DiscussionNewborn infants of diabetic mothers are at risk of developing severe hypoglycaemia. Good control of maternal diabetes during pregnancy increases the fetal survival rate.3 Recent reports4 support the hypothesis that neonatal hypoglycaemia is due to islet-cell hyperplasia, which in turn may be caused in utero by maternal hyperglycaemia. Since perfect control of maternal blood glucose is aimed at during pregnancy, it is logical to avoid excessive stimulation of fetal insulin secretion immediately before delivery.5The combined infusion of insulin and glucose is a simple way of controlling the maternal blood glucose concentration during labour. It also permits adequate hydration of the mother and prevents starvation ketosis. At the same time the stomach may be kept empty, so that a general anaesthetic can be given without delay.Infused insulin is cleared extremely rapidly from the plasma, and by means of an insulin infusion the maternal plasma insulin concentration may be readily adjusted to achieve more-constant blood glucose concentrations. Immediately after delivery maternal insulin requirements fall, and the infusion rate of insulin may be lowered accordingly.Measurement of blood glucose with Dextrostix and the reflectance meter is simple and may be performed by nurses on capillary blood samples obtained by finger-prick at the bedside. The result is available within two minutes and compares favourably with estimations performed by a standard laboratory method. Repeated estimations may be performed without undue discomfort to the patient. (During one premature labour over 100 capillary blood samples were taken in 48 hours.)Provided that simple rules are observed and equipment is properly standardised, management of diabetes during labour with this method becomes a simple procedure suitable for all obstetric units.We thank Mr M Cameron for the obstetric care of these patients, and the labour ward staff and Sister Susan Judd and the house physicians of the medical unit for help with management of the infusions.

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