Iranian Journal of

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Background: Fetal hyperinsulinemia correlated with large birth weight and impaired glucose tolerance test and obesity in second decades of life. In this study we compared the correlation between fetal insulin production (as estimated by amniotic fluid (AF) C-peptide concentration) and AF insulin with macrosomia (as estimated by neonatal birth weight 4000 gr).
Methods: Thirty eight neonates were studied. Ten infants were macrosom and 28 were normal (birth weight < 4000 gr). Amniontic fluid C-peptide and insulin concentration and mother and fetal blood C-peptide and insulin were measured during delivery with radioimmunoassay and mother and fetal glucose were measured at the same time and correlated with neonatal macrosomia within first hour of birth.
Results: There was a significant correlation between infant serum C-peptide level and macrosomia. Amniotic fluid insulin level was higher in the macrosom infants but this correlation was not significant. AF C-peptide was higher in the macrosom group. Also there was a significant correlation between maternal serum C-peptide and macrosomia. Infant and mother serum insulin was higher in the macrosom group.
Conclusion: Our results suggest that fetal insulin (as estimated by AF C- peptide) and mother insulin and C- peptide production, can influence fetal weight and induce fetal macrosomia.

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Background: Pump therapy (CSII) is offered as a safe and effective treatment for patients with type 1 Diabetes. We examined the efficacy and safety of continuous subcutaneous Insulin Infusion Therapy for six months as a before-after clinical trial study among type 1 diabetic patients. This is the first survey of this experience in Iranian patients.

Methods: We recruited, type 1 diabetic patients without chronic complications of diabetes (retinopathy, nephropathy and etc.) and followed them for six months as a before-after clinical study with use of the pump. The efficacy of this way was assessed with HbA₁C and fasting blood sugar measurements. Safety was estimated by frequency of clinical hypoglycemia episodes.

Results: Our patients were 7 men and 2 women aged 15 - 39 years with past history of diabetes by ranging from 0.1 to 15 years. Mean level of HbA₁C at the beginning of study and after six months follow-up were %8.6 and %7.1, respectively, with significant statistically difference between them (P= 0.02). During pump therapy the mean dose of insulin were decreased to 10 units with statistically significant difference to before investigation (P = 0.03). No case of hypoglycemia and weight loss was seen. One patient had 4 kg weight gain without any significant statistical effect.

Conclusion: It seems CSII Therapy in Iranian patients with type 1 Diabetes mellitus was effective and safe. We can not conclude about possible side effects of pump based on this study.