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Special situation in type 1 diabetes
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Special situation in type 1 diabetes10 January 2021 14:03
Pregnancy and diabetes:
Risks of:
- Congenital anomalies
- Foetal macrosomia, traumatic delivery and stillbirth
- Neonatal hypoglycaemia
- Diabetic retinopathy and nephropathy progression
Pre-conception HbA1c target < 48mmol/ mol
- Fasting (4.0 - 5.2 mmol/L)
- 1 hour post-prandial: 4.0 - 7.7 mmol/L
First trimester anxiety, nausea +/- vomiting
Insulin resistance increases dramatically in third trimester
• The maternal median age for developing type 1 diabetes is age 30 and for type 2 diabetes is
34.
• The rate of stillbirth in type 1 diabetes is 1.0%, whereas in type 2 diabetes is 1.7%.
• Neonatal death in type 1 and type 2 diabetes is the same (1.0%)
Kidney disease:
Diabetic nephropathy
Insulin clearance and hypoglycaemia
Glucose measurement pitfalls
In the liver, the insulin receptor internalises insulin and there is substantial insulin clearance
(substantial hepatic insulin clearance) after insulin had its initial effect.
The insulin gets away through the liver is then cleared substantially by the kidney. As filtration rate
declines, chronic kidney disease progresses. The amount of insulin clearance by kidney reduces.
This can result in major changes in pharmacokinetic and pharmacodynamic profiles of insulin
making, which last much longer in system.
Kidney disease also has an effect on glucose measurement, specifically by hand-held metres. The
measure of blood glucose level is guide to insulin therapy.
Kidney disease: glucose meter interference
Different enzyme and mediator systems have different characteristics. Glucose oxidase is particularly
affected by the oxygen concentration of blood, with glucose readings being elevated by hypoxia,
reduced by excessive oxygen concentration.
Glucose dehydrogenase is not affected to anywhere near the same extent by those interferences.
Icodextrin is a complex carbohydrate that forms as part of peritoneal dialysis fluid. Severe
hypoglycaemia cases have been result of measurement of glucose with glucose-1 dehydrogenase
pyrroloquinoline quinone conjugate which responds to Icodextrin and to several of its metabolites .
Special situation in type 1 Page 1
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