Table 1

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