Immediately following delivery and initiation of breastfeeding, the patient’s insulin pump settings were reduced to pre-pregnancy settings:

Basal


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  • Midnight: 0.325 units per hour
  • 3 AM: 0.4 units per hour
  • 7 AM: 0.35 units per hour
  • 7 PM: 0.45 units per hour
  • 10 PM: 0.3 units per hour

Bolus

  • Midnight: 1 unit per 12 grams carbohydrate consumed
  • Sensitivity: 1 unit will drop glucose by 78 mg/dL
  • Blood glucose goal: 90 to 100 mg/dL
  • Active insulin time: 4 hours

After these adjustments in insulin pump settings were made, the patient’s glucose values ranged between 80 to 100 mg/dL with no hypoglycemia. The patient was successful in breastfeeding.She was discharged from the hospital 24 hours after delivery on the above reduced insulin pump settings, with ongoing outpatient endocrinology follow-up.

The patient followed up with the endocrinology nurse practitioner 2 weeks following delivery. She continued on her insulin pump, and settings were adjusted due to some hyperglycemia noted during the day after meals.Bolus setting was adjusted from 1:12 to 1:10 g carbohydrates consumed to address this hyperglycemia.

At this visit, the patient reported that she is doing well with breastfeeding. Blood pressure is stable at 110/70. The patient reported that she had never been on statin or angiotensin-converting-enzyme (ACE) inhibitor therapy. It was requested that the patient return in 3 months for a repeat hemoglobin A1c, lipid, creatinine, and microalbumin evaluation.

At that appointment, whether or not the patient should initiate statin and/or ACE inhibitor therapy for cardiac and renal protection was assessed.At that appointment, it was be assessed if patient should initiate statin and/or ACE inhibitor therapy for cardiac and renal protection.