title: Insulin pump dosing across gestation in women with well-controlled type 1 diabetes mellitus.
abstract: OBJECTIVE
  We hypothesized that bolus and basal insulin doses in women with type 1 diabetes mellitus who use insulin pumps would increase 2-fold to maintain hemoglobin A1c <6.5% across gestation.
  
  
  METHODS
  This was a retrospective study of 9 women with type 1 diabetes mellitus with preconceptional hemoglobin A1c ≤ 7.4% using insulin pumps. The primary outcome was absolute and percentage change of basal and bolus insulin from preconception to delivery.
  
  
  RESULTS
  Total daily dose of insulin increased from 33.3 ± 7.8 U/d before conception to 93.5 ± 27.9 U/d at delivery. Basal rates rose modestly (50% increase, from 16.2 ± 6.5 U/d to 24.0 ± 9 U/d); bolus insulin doses quadrupled from 17.1 ± 6.1 U/d to 69.5 ± 29.6 U/d (P = .0001). Bolus insulin increased from approximately 50% of total daily dose of insulin before conception to 75% of total daily dose of insulin at 36 weeks' gestation.
  
  
  CONCLUSIONS
  In well-controlled type 1 diabetes mellitus, insulin requirements increased 3-fold from before conception to 36 weeks' gestation. Most of this requirement was attributed to an increase in bolus rates that are required for control with meals.
authors.affiliation: Division of Perinatology, Department of Reproductive Medicine, UC San Diego Health System, San Diego, CA, USA.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Roeder
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Moore
authors.forename: Gladys A
authors.initials: GA
authors.lastname: Ramos
mesh_terms: D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015918:Infusion Pumps, Implantable; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin