Should a pregnant woman with diabetes use an artificial pancreas

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The benefits of an artificial pancreas are ever increasing and potentially vast. Current deficiencies with fully functioning models render them imperfect, though improvements are quick to come and it is possible that there could be a fully functioning and accurate model of the entire device within the next few years. Benefits of wearing an artificial pancreas include peace of mind, such as not having to worry about not having enough insulin or having too much insulin, not having to remember to take blood glucose readings multiple times every day, and not having to remember to inject oneself with insulin before every meal and before going to bed. In addition, with an artificial pancreas there would be fewer finger sticks, less counting of calories and carbohydrates, and, if the patient's insulin delivery device and continuous glucose sensor are internal, no devices to clip to one's hip or carry in one's purse.

The risk of diabetic ketoacidosis (DKA) during pregnancy would be lower with a properly functioning artificial pancreas. DKA, a condition in which the blood becomes acidic because of a sharp increase in ketones due to insulin deficiency, is a major reason why in the past diabetic women were urged not to become pregnant. It was feared that the high incidence of DKA in pregnant women with diabetes would carry a significant risk, including death. An external device may add to the risk of DKA. Since there is no long-acting insulin in an insulin infusion device, ketosis develops in a matter of hours, if the infusion set dislodges. To ensure that there is no interruption during the night, it is suggested that when women with Type 1 diabetes are using an external insulin pump, that 0.1 U/kg of NPH be given before bed. Overnight basal infusion rate should be adjusted appropriately downward to allow for this extra insulin to be on board.

Until a cure for diabetes is found, the next best alternative is the use of an artificial pancreas to replicate the endocrine activity of the pancreas. While current models of closed-loop artificial beta cells are not perfect, trials are ongoing and a fully functional device is just around the corner. The use of these devices will hopefully be widespread and improve the quality of life for many people with diabetes.

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