Abstract
The patient of the present study was a 37-year-old woman with a triplet pregnancy who had been diagnosed with acute-onset type 1 diabetes mellitus at 25 years of age. From 27 years of age, her diabetes was managed with continuous subcutaneous insulin infusion (CSII). She delivered her first child at 33 years of age. We herein describe the management of her diabetes during her triplet pregnancy. The insulin requirement showed a tendency to slightly increase until the 18th week of pregnancy, and increased from week 23. At the 28th week, the total daily dose of insulin was 1.9 times higher than it had been prior to her pregnancy. From week 28, we began to administer ritodrine (20 mg, orally). The patient's insulin requirement (mainly bolus insulin) increased immediately, but decreased during a few days. From week 31, we began to administer ritodrine (100 mg) by continuous intravenous infusion. The patient's insulin requirement increased again, but subsequently decreased. Triplets were delivered by cesarean section on pregnancy week 33, day 6. It was possible to precisely manage the patient's insulin levels during her triplet pregnancy. The present case showed that CSII was useful in managing the patient's insulin levels even in this case which involved a triplet pregnancy, as it allowed for the insulin dosage to be adjusted to the changeable insulin requirements throughout the pregnancy and for the fluctuations in insulin that were induced by the administration of ritodrine.
