Continuous subcutaneous insulin infusion. Improved blood glucose in pregnant diabetics

The effect of continuous subcutaneous insulin infusion (c.s.i.i.) on the control of blood-glucose concentration and outcome of pregnancy was assessed in two pregnant diabetics (class B and class C White classification) who were poorly controlled with conventional insulin therapy. The insulin pump was carried in a holster and enabled the patients to ambulate freely. The patients were able to refill the syringe, to augment the infusion rate at mealtime and to change the implantation site of the needle weekly, and thus, were able to leave the hospital. Daily glucose profiles were assessed 1-3 times a week, and the infusion rate was readjusted accordingly. Twenty-four hours glucose profiles were obtained from both patients during inpatient conventional insulin regimens, and then, during c.s.i.i. which was maintained for 41 and 145 days, respectively. Mean 24 hours glucose concentrations were reduced from 156 to 113 mg/100 ml, mean fasting glucose from 152 to 106 mg/100 ml, and mean diurnal variation (maximal excursion) from 75 to 65 mg/100 ml. The favourable results achieved with the c.s.i.i. enabled both patients to reach the 18th week of gestation and to deliver healthy non-macrosomic infants, who had uneventful and morbid-free neonatal periods. Since the c.s.i.i. supplies insulin in a more physiological manner than twice daily regimens, better control of blood sugar and body fuel metabolism may be achieved. By extending the therapy to the early stages of pregnancy, or if possible to pre-conceptional period, reduced perinatal mortality and morbidity may be anticipated.