Hyperglycaemia

 

Reviewed by Jane Alsweiler
April 2013
Clinical Guidelines Back Newborn Services Home Page
Causes Complications Management Management of Insulin References

Causes of Hyperglycaemia

Complications of Hyperglycaemia

Management of Hyperglycaemia

  1. Reduce dextrose intake
  2. Insulin
    1. Criteria for insulin use: Persistent blood glucose concentration ≥ 10 mmol/L
      (If there is significant glycosuria ≥ 2+, check a blood glucose concentration)

Criteria for insulin use

  • Persistent blood glucose concentration ≥ 10 mmol/L
    (If there is significant glycosuria ≥ 2+, check a blood glucose concentration)

Exceptions to Insulin Use

  • First 72 hours of life
  • Acute transient stress e.g. post surgery, acute sepsis etc.

Management of Insulin Infusion

  1. Administer in same line as intravenous fluids, so if there are any interruptions, both are interrupted together
  2. Starting dose usually 0.05 units/kg/hr, then adjusted according to requirements
  3. Do not include insulin in the total daily fluid intake - it should be titrated on top of the prescribed fluid intake
  4. Monitor the blood glucose concentration, initially 2 hourly, and once stable at least 8 hourly
  5. Aim for a blood glucose concentration between 6 and 10 mmol/L
  6. Once the blood glucose concentration is stable within the target range, wean insulin dose at least daily, more often if tolerated

References

1 Alsweiler JM, Harding JE, Bloomfield FH. Tight glycemic control with insulin in hyperglycemic preterm babies: a randomized controlled trial. Pediatrics. 2012;129(4):639-47.
2 Collins JW, Hoppe M, Brown K, Edidin DV, Padbury J, Ogata ES. A controlled trial of insulin infusion and parenteral nutrition in extremely low birth weight infants with glucose intolerance. J Pediatr 1991; 118: 921-7.
3 Beardsall K, Vanhaesebrouck S, Ogilvy-Stuart AL, Vanhole C, Palmer CR, van Weissenbruch M, et al. Early insulin therapy in very-low-birth-weight infants. N Engl J Med. 2008;359(18):1873-84.