next article in this issue  |
|
Document Details : Title: Diabetic management in high risk patients (pregnancy, insulin pumps) Author(s): VANHAVERBEKE G, MERTENS A, MATHIEU C Journal: Acta Clinica Belgica Volume: 59 Issue: 4 Date: 2004 Pages: 173-181 DOI: 10.2143/ACB.59.4.2050403 Abstract : During the past decades our understanding about the clinical impact of diabetes has changed. We now know for certain that a good (read: near normal) glycemic control is necessary to prevent chronic complications of this disease in women regardless of the type of diabetes. Pregnancy is a specific situation whereby a “near normal” control is wanted not only for the patient but also for the fetus. Several studies have shown a correlation beween glycemic control and complications of pregnancy. Reaching optimal glycemic control is mandatory even before the pregnancy starts, considering the time window of occurance of the severe foetal congenital malformations (first weeks of pregnancy). The role of pre-conception care is emphasized. Reaching optimal control in type 1 and type 2 diabetic patients can best be reached through intensive insulin therapy, but reaching normoglycemia is mainly limited by the occurence of hypoglycemia. The introduction of the new insulin analogues is an important step in our arsenal to achieve control using multiple daily insulin injections, but Novorapid® and Lantus® have not yet been approved for use in pregnancy. Insulin pumps are often used in pregnant patients, allowing an even better glycemic control with less hypoglycemia. An absolute requirement for CSII therapy to be successful is patienteducation and motivation by an experienced team. |
