Successful pregnancy in severe diabetes

Jeandidibr, N; Miranda, E; Mathelin, Carole; Boivin, S; Pinget, M.

doi:10.1016/0140-6736(92)91258-a

Cited by 3 publications

(1 citation statement)

References 1 publication

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“…In summary, the main criteria for implantation are: age < 65, abdominal wall in good conditions, and type 1 diabetes, though good results have been reported with insulin-requiring type 2 patients [29], no major counter-indications to intensive insulin therapy (see above). Other relative counter-indications are severe handicaps e. g. vision loss, multiple abdominal surgeries, professions at risk of abdominal trauma, and finally pregnancy until insulin is approved for this latter indication, though several anecdotal experiences have confirmed safety and efficacy during pregnancy [36,37]. In all cases, a pre-implantation observational phase of some months is recommended, including some experience with an external pump.…”

Section: Indicationsmentioning

confidence: 99%

External and implantable insulin pumps: current place in the treatment of diabetes

Selam

2001

Exp Clin Endocrinol Diabetes

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External insulin infusion (CSII) pumps have regained interest since DCCT, the number of patients approaching 100,000 in the USA. Only 2 manufacturers (Minimed, Disetronic) and 2 insulins (lispro, insuman) are sharing the market. The major advantages over multiple s.c. injections (MDI) are a reduction of nightly instability and hypoglycemia, and time flexibility. Patients poorly controlled under MDI and/or with recurrent hypoglycemias thus represent the best indications. Pumps are predicted to expand in some european countries e.g. France with changes in reimbursement regulations. Implantable insulin pumps are still not commercialized except in few countries e.g. France. Therefore only 1065 pumps have been implanted worldwide so far. The only material available is the Minimed 2007 pump, with the Aventis Genapol insulin. The catheter is intraperitoneal for portal insulin absorption. Metabolic results are better than CSII in terms of glycemic fluctuations and hypoglycemias. Adverse events are limited to catheter obstructions (15% per patient-year). Ideally, indications should be restricted only to patients with recurrent severe hypoglycemias and/or poor control with CSII because of high cost of the pump ($ 15,000).

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Section: Indicationsmentioning

confidence: 99%

External and implantable insulin pumps: current place in the treatment of diabetes

Selam

2001

Exp Clin Endocrinol Diabetes

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Difficult Diabetes

Saunders¹,

Williams²

2004

International Textbook of Diabetes Mellitus

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Diabetes can be a very difficult disease to manage. This is particularly true when confronted with a patient who attends with recurrent episodes of hypoglycemia, diabetic ketoacidosis, or mixed glycemic instability. This chapter aims to explain the common causes of such presentations, and the suitable investigations to identify a treatable cause. Further to this, if a diagnosis cannot be reached and the problems still persist, the chapter then discusses the diagnosis and management of “brittle diabetes.” This complex and often misunderstood disease affects only a very small minority of patients with type 1 diabetes but requires a considered and careful approach to its diagnosis and treatment. Such issues are discussed within this chapter.

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