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Christina17

T2 TTC- insulin question- which are safe?

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Christina17

Hi all...I'm new to the forums. I'm Christina, a T2 age 36 and trying to conceive after a miscarriage 4 years ago. I went for pre-conception counseling and was advised by my OB that I can change from Janumet to Glyburide. My PHP chose to put me on insulin as he felt it was safer and I would get better BS control. I am now on Lantus 25 units at bedtime and Apidra 15units 3 times a day with meals. My most recent A1C in early September was 7.1 down from 11.5 in Feb ( my OB wants it 6 or below). I've done some research and found that both insulins are pregnancy Category C and wonder if anyone has a better suggestion from their experience. Having had a miscarriage previously I am a nervous nelly! I recently had back surgery and have had some major swings in my BS, particularly my fasting. I find that my body does not tolerate most carbs (even complex) well but I cannot stick to a totally low carb diet. I hate to keep increasing insulin and feel a bit frustrated! Help!

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telizas

I don't know much about other insulins. I used Novolog 70/30 when I was pregnant and had great control. Took it twice a day with breakfast and dinner. Since you're not pregnant already, using a Cat. C drug isn't an issue. The doc may very well switch you when you're actually pregnant.

 

You WILL have to adjust your insulin needs as your pregnancy progresses. You just will. They will go up as you get further along.

 

Also, a Cat C drugs means that there have been adverse effects in animals, but there haven't been any good studies in humans. It also means that its benefits outweigh its risks. I know that Novolog is a Cat B drug. Using something like Novolog 70/30 would mean fewer injections overall, and is proven safer.

 

Discuss it. If a Cat C drug is too risky for your own peace of mind, insist you switch. Its not an unreasonable request.

 

Good luck! :)

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Christina17

I know that my insulin needs will increase with pregnancy and I am prepared for that. I am on some other meds for blood pressure and acid reflux and just fear that too many meds in general additionally with some being cat C makes me a bit nervous. I know that the benfits outweight the risks, but just wanted to be more educated as I know there are some insulins that are cat B. My doc tends to like to prescribe what his pharm reps push and although he is willing to work with me, he seems to believe that older insulins will not give me the best control and I'm feeling that I may be being a bit paranoid. Overall I know that I will insist on something in the cat B range, and was hoping to educate myself a bit before i go to my next appt. Also some docs tend not to be as informed as I would like- his partner automatically put me on cat C insulin knowing that I am trying to conceive. I've tried googling "pregnancy cat b insulins" and haven't really found a definate answer. I greatly appreciate your input and will absolutely look into the novolog....are you also on any short acting insulins ?

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telizas

I was on Lantus and regular Novolog the last few months but I use a pump now, so its just regular Novolog all the time. The Novolog I mentioned is 70/30, so a mix of short and long acting, which is similar to taking Lantus and regular Novolog. Its just mixed to make it easier. There is also a Humalog mix as well.

 

If you stay with the two different insulins, its the same routine as MDI, which, while its more work, will give you better control. I took the mix while pregnant and then tried oral meds which made me so, so sick. I demanded to be put back on insulin and I feel so much better.

 

If it makes you feel any better, I am a birth doula and my last client was on the same routine you're on now, although she had gestational diabetes. She had a healthy 6+lb baby boy two months ago. :)

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sarahspins

When I was pregnant with my first, ALL insulins were category C. I was on R and N at the time, being newly diagnosed, that's all they would let me have.

 

With my second, only R and N had been moved to category B (safe for pregnancy)... but I pumped Novolog throughout (a category C) and really didn't give it a second though - I wouldn't have been able to get the control I had with Regular. I was also on Zantac throughout which at the time was also a category C. My OB was fine with that, and didn't seem worried about either one.

 

With my last baby, nothing had changed in terms of insulins and their pregnancy categories, but I was on Lantus and Novolog... and I kept taking both them without much concern.

 

Currently, everything but the long acting analogs and Apidra is category B, so considered safe (well, not in Canada..).

 

Right now I am using Apidra and I would continue to use it even if I were to get pregnant (hope not!) simply becuase I have bad skin reactions with the other two rapid insulins... it's what's working best for me right now.

 

I would also HIGHLY recommend consulting with an endocrinilogost... you'll want to be seeing one while pregnant for your diabetes management anyways, and they may also have some different strategies to get your A1C even lower.

 

A pump may be an option for you as well.. as a T2, pregnancy or pregnancy planning can often make pump approval much easier. Novolog and Humalog (rapid insulins similar to Apidra) are both category B and considered safe during pregnancy. Pumping can make your control easier, since you can accomodate for changes in your basal needs fairly quickly.

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Christina17

thanks so much....I feel so much better now hearing what you have to say. Although I do trust my doctors, for some reason it makes me feel better hearing from "real people" LOL and their experiences. So far I seem to be doing relatively well with the Lantus and Apidra- only some slight issues with fasting BS and my 2 hour post breakfast BS. My lunch and dinner numbers seem to be pretty good. All my numbers are ADA "normal" and my PHP doc is happy with them, however the OB requires tighter control, something my PHP claims is impossible and unrealistic. However I see that many people are managing to get A1C's well below 6 and fastings below 95 and 2 hour post meals under 120. I know it's possible with work and dedication! I will definately look into an endocrinologist as well...thanks for all your information!

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sarahspins
the OB requires tighter control, something my PHP claims is impossible and unrealistic.

 

It's possibly not a popular opinion, but for your PCP to get you there, it is unrealistic.. especially if he describes it as "impossible". You really do need the benefit of an endo and/or a *good* CDE who knows a lot about all kinds of diabetes and pregnancy to help get you there.

 

Your PCP has likely done a lot for you, especially recently by even putting you on insulin, but you may be reaching the end of his ability/knowledge. It's okay to seek assistance elsewhere.

 

As far as morning #'s and breakfast. A lot of us need more insulin to cover breakfast than other meals. Since you mentioned being on a fixed dosing schedule, that is also something else an endo/cde can help you with.. learning to adjust your insulin to match your food, rather than the other way around, and also including correction doses for higher pre-meal numbers can go a LONG way to getting tighter control and starting to see that A1C get closer to 6 (or lower) :)

 

It isn't impossible, I promise, but it will take some time and effort. You really are doing GREAT now compared to Feb and I presume before. The changes you need to get to 6 from where you are now are really pretty subtle compared to getting to 7.1 from where you were.

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Christina17

You are right, I really should be getting hooked up with an endo....I encouraged my father to do that a few years ago, however he had difficulty finding one that didn't specialize in fertility. I will definately check my insurance now. I know I will also be followed by maternal fetal medicine once I am pregnant, but will take steps to go to an endo regardless. I really appreciate the encouragement and am trying not to be too hard on myself. I still struggle ALOT with eating correctly and haven't been able to shake my darn sweet tooth yet, but fully recognize that being diabetic doesn't necessarily mean never being able to have cake again either! I need to find a balance with that. But you are so right, I have come a long way from a 11.5 to 7.1 in 6 months and getting in the 6 or beloew range is not that far off. Thanks again!!

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thesweetestlove

I am on Humulin (NPH) 46 units at bedtime and Humalog with meals and I am pregnant and due in May. My A1C is around 5% - My fasting blood sugars were always high and it took me awhile to figure things out. I am also on 1000mg of metformin twice a day. I have to have the NPH at bedtime and I have to shoot up again first thing in the morning before I do anything. If I shower first, my bs goes through the roof! Also, I have to eat low carb for brekky or it throws my whole day off. Good luck with TTC and congrats on getting your A1C down. Keep going, you can do it!!

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Christina17

thanks for the info....there seems to be so much conflicting information out there both via internet and doctors about which meds are considered safe or approved during pregnancy. My OB had suggested Glyburide as first line and advised that the metformin was only OK if I insisted on it. Whereas my primary advised insulin as being safest. It seems as though they have individualized opinions rather than there being a standard for pregnancy. I also realize that the benefits have to outweigh the risks of meds and doctors are inclined to suggest what they are familiar with. I'm am still vigilant about being informed so that I can make a good decision and find it helpful to hear from others that have experience. Congrats on the baby thesweetestlove!

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