The peripartum management of glycaemia in women with Type 1 diabetes

  1. Leonie Callaway, MBBS, (Hons), FRACP, PhD, GCELead
  1. The University of Queensland, Royal Brisbane and Women’s Hospital
  2. The University of Queensland, Royal Brisbane and Women’s Hospital
  3. The University of Queensland, Mater Health Services, Mater Medical Research Institute
  4. The University of Queensland, Royal Brisbane and Women’s Hospital
  1. Corresponding Author: Naomi Achong, Email: n.achong{at}uq.edu.au

Abstract

Objective We aimed to 1) describe the peripartum management of type 1 diabetes at an Australian teaching hospital and 2) discuss factors influencing the apparent transient insulin independence postpartum.

Research Design and Methods We conducted a retrospective review of women with type 1 diabetes delivering singleton pregnancies from 2005-2010. Information was collected regarding demographics, medical history, peripartum management and outcome and breastfeeding. To detect a difference in time to first postpartum blood glucose level (BGL) of >8mmol/L between women with an early (<4hour) and late (>12hour) requirement for insulin postpartum, with a power of 80% and a type 1 error of 0.05, at least 24 patients were required.

Results An intravenous insulin infusion was commenced in almost 95% of women. Univariate analysis showed that increased body mass index at term, lower creatinine at term, longer duration from last dose of long- or intermediate-acting insulin and discontinuation of an insulin infusion postpartum were associated with a shorter time to first requirement of insulin postpartum (p=0.005, 0.026, 0.026 and <0.001,respectively). There was a correlation between higher doses of insulin commenced postpartum and number of out-of-range BGLs [r(36)=0.358, p =0.030) and hypoglycaemia [r(36)=0.434, p =0.007). Almost 60% had at least one BGL <3.5mmol/L between delivery and discharge.

Conclusions Changes in the pharmacodynamic profile of insulin may contribute to the transient insulin independence sometimes observed postpartum in type 1 diabetes. A dose of 50-60% of the pre-pregnancy insulin requirement resulted in the lowest rate of hypoglycaemia and glucose excursions. These results require validation in a larger, prospective study.

  • Received June 8, 2013.
  • Accepted October 6, 2013.

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  1. Diabetes Care
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