My question to all

What do you do when babies get hyperglycemia with normal sugar intake of 4-6mg/kg/minutes. Do you start boluses of Rgular insulin or insulin infusion? If insulin infusion do you monitor sugar according to sliding scale? or how do you titrate insulin infusion. Please share with me your policy?

We don't have a written protocol for this and would use dose recommendations in one of the manuals (like Cloherty),

like 0.01 - 0.2 units of insuline / kg per hour

My small experience, one needs to monitor b-glucose closely...

Important to consider infection in the setting of hyperglycemia.Apart from insulin ,which needs titrating based on the B.M always consider antibiotics ,especially GBS and CONS.Also worth considering looking for ketones in urine.( interpretation can be tricky though)

It is considered better to add in insulin than reduce the glucose .However the debate goes on .......

Dr.Ajay Menon

Sheffield

U.K

Many Thanks for reply (Stefan and Ajay). My question is still remaining.Suppose baby is on antibiotics and glucose load is normal 4-6mg/kg/min but Blood Glucose is 14,17,18 or more. How do you titrate insulin by which fraction and then how to wean it off by which fraction. Anyhow thankyou for your valuable information.

I think there is no evidence and practice varies from unit to unit.

We start by reducing the dextrose infusion rate, if the condition did not resolve by 2-3 days, we resume the normal dextrose infusion rate and start insulin infusion 0.05u/kg/h and monitor blood glucose hourly, then titrate the insulin infusion accordingly. Example; if blood sugar less than 6, reduce infusion by 0.01u/kg/h. Hope this is helpful

My qustion to all

24 hrs old boderline preterm, issues are 1.resp distress at 1hr of life needs ventilatory support(NORMAL VOLUME LUNG)

2. hyperglycemia(800mg) at gir of 8 on 24 hrs of life hw i proceed?