**2.2 Case report Betty**

**Focus**: influence of pregnancy on HbA1c, INS/d, and BMI in a lady with T1D using a pump without CGM, and effects of hybrid MiniMed 780G implemented after pregnancy.

**History:** Betty (today 33 y/o) was diagnosed with T1D at the age of 14 years in September 2004 in pediatric department of regional hospital. She was immediately treated by means of an insulin pen with insulin aspart and detemir, a maximum dose of insulin was 20 IU/d. In 2007, insulin pump Animas was implemented as the main form of insulin therapy. In 2015 the pump Animas was replaced by MiniMed 640G. In the course of the first pregnancy, a decrease in HbA1c and marked increase in INS/d could be seen. She gave birth to a boy (delivery July 8, 2015 by Cesarean section, 4.48 kg, 54 cm). The parameters from August 31, 2015 demonstrated improved compensation (lower values of HbA1c), however, the amount of insulin per day was nearly doubled (**Table 2**, **Figures 5** and **6**). Betty had a second pregnancy in 2019 (delivery November 1, 2019 by Cesarean section, girl 4.75 kg, 53 cm). During this second pregnancy, there was an apparent decrease in HbA1c concentration and an increased supply of exogenous insulin (161 IU/d). To explain these similar changes in HbA1c and INS/d it is worth noting that placenta is permeable to glucose but impermeable to insulin [23, 24]. Therefore, the insulin from fetal pancreas may create new fetal adipose tissue by converting the glucose crossing through placental barrier from mother's plasma. These pathways may result in fetal macrosomia (which is a known complication associated with raised HbA1c concentration in the last trimester of pregnancy). Only a minority of pregnant women were able to optimize their glycemic control. This makes CGM and hybrid insulin pumps all the more favorable for treatment during pregnancy [25, 26]. However, Betty could receive the hybrid pump MiniMed 780G as late as in April 2021. Current TIR: 96% (January 5, 2023).


### **Table 2.**

*Betty's clinical and laboratory parameters over the last 8 years.*

*Benefits of Implementation of Insulin Pump in People with Type 1 Diabetes: 10 Case Reports DOI: http://dx.doi.org/10.5772/intechopen.110073*
