Background: Automated Insulin Delivery systems (AIDs) can improve glucose control in people with type 1 diabetes but study of their use during childbirth is limited. Some commercially available AIDs use the inControl algorithm (iCa) to automate insulin dosing. Tight glycemic control during labor and childbirth is believed to reduce the risk of neonatal hypoglycemia. Immediately postpartum insulin resistance drops leading to large reductions in insulin requirements.

Aim: To examine the performance of the iCa at time of childbirth and develop guidance for pump setting adjustments to maintain euglycemia during labor and childbirth and to prevent hypoglycemia postpartum. Cases: Five women chose to use iCa during childbirth. Two had scheduled caesarean births (CS) . One had a CS after a failed induction of labour. Two had vaginal births. All switched to lower basal rates (at least two-thirds less than their prepregnancy dose) and higher insulin sensitivity factors at least 1 hour prior to childbirth. Sleep activity (SA) was maintained prior to and during CS. Those with vaginal births switched from SA to exercise activity (EA) at time of pushing. iCa stops insulin delivery when glucose is predicted to go below 70 mmol/L in SA or 80 mmol/L in EA in the next 30 minutes.

Results: Hypoglycemia during childbirth and early postpartum was avoided in all five cases despite substantial reduction in insulin need following childbirth. Glucose levels increased after the insulin adjustments were made prior to childbirth, but rose especially after childbirth. There were larger glucose increments among those who changed from SA to EA.

Conclusion: Early adopters of iCa safely used iCa during childbirth. Precautionary reductions in insulin doses made prior to childbirth prevented hypoglycemia at time of childbirth and early postpartum. Mild hyperglycemia resulted in some. Further study is required to assess if these precautionary pump setting adjustments are necessary during labor and childbirth when using the iCa.


L.E.Donovan: Other Relationship; Dexcom, Inc., Inner Analytics, Medtronic, Tandem Diabetes Care, Inc. J.Mckeen: None. D.Feig: Advisory Panel; Novo Nordisk, Research Support; Apotex.

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