Use of Automated Insulin Delivery Systems in the Immediate Postpartum Period

Automated insulin delivery (AID) systems are increasingly used in pregnant people with type 1 diabetes, yet the necessary guidance for use during the immediate postpartum period is not well established.

A 30-year-old-nulliparous woman with type 1 diabetes presented at 36 weeks gestation with spontaneous rupture of membranes. She used Omnipod® 5 system in automated mode with a glucose target of 110 mg/dL (6.6 mmol/L) due to her high glucose variability, history of hypoglycemia, and personal preference. She underwent caesarian section with glycemia managed by continuous intravenous insulin but resumed AID immediately postpartum. Prior to delivery, she required approximately 37 units of basal insulin daily but experienced multiple hypoglycemic episodes and frequent suspension of basal insulin after giving birth, with 8.9 units of basal insulin delivered on postpartum day one. It can take 2 weeks for the Omnipod® 5 algorithm to acknowledge reduced insulin needs. Despite proactive adjustments, she experienced intermittent hypoglycemia until her carbohydrate ratio was decreased, and target glucose was increased to 140 mg/dL (7.8 mmol/L) on postpartum day four.

Although not extensively studied, potential strategies to mitigate hypoglycemia in people using AID in the postpartum period include resetting the device, using the activity feature, increasing target glucose and adjusting sensitivity and carbohydrate ratio, or switching from automated to manual mode.

This case highlights the need for further investigation regarding optimal procedures to safely manage people with type 1 diabetes using AID in the postpartum period.