Postpartum glycaemic management in women with type 1 diabetes

Immediately after delivery, women with type 1 diabetes should have their blood glucose concentrations monitored hourly for at least 6 hours. The intravenous insulin and glucose infusions should be continued until regular meals are started.

While insulin treatment is being restabilised, women with type 1 diabetes should ideally be reviewed several times each day until discharged home. Blood glucose concentration should be checked before each main meal, 2 hours after each main meal, before bedtime and at 2 am while in hospital.

When restarting subcutaneous insulin in a woman with type 1 diabetes, the required dose is usually much lower than the dose used before pregnancy. Initial preprandial (before meal) doses of rapid-acting insulin may be as low as 0.06 units/kg (eg 4 units in a woman weighing 60 kg). The initial basal insulin dose is typically 0.1 to 0.15 units/kg daily (eg 6 to 9 units daily in a woman weighing 60 kg).

For women using a continuous subcutaneous insulin infusion (CSII) pump, postpartum insulin delivery rate settings need to be lower than those used before pregnancy. Settings should be reviewed daily for the first week, and at least weekly for the first month. The required setting changes (basal rate, insulin-to-carbohydrate ratio, insulin sensitivity factor, glucose targets) should be provided as part of the management plan by the woman’s multidisciplinary diabetes team.