July 18, 2000
Family Planning, Insulin Analogs
Question from :
I’m currently using Humalog in the pump and planning a pregnancy. The doctor hasn’t said anything about switching insulins. If your blood sugar has to be 105 before meals and no higher then 120 one hour after, how would you adjust if the Humalog peaks after 2 hours? Would it be dangerous for the baby in the meantime while the insulin is working up to the peak time?
Continuing on Humalog is fine during the pregnancy. The Humalog should not be peaking that late after infusion. You may need to adjust your infusion rate and/or carbohydrate ratio if you are getting too low after meals. The baby should be fine as long as your blood glucose is not too low or high.
Additional comments from Dr. Tessa Lebinger:
I interpret your question a little differently from Dr. Jones. I believe Dr. Jones thought the problem is that you are going low after meals and has given you an appropriate answer to that problem. I am under the impression that you are concerned that your Humalog may not be working fast enough to avoid a temporary high right after you eat. I will try to give you an answer to that problem. This way you will have two answers to two different problems.
If you are concerned that your Humalog isn’t working fast enough, there are a couple of possibilities to discuss with your own doctor:
You may want to wait 15-45 minutes after injecting your bolus before you start to eat (as long as your blood sugar is not low or falling when you bolus). It has been my impression, that in many people, Humalog does not start working within 15 to 30 minutes, but may not start to work until 30 to 60 minutes after injection. Although I have no scientific data to support my observations, I think this often happens in people who had the more delayed and prolonged response to Regular. It is also my impression, that initially in some people, Humalog may start to work quickly, but after more prolonged use, may not start to work so quickly.
You may want to divide your meals into 2 or 3 smaller meals.
Keep in mind, that during pregnancy, absorption of food may be much slower than in the non pregnant state (this has nothing to do with diabetes and occurs in non-diabetic pregnant women also). Even if your Humalog doesn’t seem to work fast enough when you are not pregnant, it is possible that it may work fast enough when you are pregnant and your food is absorbed more slowly. Unexpected low blood sugars can occur without warning in pregnancy, especially during the first trimester when insulin requirements may actually transiently decrease before they dramatically increase during the second and third trimester. If you are also having delayed absorption of food, you may be more prone to low blood sugars if you delay eating so be careful and test extra if you and your doctor decide to try this approach.
Sometimes, no matter what you do, you just can’t avoid some mild elevations of blood sugar immediately after eating and avoid low blood sugars a few hours later. You must work with your own team to figure out how to have the fewest elevations of blood sugar but still avoid serious low blood sugars.
Good luck and remember that if you are being this careful now, before conception, and continue to work for the best control possible (keep in mind that it is impossible to have all your blood sugars normal in pregnancy — the only way you will know you have to raise your insulin is to see some elevated blood sugars), your chances of having a healthy, normal baby are excellent. When you are working this hard for “perfect” control and see some abnormal blood sugars despite all your efforts, it is easy to get upset (and understandable). Try not to let this spoil the thrill of expecting a baby!
Please remember not to make any changes without first consulting with your own physician.
[Editor’s comment: In an earlier question and answer, the issue of lack of information about the safety of Humalog during pregnancy, and a preliminary report of problems during pregnancy while using this product, was discussed. I’ve not seen any further concerns since then.