Rotating fluids protocol

Maternal plasma glucose	Intravenous insulin (units/hour)*^[1]	Intravenous solution
"Rotating fluids." For use in women with gestational diabetes. This protocol should not be used in women with type 1 or type 2 diabetes mellitus.
≤100 mg/dL (5.6 mmol/L)	Hold	D5NS at 125 mL/hour to achieve CBG of 100 mg/dL (5.6 mmol/L)
101 to 140 mg/dL (5.6 to 7.8 mmol/L)	Hold	Lacted Ringers or normal saline at 125 mL/hour to achieve CBG of 100 mg/dL (5.6 mmol/L)
>140 mg/dL (7.8 mmol/L)	Short- or rapid-acting insulin infusion titrated to achieve CBG of 100 mg/dL (5.6 mmol/L)	Lacted Ringers or normal saline at 125 mL/hour to achieve CBG of 100 mg/dL (5.6 mmol/L)

CBG: capillary blood glucose; D5NS: 5 percent dextrose normal saline.
* Mix 25 units regular insulin in 250 mL normal saline (1 unit:10 mL).

Reference:

Jovanovic L, Peterson CM. Management of the pregnant, insulin-dependent diabetic woman. Diabetes Care 1980; 3:63.

Data from: Rosenberg VA, Eglinton GS, Rauch ER, Skupski DW. Intrapartum maternal glycemic control in women with insulin requiring diabetes: a randomized clinical trial of rotating fluids versus insulin drip. Am J Obstet Gynecol 2006; 195:1095.

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Rotating fluids protocol