementation of this protocol has streamlined the process of glycaemic optimisation in women with GDM who receive Corticosteroids in our hospital. Further titration of the protocol is likely required in order to ensure BGLs within target range.