Optimization of insulin therapy in a pregnant woman with concomitant type 1 diabetes mellitus and a single kidney
Khasanova V.V., Yerbaktanova T.A., Yakubova E.G., Shevlyukova T.P., Arabaji O.A., Shvedsky M.S.
Relevance: Many women with type 1 diabetes mellitus (DM) are concerned about complications they experienced in previous pregnancies and they want to avoid these complications in future since it is impossible to control the level of glycemia when it goes beyond the target value and there is a need to achieve the optimal glycemic level. Case report: At 36 weeks of pregnancy a patient urgently presented to the emergency department of the Clinical Hospital "Mother and Child Tyumen" complaining of the absence of fetal movement for 12 hours and uncontrolled hyperglycemia (11–12 mmol/L according to the MiniLink monitor). The woman underwent emergency cesarean section due to the signs of fetal hypoxia, the presence of the uterine scar, type I diabetes in the stage of decompensation, diabetic nephropathy, vicar hypertrophy of the single kidney. The woman was discharged home on the 5th day from the moment of childbirth, the child was discharged from the neonatal pathology department on the 8th day in a satisfactory condition. Conclusion: The use of modern technologies in the treatment of type 1 diabetes during pregnancy including an automated insulin delivery system demonstrates promising methods of treating this complication and enables a woman to carry and give birth to a living and healthy child.
Authors’ contributions: Khasanova V.V., Yerbaktanova T.A. – collecting and processing the material; Khasanova V.V., Yakubova E.G., Yerbaktanova T.A. – writing the text; Arabaji O.A., Shvedsky M.S. – developing the design and concept of the study; Shevlyukova T.P. – editing the article.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
Patient Consent for Publication: The patient signed an informed consent for the publication of her data.
For citation: Khasanova V.V., Yerbaktanova T.A., Yakubova E.G., Shevlyukova T.P., Arabaji O.A., Shvedsky M.S. Optimization of insulin therapy in a pregnant woman with concomitant type 1 diabetes mellitus and a single kidney. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (10): 194-198 (in Russian) https://dx.doi.org/10.18565/aig.2023.2
Keywords
diabetes mellitus
insulin pump
single kidney
newborn
pregnancy
References
- Kleinwechter H., Schäfer-Graf U., Bührer C., Hoesli I., Kainer F., Kautzky Willer A. et al. Diabetes and pregnancy. Exp. Clin. Endocrinol. Diabetes. 2021; 129(1): 1-8. https://dx.doi.org/10.1055/a-1284-5758.
- Mackin S.T., Nelson S.M., Kerssens J.J., Wood R., Wild S., Colhoun H.M. et al. Diabetes and pregnancy: national trends over a15 year period. Diabetologia. 2018; 61(5): 1081-8. https://dx.doi.org/10.1007/s00125-017-4529-3.
- Айламазян Э.К., Абашова Е.И., Коган И.Ю., Аржанова О.Н. Сахарный диабет и репродуктивная система женщины. Руководство для врачей. М.: ГЭОТАР-Медиа; 2019: 432c. [Aylamazyan E.K., Abashova E.I., Kogan I.Yu., Arzhanova O.N. Diabetes mellitus and reproductive system of women. Guide for doctors. Moscow: GEOTAR-Media; 2019: 432p. (in Russian)].
- Шилова Е.С., Боровик Н.В., Ярмолинская М.И. Диабетическая нефропатия у беременных с сахарным диабетом 1 типа. Современный взгляд на проблему. Сахарный диабет. 2020; 23(4): 340-8. [Shilova E.S., Borovik N.V., Yarmolinskaya M.I. Diabetic nephpopathy in type 1 diabetes and pregnancy. Modern view of the problem. Diabetes Mellitus. 2020; 23(4): 340-8. (in Russian)]. https://dx.doi.org/10.14341/DM12228.
- Мищенко О.И., Елгина С.И., Мозес К.Б., Мозес В.Г., Рудаева Е.В. Стратегии лечения сахарного диабета первого типа на этапе преконцепционной подготовки, во время беременности и родов. Медицина в Кузбассе. 2020; 19(4): 78-84. [Mishchenko O.I., Elgina S.I., Moses K.B., Mozes V.G., Rudaeva E.V. Strategies for the treatment of type 1 diabetes at the pre-conception stage, during pregnancy and childbirth. Medicine in Kuzbass. 2020; 19(4): 78-84. (in Russian)]. https://dx.doi.org/10.24411/2687-0053-2020-10043.
- Мищенко О.И., Рудаева Е.В., Мозес В.Г., Мозес К.Б., Елгина С.И., Рыбников С.В., Рудаева Е.Г., Помыткина Т.Е. Новые технологии лечения сахарного диабета 1 типа во время беременности. Мать и дитя в Кузбассе. 2021; 84(1): 24-31. [Mishchenko O.I., Rudaeva E.V., Mozes V.G., Mozes K.B., Elgina S.I., Rybnikov S.V., Rudaeva E.G., Pomytkina T.E. New technologies for the treatment of type I diabetes during pregnancy. Mother and Child in Kuzbass. 2021; 84(1): 24-31. (in Russian)]. https://dx.doi.org/10.24411/2686-7338-2021-10002.
- Капустин Р.В., Аржанова О.Н., Тиселько А.В. Оксидативный стресс у беременных с сахарным диабетом. Сахарный диабет. 2017; 20(6): 461-71. [Kapustin R.V., Arzhanova O.N., Tiselko A.V. Oxidative stress in pregnant women with diabetes mellitus. Diabetes Mellitus. 2017; 20(6): 461-71. (in Russian)]. https://dx.doi.org/10.14341/DM8669.
- Kennedy-Grant A., Golden L. Pregnancy and type 1 diabetes: updates on technology and treatment. Curr. Opin. Endocrinol. Diabetes Obes. 2021; 28(1): 30-4. https://dx.doi.org/10.1097/MED.0000000000000605.
- Maresh M.J., Holmes V.A., Patterson C.C., Young I.S., Pearson D.W., Walker J.D., McCance D.R.; Diabetes and Pre-eclampsia Intervention Trial Study Group. Glycemic targets in the second and third trimester of pregnancy for women with type 1diabetes. Diabetes Care. 2015; 38(1): 34-42. https://dx.doi.org/10.2337/dc14-1755.
- Тиселько А.В., Ярмолинская М.И., Мишарина Е.В., Милютина Ю.П. Оценка вариабельности гликемического профиля как основа стратегии инсулинотерапии у беременных с сахарным диабетом 1 типа. Сахарный диабет. 2019; 22(6): 526-35. [Tiselko A.V., Yarmolinskaya M.I., Misharina E.V., Milyutina Yu.P. Evaluation of glycaemic profile variability as a basis for insulin therapy strategy in pregnant women with type 1 diabetes. Diabetes Mellitus. 2019; 22(6): 526-35. (in Russian)]. https://dx.doi.org/10.14341/DM10214.
- Иругова Э.З., Тлостанова Л.К., Сабанова Р.К. Влияние сахарного диабета на течение беременности. Вестник молодого ученого. 2019; 8(4): 126-8. [Irugova E.Z., Tlostanova L.K., Sabanova R.K. Influence of diabetes on pregnancy. Young Scientist's Bulletin. 2019; 8(4): 126-8. (in Russian)].
- Hoek-Hogchem R., Bovenberg S., Dekker P., Birnie E., Veeze H.J., Duvekot H.J. et al. Effects of peri-conception and pregnancy glycemic variability on pregnancy and perinatal complications in type 1 diabetes: a pilot study. Exp. Clinl. Endocrinol. Diabetes. 2022; 130(11): 740-50. https://dx.doi.org/10.1055/a-1797-8317.
- Копина В.Н. Эволюция методов самоконтроля гликемии на примере клинического случая сахарного диабета 1 типа. Эндокринология: новости, мнения, обучение. 2021; 10(3): 101-3. [Kopina V.N. The evolution of methods of self-control of glycemia on the example of a clinical case of type 1 diabetes mellitus. Endocrinology: News, Opinions, Training. 2021; 10(3): 101-3. (in Russian)]. https://dx.doi.org/10.33029/2304-9529-2021-10-3-101-103.
- Плеханова М.А., Бурумкулова Ф.Ф., Петрухин В.А. Вариабельность глюкозы у беременных с впервые выявленной гипергликемией. Альманах клинической медицины. 2020; 48(7): 469-75. [Plekhanova M.A., Burumkulova F.F., Petrukhin V.A., Budykina T.S., Panov A.E. Glucose variability in pregnant women with newly diagnosed hyperglycemia. Almanac of Clinical Medicine. 2020; 48(7): 469-75. (in Russian)]. https://dx.doi.org/10.18786/2072-0505-2020-48-069.
- Тиселько А.В. Факторы риска развития патологической вариабельности глюкозы у беременных с сахарным диабетом 1-го типа. Журнал акушерства и женских болезней. 2019; 68(3): 41-50. [Tiselko A.V. Risk factors of pathological glycemic variability in pregnant women with type 1 diabetes mellitus. Journal of Obstetrics and Women's Diseases. 2019; 68(3): 41-50. (in Russian)]. https://dx.doi.org/10.17816/JOWD68341-50.
- Schäfer-Graf U., Laubner K., Hummel S., Gembruch U., Groten T., Kainer F. et al. Gestational Diabetes Mellitus (GDM), diagnostics, therapy and ollow-up care. Exp. Clin. Endocrinol. Diabetes. 2021; 129(1): 9-19. https://dx.doi.org/10.1055/a-1284-6011.
- Ушанова Ф.О., Демидова Т.Ю., Измайлова М.Я. Флеш-мониторинг глюкозы при гестационном сахарном диабете: возможности оценки вариабельности гликемии. Медицинский совет. 2021; 12: 414-9. [Ushanova F.O., Demidova T.Yu., Izmaylova M.Y. Flash glucose monitoring in gestational diabetes mellitus: possibilities for assessing glycemic variability. Medical Council. 2021; (12): 414-9. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2021-12-414-419.
Received 09.01.2023
Accepted 15.08.2023
About the Authors
Valentina V. Khasanova, PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology of the Institute of Motherhood and Childhood, Tyumen State Medical University, Ministry of Health of Russia; Head of Maternity Department, Clinical Hospital "Mother and Child Tyumen", +7(922)-268-81-18,malofeeva-vv@yandex.ru, https://orcid.org/0000-0002-3764-5086, 625023, Russia, Tyumen, Odesskaya str., 54.
Tatiana A. Yerbaktanova, PhD, Chief Physician, Clinical Hospital «Mother and Child Tyumen», 72@mcclinics.ru, 625062, Russia, Tyumen, Yu. Semovskikh str., 20.
Elena G. Yakubova, PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology of the Institute of Motherhood and Childhood, Tyumen State Medical University, Ministry of Health of Russia, , yakubova-eg@yandex.ru, https://orcid.org/0000-0001-7201-600X, 625023, Russia, Tyumen, Odesskaya str., 54.
Tatiana P. Shevlyukova, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology of the Institute of Motherhood and Childhood, Tyumen State Medical University, Ministry of Health of Russia, tata21.01@mail.ru, http://orcid.org/0000-0002-7019-6630, 625023, Russia, Tyumen, Odesskaya str., 54.
Oksana A. Arabaji, PhD, Associate Professor at the Department of Obstetrics and Gynecology of the Institute of Motherhood and Childhood, Tyumen State Medical University, Ministry of Health of Russia; Head of the Women's Health Clinic, Clinical Hospital «Mother and Child Tyumen», 625023, Russia, Tyumen, Odesskaya str., 54.
Maxim S. Shvedsky, VI-year student of the Institute of Clinical Medicine, Tyumen State Medical University, Ministry of Health of Russia, 625023, Russia, Tyumen,
Odesskaya str., 54.
Corresponding author: Valentina V. Khasanova, malofeeva-vv@yandex.ru
Similar Articles
