Hypoglycemia Basics
What defines hypoglycemia in the first 48-72 hours of life?
Blood glucose less than 40-45 mg/dL
What blood glucose level defines hyperglycemia?
Greater than 150 mg/dL
What is the recommended dose range for glucose gel?
200-400 mg/kg of 40% dextrose gel
When should the first glucose check be done for an IDM?
Within the first hour of life
Which group of infants has the highest risk of hyperglycemia?
Extremely low birth weight infants
Name three signs of symptomatic hypoglycemia
Jitteriness, poor feeding, lethargy, apnea, or seizures
Name two complications of neonatal hyperglycemia
Increased risk of IVH and increased risk of sepsis
At what glucose concentration must IV fluids be given centrally?
Greater than 12.5% dextrose
How long should at-risk infants be monitored for hypoglycemia?
Minimum 24 hours or until glucose stable
Why are SGA infants at risk for hypoglycemia?
Limited glycogen stores due to limited nutrient transfer in utero
What is the primary difference in glucose metabolism between term and preterm infants?
Preterm infants have limited glycogen stores due to missing third trimester storage period
What is the initial intervention for hyperglycemia?
Decrease glucose infusion rate (GIR)
What is the initial D10W bolus dose for symptomatic hypoglycemia?
2 mL/kg
What is the target glucose range after 72 hours of life?
60-70 mg/dL or higher
What percentage of IDM babies typically develop hypoglycemia?
20-35%
Explain why IDM babies are at high risk for hypoglycemia
High maternal glucose causes increased fetal insulin production, which continues after birth when glucose supply is cut off
When starting insulin, what is the recommended monitoring frequency?
Every 15-30 minutes while titrating, then hourly once stable.
Name three situations where glucose gel should NOT be used
Symptomatic hypoglycemia, NPO status, or unable to protect airway
Name three ways to prevent hypoglycemia in at-risk infants
Early feeding, skin-to-skin care, appropriate glucose infusion rates
Name three non-glucose problems commonly seen in IDM babies?
Macrosomia, respiratory distress, polycythemia, cardiac problems
What makes hypoglycemia in IDM babies particularly dangerous for brain function?
High insulin levels prevent alternative fuel use (ketones and lipids) by the brain during hypoglycemia
Calculate the glucose infusion rate for a 1 kg baby receiving D10W at 80mL/kg/day
5.5 mg/kg/min
Describe the step-by-step process for proper glucose gel administration
Dry mucosa, apply with gloved finger to buccal mucosa, massage in portions, can repeat up to 3 times
Explain why point-of-care glucose testing should be confirmed by lab values
POC testing may underestimate true glucose levels by 10-15%
Explain the pathophysiology of hypoglycemia in perinatal stress
Increased glucose utilization due to anaerobic metabolism and depleted glycogen stores