Endocrine Abstracts

Objectives: The gestations in patients with type 1 diabetes are associated with an increase in maternal-fetal complications. Adequate glycemic control during pregnancy has been shown to reduce adverse events. Given that, the treatment with insulin pump improves glycemic control and that pregnancy implies constant changes in insulin resistance, our objective is to analyze the changes in insulin requirements in pregnant patients under CSII.

Materials and methods: This is a retrospective study of 20 women (39 gestations) with a mean age of 34.3 years (range: 28–41) and a mean time of diabetes duration of 19 years (range: 8, 31). Seven therapies were started with gestational desire (35%) and the mean time under CSII was 4.9 years (range: 0.5–12). Statistical analysis with SPSS 20.0.

Results: The average pre-conception HbA1c was 6.90% (S.D.:0.623) and during pregnancy 6.70% (S.D.:0.61). Thougout pregnancy the total insulin requirements increase by 87.5%: from 33.51 (S.D.:8.85) to 62.84 (S.D.:21.16) (Sig 0.00). These modifications compared with the pregestational values are summarized in the following table (Table 1): nine patients experienced miscarriaged (23%) none preceded by severe hypoglucemia and 1 perinatal death. Macrosomia was found in six gestations (15.38%).

Conclusions:

1. During pregnancy, total insulin requirements increase by 87%.

2. This increase occurs at the expense of both basal insulin and carbohydrate-to-insulin-ratio:

- The increase of the basal insulin is marked after the 2nd trimester, reaching statistical significance.

- The increase in carbohydrate-to-insulin-ratio is significant in all mealtimes after 2nd trimester, being more marked at breakfast, where it increased by 134% at the end of pregnancy (from 1.08 to 2.22).