I am currently pregnant with my second child, having developed type 1 whilst pregnant with my first child three years ago. I now have an insulin pump and, barring “difficulties,” would prefer to use this to control levels during labour rather than go on a I.V. drip, if at all possible. Happily, my diabetes team is positively inclined towards this approach, but have no practical experience themselves either. Could you offer any advice on pump protocols for labour? What would be a reasonable blood sugar range during labour before best practice would dictate use of a I.V., for example?

During labor, I try to keep my patient’s blood glucose less than 100 mg/dl (5.6 mmol/dl). If this can be done with the pump, then that is great. There are no specific guidelines. Women in labor do not eat very much. Therefore, it is important to check blood glucose values often (every hour to two hours) and respond accordingly. My personal feeling is that I.V. insulin is very easy to use. When insulin is given I.V., it is metabolized quickly, so it is very easy to control blood glucose. For example, if the patient’s blood glucose is too low, then turning off the I.V. infusion will stop the decrease. Similarly, if the glucose is too high, then turning up the infusion rate will quickly correct the level. Either approach is fine as long as you are watching your glucose values closely.

OWJ