title: Insulin requirements in late pregnancy in women with type 1 diabetes mellitus: a retrospective review.
abstract: Pregnancy in women with type 1 diabetes mellitus (T1DM) is generally associated with increased insulin requirements.
  
  
  OBJECTIVE
  To determine the frequency and significance of declining insulin requirements in late gestation in women with T1DM.
  
  
  METHODS
  We conducted a retrospective review of 54 women seen at our institution from 2006 to 2010 with a diagnosis of T1DM pre-pregnancy and presentation for antenatal care prior to 28 weeks. Information was collected regarding patient demographics, insulin dose and pregnancy outcome. A 15% difference in weight-adjusted basal insulin from 30 weeks gestation to delivery was considered significant.
  
  
  RESULTS
  Five women (9.3%) had a fall of 15% or more and 23 (42.5%) had a rise of 15% or more rise in insulin requirements. There were fewer neonatal intensive care admissions but more infants with an APGAR <8 at 5 min in women with a fall in insulin requirements. These differences were not evident when the data were re-analysed by quartiles of change.
  
  
  CONCLUSIONS
  In most women with T1DM, insulin requirements show little change from 30 weeks gestation until delivery. Almost 10% of women had a significant fall in insulin requirements which did not correlate with adverse neonatal outcome. These results require validation in a larger, prospective trial.
authors.affiliation: University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia. Naomi_Achong@health.qld.gov.au
authors.forename: N
authors.initials: N
authors.lastname: Achong
authors.forename: L
authors.initials: L
authors.lastname: Callaway
authors.forename: M
authors.initials: M
authors.lastname: d'Emden
authors.forename: H D
authors.initials: HD
authors.lastname: McIntyre
authors.forename: K
authors.initials: K
authors.lastname: Lust
authors.forename: H L
authors.initials: HL
authors.lastname: Barrett
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D004351:Drug Resistance; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D010044:Outpatient Clinics, Hospital; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011254:Pregnancy in Diabetics / Q000097:blood / Q000188:drug therapy*; D011295:Prenatal Care; D011793:Queensland; D012189:Retrospective Studies; D017216:Telemedicine
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin