A pregnant woman at 28 weeks with pre-existing type 1 diabetes has HbA1c 7.8%. She develops sudden symptomatic hypoglycaemia (BG 42 mg/dL). Which insulin adjustment is LEAST appropriate in the immediate management?

• A Administering 15–20 g of fast-acting carbohydrate and rechecking in 15 minutes
• B Reviewing insulin-to-carbohydrate ratio and recent dietary intake for contributing causes
• C Fetal monitoring after resolution of hypoglycaemic episode
• D Increasing the basal insulin dose by 20% to prevent future hypoglycaemia ✓

Explanation

Increasing basal insulin during or immediately after a hypoglycaemic episode is dangerous and counterproductive — it would worsen hypoglycaemia. The correct immediate management is the 15-15 rule (15–20 g fast-acting carbohydrate, recheck in 15 minutes). The cause of hypoglycaemia (missed meal, excess insulin) should be identified and the basal dose reviewed for possible reduction, not increase. Fetal monitoring is appropriate after stabilisation as fetal distress can occur during maternal hypoglycaemia.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.