Suggested management of hyperglycaemia in preterm babies
Treat underlying cause (if appropriate/possible) |
Commonly |
Impaired glucose homeostasis |
Iatrogenic from excessive intravenous glucose delivery |
Sepsis |
Stress |
Drugs particularly inotropes/corticosteroids |
Rarely (to be considered if persistent hyperglycaemia) |
Transient neonatal diabetes |
Permanent neonatal diabetes |
Pancreatic agenesis |
Measure true blood glucose to confirm diagnosis |
Calculate glucose infusion rate |
If >12 mg/kg/min, reduce |
Treat with insulin |
If blood glucose >10 mmol/l |
Osmotic dieresis |
As some preterm babies are exquisitely sensitive to insulin, suggested starting dose 0.02 units/kg/h and alter depending on response |
Accurate blood glucose monitoring essential to avoid hypoglycaemia |
In most babies with hyperglycaemia secondary to dysregulation, insulin may be discontinued after a few days once hormonal maturation and maturation of the liver has occurred |
If hyperglycaemia persists, exclude neonatal diabetes (rare, incidence 1 in 400 000) and measure |
Concomitant blood glucose, insulin, C peptide and ketone bodies |
Urinary ketones |
Treatment with insulin may be temporary (months) or permanent. This may be given as subcutaneous intermittent boluses or via an insulin pump |
Babies diagnosed with neonatal diabetes will require referral to a paediatric diabetologist and geneticist |
Neonatal diabetes caused by mutation in the Kir6.2 mutation might be amenable to treatment with sulphonylureas |
Permanent neonatal diabetes will require life-long insulin therapy |
Transient neonatal diabetes may re-emerge as type 2 diabetes in adolescence |