title: Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction.
abstract: OBJECTIVE
  The aim of the study was to analyse the insulin requirements of women with type 1 diabetes mellitus throughout pregnancy.
  
  
  METHODS
  We have examined the weekly mean blood glucose (mmol/l), insulin requirements (U kg(-1) day(-1)) and total insulin requirements (U/day) in 65 women with type 1 diabetes mellitus and tight metabolic control since before pregnancy (HbA(1c) < or =6.0%).
  
  
  RESULTS
  Both insulin requirement and total insulin requirement displayed a peak in week 9, a nadir in week 16 and a second peak in week 37. For the change in insulin requirement (4.08% per week) and in total insulin requirement (5.19% per week), the sharpest slope was observed from week 16 to week 37. However, two changes of direction took place in the first 11 weeks and eight out of nine episodes of severe hypoglycaemia requiring treatment with glucagon or i.v. glucose took place in the first 16 weeks.
  
  
  CONCLUSIONS
  Pregnant women with type 1 diabetes mellitus and tight metabolic control since before pregnancy displayed changes in insulin requirement and total insulin requirement with successive changes of direction. The sharpest slope was observed between 16 and 37 weeks, but insulin requirements were more unstable in the first 16 weeks. This information could help patients and physicians to react to changes in glycaemic pattern in a prompt and adequate way.
authors.affiliation: Department of Endocrinology and Nutrition, Hospital de Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, Barcelona 08025, Spain.
authors.forename: A
authors.initials: A
authors.lastname: García-Patterson
authors.forename: I
authors.initials: I
authors.lastname: Gich
authors.forename: S B
authors.initials: SB
authors.lastname: Amini
authors.forename: P M
authors.initials: PM
authors.lastname: Catalano
authors.forename: A
authors.initials: A
authors.lastname: de Leiva
authors.forename: R
authors.initials: R
authors.lastname: Corcoy
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D048909:Diabetes Complications / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000378:metabolism; D005260:Female; D005865:Gestational Age; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin; D002097:C-Reactive Protein