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 |