Though not FDA approved for use in pregnancy ( a very difficult and expensive approval and frequently not pursued by the drug companies), there are many cases of use of lantus during pregnancy. Its important to use what works the best to control your blood sugars. I don't believe the insulin used in the pumps are FDA approved either (but am not certain).
Switching to an insulin pump is an option that should be pursued in advance of pregnancy as there is an increased risk for DKA for patients on insulin pumps and also much greater increased risk of DKA for women who are pregnant.
Pregnancy with diabetes is not a cake walk. Its important to take anecdotes about poorly controlled diabetes and healthy outcomes with a grain of salt. Every pregnancy is different and it is dangerous to assume that you'd have the same outcome.
That being said, the stress and the worrying is worth it in the end.
I am going to try Lantus again to see if it makes a difference in my control. I know that there is no evidence to say that it isn’t safe, but adding another possible risk factor does worry me. I realize, though, that it would be better to be controlled on Lantus than uncontrolled on N. if I’m still having problems on Lantus, maybe I will try a pump.
I have the most trouble with my sugars overnight. Sometimes my sugar seems to creep up all night, and other times I wake up at 50 at 2am and need to have juice. My doctor said the goal is to wake up under 95 each day, which seems really difficult to me. A lot of times, I am around 120 in the morning, but is that too high? Have other people been able to consistently be under 95 in the morning?
Jenpsu2, I have been taking NPH before bed each night, and been pretty successful at having sugars between 75 and 90 every morning without having lows at night. Just have to find the right amount, and keep records so you can tell if your BGs start creeping up and you need to start taking more and more. At the beginning of my pregnancy, I was taking 10 units NPH before bed- now at 37 weeks, I'm taking 20.
Make sure to test before bed too- I usually eat about 15 carbs or so if I'm under 90 before bed just in case, and since it won't raise my BG too high. Just make sure not to take short-acting insulin right before bed, unless maybe you're really high, but then set an alarm to wake up to test just in case.
I would definitely advise a pump, and if you don't like the idea of disconnecting for sex, the Omnipod (tubeless pump) is great. You can keep it on while you shower, swim, have sex, do sports...everything. I actually hated the traditional pump and was on shots until my doc suggested the Omnipod -- and now I love the control the pump gives me, particularly now during pregnancy. Whichever path you take though, pregnancy is a lot of hard work, but it is very do-able.
Pumps are definitely more convenient. However, studies have demonstrated no improvement in glycemic control for pump users as compared to those on injections. Though many of us can provide anecdotes, its not applicable to everyone.
A pump is a large expense and once you dig in, you're in with that company for 4 years or duration of warranty.
While Omni-Pod is the first "patch" (or tubeless) pump, there are several more on the horizon that are sleeker and may be more appealing. It would be a pity to enter into a contract deal and then have to wait for 4 years for the subsequent upgrade.
There are two patch pumps in the works of FDA approval about which I'm excited. First, the Solo Micro Pump (http://www.solo4you.com) is sleeker but seems very similar to the Omnipod.
Even more exciting is the Jewel (http://www.jewelpump.com). What is so innovative about this (aside from the sleek and colorful infusion cartridges) is that rather than the wireless controller, you can control it with your PDA or smart phone. I think this one will be the big deal given that carrying around the wireless remote AND a phone seems like too much when you can carry one.
Until then, Tandem diabetes has a sleek new tubed pump that has garnered FDA-approval.
These are just a few things to think about.
As I mentioned, pumps offer convenience but don't necessarily confer much glycemic advantage. However, continuous glucose monitoring is a different story and has been demonstrated to improve HbA1c in patients on both insulin pumps and injection therapy. Personally, I believe that all people with type 1 diabetes should be on a CGM. The information is invaluable and can reduce the amount of time spent hyperglycemic (high) as well as alert you prior to becoming hypoglycemic (low).
It’s reassuring to hear about your successes with pregnancy and diabetes! For those of you who have had A1Cs close to 6 during pregnancy, are your sugars ever in the 200s? I have a Drs appointment in the beginning of March to see if my sugars have been good enough to start TTC. I think my A1C will be in the low 6s (hopefully) but I still have some sugars that are 250 and some that are 50. I am 50 more than I am 250. I’m not bouncing between high and low all day, but I get the occasional high reading. Is my Dr going to say this isn’t good enough? Do other people have some highs or are you able to keep your sugars very tight?
Yes, I did (this was a long, long time ago in what feels like a galaxy far, far away ;-). You will have BGs outside that 'perfect' window. Hopefully you are checking BG more often and can fix them faster than you normally would. That is what pregnancy is all about. Try not to worry too much about the individual numbers - fix and move on. Good luck at your appt!
I wanted to comment on the question about the pump- I didn't want to be attached to anything either and it was my main reason for not getting a pump, but a few years ago I started using the Omnipod pump and it's been amazing- there is no tubing, it's just an individual pod that sticks to skin and you work it with a remote control of sorts, change it every 3 days. That coupled with the CGM has been amazing and knowing that you can watch your blood sugars on the CGM and either increase or decrease your basals to adjust has been so much better for management! My husband and I are just now starting to try for a baby and these 2 things are the reason I feel comfortable doing now .
I have a pump and dresses were an issue for me... I found that wearing spanx the ones to just above the knee (of course when I'm not pregnant) and putting the pump in the leg of the spanx with the buttons facing out for easy button access under the table... its not 100% comfortable but it is better than the bra stuffing trick i used to try!