I have type 1 diabetes and am planning on conceiving my second child. When I had my first child, I was taking NPH with Regular and had no problems, but now I am taking NPH with Humalog and my doctor wants to try Lantus instead of NPH. I’m a little worried about being on different medication from the first pregnancy. Are Humalog and Lantus safe for the unborn baby and for nursing?

Neither one of these types of insulin have been formerly investigated in pregnancy. I have used Humalog in pregnancy with good results and no bad outcomes which is probably the general experience. There was a letter published in The New England Journal of Medicine that expressed concern about Humalog, because of a possible increased risk of fetal abnormalities. However, this was not a scientific study, and I have heard nothing further.

I have not used Lantus (insulin glargine) and have had not patients yet who came to me already on this type of insulin. If you want to minimize your risks, I would suggest using R and N during the first 10 weeks of pregnancy and then switching over to the other types. There should be no problems with breast feeding.

OWJ