I am almost 10 weeks pregnant and when I first found out at 4 weeks the perinatologist switched me from Lantus (that was working fairly successful for me) to NPH. (I also do MDI of Humalog and check my BS almost once an hour). She said it was easier to make adjustments as the pregnancy continued. I also read up about Lantus not being approved for pregnancy because their really hasn’t been enough studies done on it. The NPH has spikes that do not coincide with my body and I do not appreciate the lows I keep having in the middle of the night. My Endo and my new OB are working with me to try and figure out the best solution. In the meantime, I’m frustrated and having a hard time enjoying the joys of growing a baby! My OB also said that he was completely fine with me going back to Lantus if I wanted. I have tried the pump in the past (before pregnancy) and it didn’t seem to be the best things for me for a number of reasons.
Has anyone used Lantus and found it to be successful for their entire pregnancy? I’m not sure what to do. Any thoughts or suggestions are appreciated!
I am on Lantus and Humalog normally. I take injections not a pump. But even when I was thinkning aobut getting pregnant, my endo also ADDED NPH. She did not replace the Lantus with NPH. I know this is not a site for medical advice, but in my humble opinion I would disagree with taking the Lantus away all together.
You are correct, NPH is going to have a spike about 5-6 hours after you take it. for instance, I take 2 units at 11 PM to fihgt off morning highs, but that is it. I still take Lantus 2 times a day morning and night for 24 hour base coverage. I have not seen or heard anything about Lantus not being approved during pregnancy at least not in the US.
I am 22 weeks along with my first child and having the regiment my endo has given me has my A1C at 5.8 and I do not need to worry that I am going to hit a low in 5-6 hours because I took a shot of NPH. To me going back to NPH like this is stepping back 15 years. I hope others will have thoughts for you as well, but that is my 2 cents.
What about Levemir? I used to be on Lantus but switched to Levemir about a year ago and I don’t really notice a difference. I believe Levemir is approved for pregnancy.
I was on Lantus and Humalog when I became pregnant. My endo switched me to Levemir early on because it has been approved for pregnancy. It ended up being very similar to Lantus and worked well for me throughout the pregnancy.
Thank you for sharing your experience!!! I have spoken with both my Endo and my Ob. I am going to go back on the Lantus with the option of using the NPH additionally if needed. He said that right now the known risk of all the lows outweighs the unknown risks of using Lantus during pregnancy. My doctors have very little experience with Levemir.
Lantus users-How many units of lantus per day did you use pre-pregnancy? I take 26 units per day. I also use humalog with a 1:15 carb ratio. According to www.lantus.com/.../dosing-calculator.aspx my dosage is much higher than the starting dosage for my weight. My endo started me with around 22 units around 5 years ago. I used NPH previously.
I've never seen or used the Lantus calculator for insulin dosages. My doctor based it on what I was taking previously with NPH and then what my sugars were after fasting and throughout the night. Also, we took into account the Humalog that I am taking for my meals which was also 1:15 like yours. That said, pre-pregnancy, I was taking 12 units of Lantus before bed and 5 units in the morning. I'm 5'7" and weight 135lbs. Every body is different in how we process and digest food, so I'm not sure there is a right answer based just on weight.
Do you find yourself needing less Humalog than 1:15 during the day? Are you having lows every night? How often are you checking your sugars? All these questions helped me in finding the right balance of insulin.
There's a really good book called "Using Insulin" by John Walsh that gives the formulas but then also gives advice for tweaking your dose. You really should visit with your doctor to make adjustments.
There are a lot of factors that affect insulin sensitivity. The timing and amount of insulin you need is purely personal and varies a lot from one person to another.
My guess is that your lows are because Lantus/Levemir give a flat base rate of insulin. Most of us have a naturally decrease in our base insulin needs from mid-morning until after midnight.
You might need to compensate for that by adjusting your carb ratio during the day, e.g. use 1:15 at breakfast then switch to 1:20 or 1:25 for the rest of the day. You may also need to eat snacks to offset the lows, especially if you're having a low at night, have a bedtime snack with some carb and protein. Set your alarm for 3am to test.
When pregnant I would test:
First thing in the morning
Before eating
1 hour after eating (to see if a correction bolus was needed)
Before bed
If I woke up in middle of the night
Before exercise
About an hour after exercise
Before driving (I do this as a safety thing, especially when I'm stressed)
When I was on Lantus pre-pregnancy I was taking 14 units per day, but I split it into two doses: 7 units in the am and 7 units in the pm. Lantus never seemed to last 24 hours for me. I took the same amount when I switched to Levemir while pregnant (and the amount didn't actually increase during pregnancy even though my Humalog ratio went from 1:15 to about 1:4 by the third trimester).
But of course this varies from person to person and you have to find the amount that keeps your blood sugar stable when not eating for several hours. If 26 units works for you, I wouldn't worry about it being "too much for your weight," but if you are having a lot of lows throughout the day, you may need to adjust it. My endo used "total units of long term and short acting should be roughly the same each day" to set my dose initially, and then we adjusted from there. I don't know how much there is to the total units per day argument, and it certainly was not true during pregnancy, but it worked for setting up my dosing initially.