I am attempting to lower my A1c in preparation for attempting to conceive. I was using Lantus and Humalog and found control relatively easy, I have swapped to Humulin Lente from Lantus on my doctor’s advice, but am finding control much harder to achieve. My A1c is okay, but I am getting lots of peaks and dips which I know are potentially dangerous and I fear could get worse with pregnancy. What is the current thinking on using Lantus during pregnancy? I am trying to weigh up the relative risks of using it or continuing with these fluctuations!

There is essentially no useful data on Lantus and pregnancy at this time. There are concerns about a theoretical risk of worsening retinopathy as well as some speculation about potential toxic effects on the fetus (not as a direct effect of Lantus, but rather through stimulation of other factors). Nothing has been demonstrated in humans. Thus, the current recommendation is to not use Lantus during pregnancy. Even so, I have had some patients who used it without apparent ill effect. The only advantage of Lantus is that it is long-acting with no real peak in activity. You should be able to achieve quite good control using NPH (probably two injections daily) along with Humalog (lispro) prior to each meal. By the way, I would strongly recommend that you add a folate supplement to your diet (4-5 mg/daily). This is to reduce the risk of spina bifida in the developing fetus.

OWJ