Treating women with diabetes during pregnancy is currently a complicated, labor intensive effort for both the woman and her doctors! Work is underway to compare an insulin injection schedule using 6 injections a day versus using only 3 injections per day. The three injections a day is an experiment designed to see if a mixture of insulin of an intermediate type of insulin (NPH) combined with a rapid acting insulin (insulin lispro). The mixture is called 50/50 mix because it has an equal amount of NPH and rapid acting lispro in the solution. Taking 3 injections a day is less onerous than 6 injections and thus may prove to result in better adherence to the treatment program. 

Understanding the changes in hormones that affect women in pregnancy helps us to understand why some women develop diabetes during pregnancy called gestational diabetes mellitus (GDM). We are evaluating the levels of a relatively less well understood hormone called Glucagon-Like Polypeptide-1  (GLP-1) that influences appetite and insulin metabolism. It is known that GLP-1 is important in the development of abnormal glucose tolerance seen in  type 2 diabetes mellitus and thus  we hypothesize  it may be important in GDM because GDM has the same etiology as type 2 diabetes mellitus. Hopefully there may be new ways of managing glucose control in women with gestational diabetes in the future.

Many women with type 1 diabetes melitus find that they need less insulin during their pregnancies than would be predicted based on weight and stage of pregnancy. It is believed that everyone, even people with type 1 diabetes, make new insulin producing cells all of the time. People with type 1 diabetes mellitus, however, destroy these new cells faster than they can make them. We are studying pregnant women with type 1 diabetes mellitus to learn if pregnancy reduces how aggressively pregnant women destroy their new insulin making cells, and how we may be able to reproduce this rejuvenation of insulin secretion outside of pregnancy. We plan to start a study in which women who showed an increase in insulin production during pregnancy are given a hormone cocktail to see if we can increase their ability to make insulin even when they are no longer pregnant.