[Insulin-dependent diabetes and pregnancy. A model of coordinated approach].
A historical account of the relation between diabetes and pregnancy is followed by the presentation of a personal series of 10 insulin-dependent diabetic pregnant women (3 White's class B, 2 class C, 3 class D and 2 class F/R) treated in accordance with a newly applied quarterly and fortnightly protocol. Nearly normal blood sugar (HbA1 maintained around 8% in the second and third trimester) was achieved through home blood glucose self-monitoring, in keeping with the Karen Bruni Centre's educational programme. This includes self-management of intensified insulin treatment in the form of 2-3 injections per day (Monotard MC and HM, Actrapid MC and HM), as well as the use of Novo Pen (100 U/ml Actrapid HM) for supplementary insulinisation. Average insulin initial dose: 0.51 U/Kg/day (range 0.2-0.7); final dose 0.83 U/Kg/day (range 0.6-1.2). Delivery was by caesarean section on obstetric indication: 9 at the 36th week, 1 at the 34th for trisymptomatic gestosis. There were no foetal nor neonatal death. All children were subjected to intensive neonatological care. There were 3 cases of macrosomia and 1 tetralogy of Fallot, which followed a benign course. Despite their absence of statistical value, these data show that optimised multidisciplinary treatment can be of utility in preventing neonatal morbidity and mortality in an insulin-dependent diabetic pregnancy. They also indicate that a coordinated treatment model can equally be put into effect even in a non centralised structure, provided certain facilities exist: in our case, voluntary support on the part of Karen Bruni Diabetic Association, obstetric interest in diabetology and a neonatological background for treatment of the offspring of diabetic mothers. Lastly, this series substantiate the effectiveness of the programme of self-checking and self-management of diabetes in the accomplishment of "optimised" blood glucose control and containment of costly hospitalisation at the time of delivery.
Gamba
S
S
Centro di Diabetologia Karen Bruni Böcher Divisioni di Ostetricia e Ginecologia A e B, Ospedale Maria Vittoria di Torino.
Barolo
P
P
Blatto
A
A
Grassi
G
G
Carlini
M
M
Winkler
T
T
Zanno
C
C
Bianciotto
F
F
Guala
G
G
Gandolfo
M T
MT
D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000266:history; D005314:Embryonic and Fetal Development; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000188:drug therapy* / Q000266:history; D012646:Self Administration; D012648:Self Care / Q000379:methods*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
Diabete insulino-dipendente e gravidanza. Un modello di approccio coordinato.