Lantus For Gestational Diabetes

Meta-analysis Of Maternal And Neonatal Outcomes Associated With The Use Of Insulin Glargine Versus Nph Insulin During Pregnancy

Copyright © 2012 Jacques Lepercq et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract As glargine, an analog of human insulin, is increasingly used during pregnancy, a meta-analysis assessed its safety in this population. A systematic literature search identified studies of gestational or pregestational diabetes comparing use of insulin glargine with human NPH insulin, with at least 15 women in both arms. Data was extracted for maternal outcomes (weight at delivery, weight gain, 1st/3rd trimester , severe hypoglycemia, gestation/new-onset hypertension, preeclampsia, and cesarean section) and neonatal outcomes (congenital malformations, gestational age at delivery, birth weight, macrosomia, LGA, 5 minute Apgar score 7, NICU admissions, respiratory distress syndrome, neonatal hypoglycemia, and hyperbilirubinemia). Relative risk ratios and weighted mean differences were determined using a random effect model. Eight studies of women using glargine (331) or NPH (371) were analyzed. No significant differences in the efficacy and safety-related outcomes were found between glargine and NPH use during pregnancy. 1. Introduction An estimated 4% of pregnancies in the United States are complicated by diabetes [1]. Whether due to preexisting type 1 or type 2 diabetes mellitus (pregestational) or diabetes that developed during pregnancy (gestational), hyperglycemia during pregnancy is associated with increased risk of various maternal and fetal complications. Subclinical increases in fasting blood glucose levels as little as 6.9 mg/dL and elevated postprandial plasma glucose levels have been associated with Continue reading >>

Drugs For Gestational Diabetes

Aust Prescr 2010;33:141-41 Oct 2010DOI: 10.18773/austprescr.2010.066 The prevalence of gestational diabetes is increasing in Australia. Non-pharmacological intervention with dietary measures and exercise is the mainstay of therapy in most cases, but insulin is increasingly necessary to achieve adequate glycaemic control in some women. Basal-bolus insulin is the optimal management strategy, but therapy needs to be individualised. Although there is mounting evidence for the efficacy and safety of metformin, the lack of long-term follow-up data has prevented it from being recommended by most experts in the field. Women with gestational diabetes need long-term follow-up because of their increased risk of type 2 diabetes. Gestational diabetes is defined as an intolerance to glucose that is first diagnosed or has its onset during pregnancy. It is estimated to affect almost 5% of pregnancies in Australia and between 3% and 9% worldwide. Its prevalence increases with age, from 1% in women aged 1519 years to 13% in those aged 4449 years. 1 Other risk factors for developing gestational diabetes include being overweight or obese, having a family history of type 2 diabetes or a personal or family history of gestational diabetes or glucose intolerance, being from an Aboriginal or Torres Strait Islander background or belonging to certain ethnic groups (for example Polynesian, Middle Eastern, Indian or other Asian origin). 2 Although gestational diabetes does not affect perinatal mortality, it does increase morbidity, including the risk of shoulder dystocia, nerve palsies and neonatal hypoglycaemia. Maternal outcomes are also affected, with a higher incidence of pre-eclampsia and caesarean section (particularly with poor glycaemic control) in mothers who develop gestational diabetes. Continue reading >>

Using Insulin In Pregnancy: Fda Approves Levemir

Novo Nordisk’s Levemir (insulin detemir) has been classified as Category B for pregnant women. “This is the most thrilling news since the discovery of insulin,” says Dr. Lois Jovanovic, CEO and Chief Scientific Officer of the Sansum Diabetes Research Institute and world-renowned expert in diabetes and pregnancy. “I am thrilled.” Given that Dr. Jovanovic is so unequivocally positive, the news deserves a bit more explanation for those of us who aren’t experts and aren’t pregnant. Levemir is the first long-acting insulin other than NPH to be classified as Category B. But what exactly does that mean? And why are we so worried about insulin in pregnancy anyway? The FDA, Dr. Jovanovic explains, needs to make sure drugs taken by women during pregnancy are safe for the baby, and not going to cause any birth defects or abnormalities. The FDA therefore assigns drugs to a category that indicates how they should be used in pregnancy. Category A drugs are things like vitamins—not just okay to use, but actually good for the pregnant woman and the fetus. Category B drugs are not necessarily positive for pregnancy, but all animal and human studies must indicate that the drug is safe for the mother and the baby. Category C drugs are not known to cause birth defects, but have not been sufficiently tested in humans to really be certainly safe. Up until now, untested insulin analogues, and all long-acting insulin analogues other than NPH, fell into Category C—not known to be harmful, but not known to be safe either. Now, normal, non-diabetic women produce their own insulin, and that insulin is obviously safe for fetuses. What, then, makes insulin analogues different and riskier? The answer is that insulin analogues may behave similarly to human insulin in the body, but th Continue reading >>

Safety Of Insulin Glargine Use In Pregnancy

The study was done to compare the safety of using Glargine in place of NPH insulin…. The prevalence of diabetes in women of childbearing age is increasing. As such, the number of pregnancies complicated by diabetes will inevitably increase. New insulin analogues such as the long-acting analogue insulin glargine may represent beneficial treatment options in pregnancy by ensuring that patients achieve excellent glycemic control without risk of maternal hypoglycemia. The study was done to determine the fetal safety of insulin glargine use in the treatment of diabetes in pregnancy compared with NPH insulin therapy. A systematic review and meta-analysis was performed of all original human studies that reported neonatal outcomes among women with pregestational or gestational diabetes who were managed with either insulin glargine or NPH insulin during pregnancy. A systematic literature search was conducted from 1980 to June 1, 2010. Outcomes included large size for gestational age, macrosomia, neonatal hypoglycemia, neonatal intensive care unit admissions, birth trauma, congenital anomalies, preterm delivery, perinatal mortality, respiratory distress, and hyperbilirubinemia. Relative risk ratios and weighted mean differences were computed with 95% confidence intervals. Eight studies reporting on a total of 702 women with pregestational or gestational diabetes in pregnancy treated with either insulin glargine (n = 331) or NPH insulin (n = 371) met the inclusion criteria. There were no statistically significant differences in the occurrence of fetal outcomes studied with the use of insulin glargine compared to NPH insulin. Several new insulin analogues have become available during the past decade, yet data on the fetal safety of insulin glargine are scarce. By avoiding high pe Continue reading >>

Safety Of Insulin Glargine Use In Pregnancy: A Systematic Review And Meta-analysis.

Ann Pharmacother. 2011 Jan;45(1):9-16. doi: 10.1345/aph.1P327. Epub 2011 Jan 4. Safety of insulin glargine use in pregnancy: a systematic review and meta-analysis. Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada. The prevalence of diabetes in women of childbearing age is increasing. As such, the number of pregnancies complicated by diabetes will inevitably increase. New insulin analogues such as the long-acting analogue insulin glargine may represent beneficial treatment options in pregnancy by ensuring that patients achieve excellent glycemic control without risk of maternal hypoglycemia. To determine the fetal safety of insulin glargine use in the treatment of diabetes in pregnancy compared with NPH insulin therapy. A systematic review and meta-analysis was performed of all original human studies that reported neonatal outcomes among women with pregestational or gestational diabetes who were managed with either insulin glargine or NPH insulin during pregnancy. A systematic literature search was conducted using MEDLINE, EMBASE, CINAHL, the Cochrane Central Register for Controlled Trials database, and Web of Science from 1980 to June 1, 2010. Outcomes included large size for gestational age, macrosomia, neonatal hypoglycemia, neonatal intensive care unit admissions, birth trauma, congenital anomalies, preterm delivery, perinatal mortality, respiratory distress, and hyperbilirubinemia. Relative risk ratios and weighted mean differences were computed with 95% confidence intervals. Eight studies reporting on a total of 702 women with pregestational or gestational diabetes in pregnancy treated with either insulin glargine (n = 331) or NPH insulin (n = 371) met the inclusion criteria. There were no statistically sig Continue reading >>

Diabetes Management Guidelines

Endocrine Society Guideline on Diabetes and Pregnancy Source: Blumer I, Hadar E, Hadden DR, et al. Diabetes and pregnancy: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(11):4227-4249. Available here. Refer to source document for full recommendations, including strength of recommendations and quality of evidence. Jump to a topic or click back/next at the bottom of each page Antihyperglycemic Therapy During Pregnancy Insulin therapy Long-acting insulin detemir Initiate during pregnancy in women who require insulin therapy and for whom appropriate doses of NPH insulin have caused/may cause hypoglycemia* Continue if used successfully prior to pregnancy* Insulin glargine Continue if used successfully prior to pregnancy† Rapid-acting insulin lispro and aspart Use in preference to regular soluble insulin‡ Continuous SC insulin infusion Recommended when treatment has been prior to pregnancy§ Do not initiate during pregnancy unless other insulin strategies – including multiple daily doses of insulin – tried and unsuccessful† Insulin glargine is classified as FDA Pregnancy Category C and should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus *Less strong recommendation, very high quality evidence †Less strong recommendation, low quality evidence ‡Less strong recommendation, moderate quality evidence §Strong recommendation, moderate quality evidence Noninsulin therapy Glyburide May be used as alternative to insulin in women with GDM who do not achieve sufficient glycemic control after 1-week trial of medical nutrition therapy and exercise* Exceptions, in which case insulin is preferred therapy:* Diagnosis of GDM before 25 weeks FPG >110 mg/dL (6.1 mmol/L) Metformin Use only for wo Continue reading >>

Use Of Metformin In Gestational Diabetes

Metformin is associated with improved treatment satisfaction and a favorable impact on quality of life (QoL) compared with insulin alone or in combination…. The rise in obesity and the increasing age of mothers have contributed to an increasing incidence of GDM. Depending on the diagnostic criteria used, GDM complicates up to 10% of pregnancies. Treatment conventionally consists of lifestyle measures (diet and physical activity) initially. If target glucose values are not achieved, insulin has traditionally been instituted. Because of the need for constant injections, the risks of hypoglycemia and the potential for weight gain, insulin therapy might be expected to have a negative impact on the QoL for GDM mothers. By contrast, metformin is gaining increasing acceptance as a safe alternative to insulin in the management of GDM. It is associated with improved insulin sensitivity and less maternal weight gain and there is evidence of reduced maternal risk of pre-eclampsia and need for operative delivery. In this study, Latif et al, compare treatment satisfaction and QoL in GDM women receiving metformin alone, insulin alone or a combination of both treatments. One hundred and ninety seven women whose pregnancies had been complicated by GDM were recruited over a 12-month period (2011–2012). Of those, 128 were eligible to be analyzed and 68 patients were treated with metformin alone, 32 with insulin and 28 with the combination of metformin and insulin.Patients had started on insulin as NovoRapid with meals and Insulatard at night if metformin was relatively contra-indicated (renal impairment, history of GI symptoms, inadequate fetal growth on scan) or if this was patient preference. Otherwise, patients were offered metformin initially at a daily dose of 500 mg with meals, Continue reading >>

The Use Of Insulin Glargine With Gestational Diabetes Mellitus

We agree with the recent letter by Woolderink et al. (1) that insulin glargine use during pregnancy may be appropriate. In contrast to that letter, which described the use of insulin glargine in pregnant women with type 1 diabetes, we detail the use of insulin glargine in four patients with gestational diabetes mellitus (GDM). Target blood glucose levels set by the American College of Obstetricians and Gynecologists for women with GDM include fasting glucose ≤95 mg/dl and 1-h postprandial glucose ≤130–140 mg/dl or 2-h postprandial glucose ≤120 mg/dl (2). These criteria are used by the Maternal-Fetal Medicine Clinic at Wake Forest University School of Medicine to determine the need for insulin. The four women whose treatment we describe here were referred to our clinic and delivered between 1 December 2003 and 31 March 2005. The decision to initiate insulin glargine in these patients was based on postprandial self-monitored blood glucose readings <150 mg/dl. All four maintained blood glucose values that, on average, met the American College of Obstetricians and Gynecologists’ criteria for the remainder of their pregnancies using insulin glargine alone. Two of four patients had average fasting blood glucose values ≤95 mg/dl; the other two maintained average fasting blood glucose values ≤98 mg/dl. Their starting doses of insulin glargine ranged from 10 to 50 units, with an average of 29 units. Doses at delivery ranged from 18 to 78 units, with an average of 44 units. For three patients with well-documented blood glucose values before initiating insulin glargine, the average reduction in fasting blood glucose was 15 mg/dl and the average postprandial decrease was 17 mg/dl. One patient experienced an average blood glucose reduction of 30 mg/dl, including reduct Continue reading >>

Gestational Diabetes Mellitus

From the Department of Internal Medicine, Endocrine Section, Taibah University Medical College, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia From the Department of Internal Medicine, Endocrine Section, Taibah University Medical College, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia Address correspondence and reprint request to: Dr. Eman M. Alfadhli, Department of Internal Medicine, Endocrine Section, Taibah University Medical College, Aljameat Road, PO Box 344, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia. Fax. +966 (14) 8443195. E-mail: [email protected] Author information Copyright and License information Disclaimer This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. It is associated with maternal and neonatal adverse outcomes. Maintaining adequate blood glucose levels in GDM reduces morbidity for both mother and baby. There is a lack of uniform strategies for screening and diagnosing GDM globally. This review covers the latest update in the diagnosis and management of GDM. The initial treatment of GDM consists of diet and exercise. If these measures fail to achieve glycemic goals, insulin should be initiated. Insulin analogs are more physiological than human insulin, and are associated with less risk of hypoglycemia, and may provide better glycemic control. Insulin lispro, aspart, and detemir are approved to be used in pregnancy. Insulin glargine is not approved in pregnancy, but the existing studies di Continue reading >>

Insulin Glargine (lantus)

What is INSULIN GLARGINE-INJECTABLE, and how does it work (mechanism of action)? Insulin glargine is a bioengineered (man-made) injectable form of long-acting insulin that is used to regulate sugar (glucose) levels in type 1 and type 2 diabetes. Individuals with type 1 diabetes do not produce insulin on their own; and individuals with type 2 diabetes do not produce enough insulin, or insulin is not as effective due to insulin resistance. Insulin glargine works the same way as natural human insulin, but it's action lasts longer. It helps diabetic patients regulate glucose or sugar in the body. Insulin glargine works by promoting movement of sugar from blood into body tissues and also stops sugar production in liver. Insulin glargine is man-made insulin that mimics the actions of human insulin. The FDA approved insulin glargine in April 2000. What are the side effects of INSULIN GLARGINE-INJECTABLE? Common side effects of insulin glargine are: Local allergic reactions that may occur at the injection sites are: Long term use of insulin glargine can lead to thickening of fat tissues at the injection site. Severe allergic reactions are: Swelling under the skin Bronchospasm (tightening of chest that leads to difficulty breathing) Individuals should contact a healthcare professional if they experience any of the above reactions. What Is Type 2 Diabetes? Type 2 diabetes can affect all people, regardless of age. Early symptoms of type 2 diabetes may be missed, so those affected may not even know they have the condition. An estimated one out of every three people within the early stages of type 2 diabetes are not aware they have it. Diabetes interferes with the body's ability to metabolize carbohydrates for energy, leading to high levels of blood sugar. These chronically high blo Continue reading >>

Insulin For Gestational Diabetes - What It Is And How It Works

Where blood sugar levels cannot be lowered and stabilised enough through dietary and lifestyle changes, or through using medication such as Metformin, some ladies will be required to use insulin for gestational diabetes. Insulin is a hormone in the body produced by the pancreas. Your body uses insulin to move the sugar (glucose) obtained from food and drink from the bloodstream into cells throughout the body. The cells are then able to use the sugar for energy. Here are the most commonly asked Q&A on insulin for gestational diabetes from our Facebook support group Why do I need to take insulin for gestational diabetes? If lower blood sugar levels cannot be reached through diet, exercise and medication such as Metformin, then many will be required insulin for gestational diabetes. If blood sugar levels remain high, then the diabetes is not controlled and can cause major complications with the pregnancy and baby. If your levels are rising out of target range, your own insulin production may need to be topped up at the meal time. You may need to take insulin at one or all of your meals. Sometimes the insulin you produce in-between your meals and overnight may also require a top up. This may mean that you require an extra slower-release insulin at bedtime and/or in the morning. Some consultants will prescribe insulin on diagnosis of gestational diabetes on the basis of your GTT results or following other complications relating to gestational diabetes. For the majority, you will be given some time to try diet and exercise changes and then medication such as Metformin before insulin is introduced as a way to help lower and control your levels. NICE guidelines for timing and use of insulin for gestational diabetes 1.2.19 Offer a trial of changes in diet and exercise to women w Continue reading >>

Insulin For The Treatment Of Women With Gestational Diabetes

Abstract This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects of insulin in treating women with gestational diabetes. Background The original review by Alwan 2009 has been split into three new reviews due to the complexity of the included interventions. The new review protocols include the following. Lifestyle interventions for the treatment of women with gestational diabetes (Brown 2015a) Oral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes (Brown 2015b) Insulin for the treatment of women with gestational diabetes (this protocol). There will be similarities in the background, methods and outcomes between these three systematic reviews. Portions of the methods section of this protocol are based on a standard template used by the Cochrane Pregnancy and Childbirth Review Group. Description of the condition Gestational diabetes mellitus (GDM), often referred to as gestational diabetes can be defined as 'glucose intolerance or hyperglycaemia (high blood glucose concentration) with onset or first recognition during pregnancy' (WHO 1999). GDM occurs when the body is unable to make enough insulin to meet the extra needs in pregnancy. The high blood sugars associated with GDM will usually return to normal after the birth of the baby. However, there is currently no universally accepted diagnostic criteria (ACOG 2013; ADA 2013, Coustan 2010; HAPO 2008; Hoffman 1998; IADPSG 2010; Metzger 1998; NICE 2015) (Table 1). GDM may include previously undetected type 1 diabetes, type 2 diabetes, or diabetes presenting only during pregnancy depending on when the timing of when diagnosis is made (HAPO 2008; IADPSG 2010; Metzger 1998; Nankervis 2014; WHO 2014). Table 1. Examples of diagnosti Continue reading >>

Insulin Glargine Safety In Pregnancy

Abstract OBJECTIVE Insulin glargine (Lantus) is an extended-action insulin analog with greater stability and duration of action than regular human insulin. The long duration of action and decreased incidence of hypoglycemia provide potential advantages for its use in pregnancy. However, the placental pharmacokinetics of insulin glargine have not been studied. Therefore, the objective of this study was to determine whether insulin glargine crosses the human placenta using the human perfused placental lobule technique. RESEARCH DESIGN AND METHODS Placentae were obtained with informed consent after elective cesarean section delivery of noncomplicated term pregnancies. Insulin glargine, at a therapeutic concentration of 150 pmol/l (20 μU/ml) was added to the maternal circulation. Additional experiments were carried out at insulin glargine concentrations 1,000-fold higher than therapeutic levels (150, 225, and 300 nmol/l). A subsequent perfusion for which the maternal circuit remained open and insulin glargine was continuously infused at 150 pmol/l was completed for further confirmation of findings. The appearance of insulin glargine in the fetal circulation was analyzed by a chemiluminescence immunoassay. RESULTS Results from perfusions carried out at therapeutic concentrations (150 pmol/l) of insulin glargine showed no detectable insulin glargine in the fetal circuit. After perfusion with very high insulin glargine concentrations of 150, 225, and 300 nmol/l, the rate of transfer remained low at 0.079 ± 0.01, 0.14, and 0.064 pmol · min−1 · g tissue−1, respectively. CONCLUSIONS Insulin glargine, when used at therapeutic concentrations, is not likely to cross the placenta. Several new long-acting insulin analogs, such as glargine and detemir, are currently available f Continue reading >>

Gestational Diabetes - I Need The Voices Of Experience Please!

Gestational Diabetes - I need the voices of experience please! New Member Gestational Diabetes since February 2007 Gestational Diabetes - I need the voices of experience please! Hi, My name is Angie & I am 7 months pregnant (25 Weeks) and was diagnosed a couple of months ago with gestational diabetes. I have been following the diet that the dietitian gave me & my sugars haven't been too bad, except for my after breakfast reading. My morning sugars are usually below 5.3 mmol/L < = 95 mg/dl>(at 8:00am), but when I have breakfast (which is really more like a snack consisting of 1 carb, 1/2 Cup skim milk & 1 protein - which usually translates to cereal, 1/2 cup of milk and walnuts) my blood sugar goes up to 9's & 10'smmol/L . I take 160 units of NovoRapid (fast acting) & 6 units of NPH (slow acting) before breakfast. My blood sugar drops very rapidly and I will have a low blood sugar (in the 2's & 3's mmol/L = 36 - 54 mg/dl) if I don't eat again by 10:00am - it has actually dropped to 1.7 mmol/L or 31 mg/dl while I was eating my snack. I don't do heavy exercise after breakfast, but I do make it a point not to sit around. We (diabetes clinic @ hospital & I) have tried many different things to get the morning number down, as well as lessen the amount of rapid insulin I seem to need in the morning, but nothing seems to work. I have tried eating different things in smaller and smaller amounts, getting up at different times, using longer needles, injecting in more than one site... If anyone has any suggestions, I would love to hear them since I am out of ideas, and unfortunately, the diabetes clinic seems to be as well (don't get me wrong, though, they have been great!) I still have another 15 weeks of pregnancy left to go (my due date is August 20) and Continue reading >>

Gestational Diabetes Insulin Management

Failed Gastational Diabetes Diet Management III. Protocol: Calculate Ideal Body Weight Start with 100 pounds + 5 pounds per inch over 5 feet IV. Protocol: Calculate Total Daily Calories Calories/day = Ideal Weight (in kg) x 35 KCal/kg Calories/day = actual weight (in kg) x 25 Kcal/kg V. Protocol: Calculate Daily Insulin Dosing Note that Lantus and Levemir are not recommended due to lack of data in pregnancy Insulin per day (based on pre-pregnancy weight) Regimens (Divide Insulin Dosing over course of day) Long acting Insulin or basal Insulin (e.g. Glargine / Lantus or Dememir/ Levemir ) Give 50% of total daily Insulin requirements in a single dose of long acting Insulin Give 50% of total daily Insulin requirements divided over 3 doses of short acting Insulin at meals NPH Regimen (historical, older regimen and for those unable to afford other agents) Garrison (2015) Am Fam Physician 91(7): 460-7 [PubMed] Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Gestational Diabetes Insulin Management." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6546 interlinked topic pages divided into a tree of 31 specialty books and 722 chapters. Content is updated monthly with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by S Continue reading >>