Continuous insulin delivery systems for the pregnant diabetic patient.

In highly unstable diabetes (brittle diabetes) the degree of metabolic control called for today in managing the pregnant diabetic patient is not achievable by intensified conventional insulin therapy. These cases have been markedly improved by continuous insulin delivery systems. In the course of 2 years, 6 diabetic pregnant patients (8%) were treated with insulin pumps for a total of 910 days, using the intravenous route once, the intraperitoneal route twice and the subcutaneous route three times. The group consisted of one White C, one White D and four White R diabetic patients. Metabolic control was achieved by 5,916 blood sugar measurements, 42 determinations of glycosylated hemoglobin (HbA1) and 19 determinations of amniotic fluid insulin. The intravenous and the subcutaneous route showed about the same rate of hypoglycemia as intensified conventional insulin therapy. Hypoglycemia did not appear, however, under intraperitoneal insulin administration. Mean blood glucose in patients on the pump dropped from 121.0 to 97.4 mg/dl. The standard deviation of the blood glucose values during one week dropped from 64.5 to 35.2 mg/dl, the mean amplitude of glycemic excursions (MAGE) from 100 to 43 mg/dl and the mean of daily differences (MODD) from 72 to 29 mg/dl. The concentration of glycosylated hemoglobin sank from 10.5 to 6.8%. The metabolic condition improved significantly. On average, the patients were hospitalized for 7.5 (1.7-12.8) weeks. Fetal hyperinsulinism developed in 2 patients on the pump and was reversible by closer metabolic management. Neonatal weight was in the normal range and there were no signs of diabetogenic fetopathy.