I am 35 years old and 31 weeks pregnant.I have been on Lantus ever since I was pregnant. This is my second pregnancy. My current A1c is 6.5%. My first pregnancy was well controlled with an average A1c of 5.8%. My delivery was normal and son’s weight was 7 pounds (3.2 kilograms). My endocrinologist changed me to Lantus before knowing I was pregnant, but he didn’t discontinue it because he felt that nighttime lows were more dangerous in my case.

During labor, can I opt not to have a drip of insulin and glucose? I understand that Lantus works 24 hours so is there still a need for an insulin drip? Also, I read somewhere that Lantus cannot be administered intravenously am I correct? If so, what alternatives are there if I HAVE to have a drip regardless?

You do not always have to have an insulin drip during labor. The advantage is that it is very easy to control blood sugar with I.V. insulin since the effect is immediate. The disadvantage is that you have to check your blood sugar frequently, usually every hour while the drip is going. Lantus is designed for slow absorption and prolonged action, thus there is no point to using it intravenously. In fact, the PDR specifically cautions against intravenous use because of the risk of severe prolonged hypoglycemia. Typically, Humalog or Regular insulin are given intravenously. The dose is around one or two units/hour to keep blood glucose between about 90 and 105 mg/dl [5.0 and 5.8 mmol/L]. The alternative is to check your blood sugar frequently during labor and either give you glucose or a short acting subcutaneous insulin as needed. The benefit of maintaining a moderate glucose level is to minimize the possibility of neonatal hypoglycemia.

OWJ