HYPOGLYCEMIA - THE PRICE OF INTENSIVE INSULIN THERAPY FOR PREGNANT-WOMEN WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Objective: To evaluate the risk of hypoglycemia associated with intens ive insulin therapy of type I diabetes during pregnancy. Methods: Eigh ty-four women with type I diabetes were recruited before 9 weeks' gest ation and received intensive insulin therapy throughout pregnancy. Pat ients monitored glucose concentrations with memory glucometers, and in sulin dosages were adjusted weekly accordingly. A detailed history of clinical hypoglycemic events was obtained at each weekly clinic visit. Results: Clinically significant hypoglycemia requiring assistance fro m another person occurred in 71% of pregnant patients, with a peak inc idence between 10-15 weeks. Severe hypoglycemia during the early weeks of embryogenesis was not associated with an increase in embryopathy. Glycemic control was similar in women with or without recurrent hypogl ycemia, but glucose fluctuations were significantly greater in hypogly cemic women. Conclusion: Severe hypoglycemia is a significant maternal risk associated with intensive insulin therapy of pregnant women with type I diabetes. In women with recurrent episodes of hypoglycemia, th e clear benefits of strict glycemic control must be weighed against th e hazards of hypoglycemia.