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Question:

From Kaohsiung, Taiwan:

I have type 1 diabetes and have recently become pregnant. I've been using NovoRapid in conjunction with Insulatard for the past three years. Prior to that, I was using Novolin NPH and Humalog. I moved several years ago to a different country and that is what caused the switch in insulin. I find I get my best control when I do the basal and bolus system and base my bolus injections on the number of grams of carbohydrates at each meal.

I went to my endocrinologist to have my A1c checked and to tell him that I'm pregnant. He immediately told me that I could no longer take NovoRapid and that I would need to switch to a slower acting insulin. This, of course, infuriated me because I know from past experience that I do not have good control using the slower insulins. Within the first day of the switch, my before meal sugars went from 5.5 to 10 mmol/L [99 to 180 mg/dl] and my one hour post meal blood sugars went from 7.3 to 16.5 mmol/L [131 to 297 mg/dl]. I'm not happy, to say the least, because I'm still in the very early and very vulnerable stage of pregnancy. I don't understand why the doctor would switch me from a good program to an unknown program at such a vulnerable stage. I don't understand why he would take me off NovoRapid and insist that I use Actrapid instead.

My husband and I both agree that this doctor doesn't know what he's doing. In fact, he had to leave the room and consult with another doctor during my visit because he wasn't "sure" of what he was telling me. When I asked him his reasoning for the insulin change, he said it was because NovoRapid is not proven okay to use in pregnancy. I know from personal research that NO insulin is proven okay for use during pregnancy because you can't test in vitro for medicine safety. And, I also know that in the U.S. and Canada, NovoRapid or Humalog are frequently used during pregnancies. I was switched to Humalog years ago for the simple reason that I was trying to get pregnant and my doctor at the time felt I would have better control before, during and after by using it.

I, of course, will be finding a new doctor, but, in the meantime, I also want to switch back to using my NovoRapid and throw out this nonsense Actrapid. I don't want to lose or harm my baby. What's your recommendation?

Answer:

I have used Humalog in combination with NPH without any problems in my patients. If you want to be completely strict about it, the most experience in managing diabetes in pregnancy has been with Regular and NPH insulins. There is some theoretical concerns with the very long acting insulin (Lantus), but, once again, there is no data in pregnancy and the general experience has been positive. Thus, if your best control is with the very short acting and medium acting insulins, then I would recommend that you continue with this regimen.

OWJ

DTQ-20060629012004
Original posting 5 Jul 2006
Posted to Insulin and Pregnancy

  
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Last Updated: Tuesday April 06, 2010 15:10:08
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