title: Peripartum management of glycemia in women with type 1 diabetes.
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.
  
  
  METHODS
  We conducted a retrospective review of women with type 1 diabetes delivering singleton pregnancies from 2005 to 2010. Information was collected regarding demographics, medical history, peripartum management and outcome, and breast-feeding. To detect a difference in time to first postpartum blood glucose level (BGL) >8 mmol/L between women with an early (<4 h) and late (>12 h) 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 BMI 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 hypoglycemia (r[36] = 0.434, P = 0.007). Almost 60% had at least one BGL <3.5 mmol/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 prepregnancy insulin requirement resulted in the lowest rate of hypoglycemia and glucose excursions. These results require validation in a larger, prospective study.
authors.affiliation: Corresponding author: Naomi Achong, n.achong@uq.edu.au.
authors.forename: Naomi
authors.initials: N
authors.lastname: Achong
authors.forename: Emma L
authors.initials: EL
authors.lastname: Duncan
authors.forename: H David
authors.initials: HD
authors.lastname: McIntyre
authors.forename: Leonie
authors.initials: L
authors.lastname: Callaway
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy*; D007328:Insulin / Q000627:therapeutic use*; D058725:Peripartum Period; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000188:drug therapy; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin