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Novolog Pregnancy Category

Insulin Use In Pregnancy: An Update

Insulin Use In Pregnancy: An Update

As of June 2015 in the United States, 2.7% of women who are 18–44 years of age have a diagnosis of type 1 or type 2 diabetes (1). About 5% of all diagnosed diabetes is type 1 diabetes, and 90–95% is type 2 diabetes. It is projected that, by 2050, one in three people will have some type of diabetes. An estimated 5,000 new cases of type 2 diabetes will be diagnosed annually in American children <20 years of age (2). Gestational diabetes mellitus (GDM) could affect up to 8.7% of all pregnancies in the United States (3). The Centers for Disease Control and Prevention reports that these numbers are still on the rise (2). As the age of diabetes diagnosis decreases in U.S. youth, the prevalence of pregestational diabetes is likely to increase in the pregnant population. Maternal diabetes causes complications in the embryo/fetus that start in the uterus, are present immediately after birth, and could potentially last a lifetime. Women with type 1 diabetes or type 2 diabetes diagnosed before or during the first trimester of pregnancy are at the greatest risk for fetal congenital anomalies and spontaneous abortions. This risk is associated with both frequent and severe hyperglycemia before conception and during organogenesis (5–8 weeks after the last menstrual period) (4,5). The more severe the maternal hyperglycemia, the greater is the risk for fetal abnormalities. Structural anomalies are a common result, with ∼37% of these affecting the cardiovascular system, 20% affecting the central nervous system, and 14% affecting the urogenital system (6). GDM develops and is diagnosed later in pregnancy, at 24–28 weeks’ gestation, when impaired glucose tolerance is detectable. Therefore, women with GDM are most likely euglycemic during organogenesis and have a decreased risk Continue reading >>

Levemir® — The First Basal Insulin Analog With Pregnancy Category B Classification.1

Levemir® — The First Basal Insulin Analog With Pregnancy Category B Classification.1

Levemir® is the first FDA-approved basal insulin analog with Pregnancy Category B classification. In a randomized, controlled clinical trial1: Pregnant women with type 1 diabetes (n=310) were treated with either Levemir® (n=152) or NPH insulin (n=158) in a basal-bolus regimena Women were randomized either as pregnant or planning pregnancy; those who where randomized as pregnant were between weeks 8 and 12 of gestationb Approximately one-half of the study participants in each arm were randomized as pregnant and were exposed to NPH insulin or other insulins prior to conception and in the first 8 weeks of gestation According to pretrial insulin regimen: Levemir® was administered once or twice daily NPH was administered once, twice, or 3 times a day An open-label, randomized, parallel-group, multinational study in women with type 1 diabetes who were on insulin for at least 12 months before randomization and who were planning to become pregnant or already pregnant at gestational weeks (GWs) 8 to 12. Patients could enroll in the study with intention to become pregnant. Patients were withdrawn from the trial if they did not become pregnant within 1 year. Patients were separated at randomization as pregnant and nonpregnant and all were required to have A1C ≤8% at confirmation of pregnancy. Patients were randomized 1:1 to Levemir® (n=152) or NPH insulin (n=158). Both groups used NovoLog® (insulin aspart injection) 100 U/mL as mealtime insulin. Approximately 50% of the women also received Levemir® or NPH insulin prior to conception and in the first 8 weeks of gestation. Regimen was followed from randomization until termination/6 weeks postdelivery.2 Adapted from Mathiesen et al, 2012.2 aBoth groups used NovoLog® (insulin aspart injection) 100 U/mL as mealtime insulin. bP Continue reading >>

Using Insulin In Pregnancy: Fda Approves Levemir

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 >>

Fda Authorizes Novolog For Pregnant Women With Type 1 Diabetes

Fda Authorizes Novolog For Pregnant Women With Type 1 Diabetes

Home / Resources / Articles / FDA Authorizes NovoLog for Pregnant Women With Type 1 Diabetes FDA Authorizes NovoLog for Pregnant Women With Type 1 Diabetes NovoLog has now been given a pregnancy category B rating, indicating that adequate studies in pregnant women with type 1 diabetes have demonstrated that NovoLog does not increase risk to the unborn baby. As a safety precaution, the FDA classifies prescription drugs with specific category ratings to provide guidelines for physicians treating pregnant women. Previously, NovoLog was classified as a category C rating, which indicates that adverse effects on the fetus have been demonstrated in animal reproduction studies, and that studies in pregnant women have not been conducted to demonstrate safety. The FDA category change was based on a review of a trial using an insulin analog in pregnant women with type 1 diabetes. The study compared the safety and efficacy of NovoLog versus human regular insulin (HRI). Data demonstrated that changes in HbA1c and rates of maternal hypoglycemia were comparable with NovoLog compared to HRI. The study was not large enough to evaluate the risk of congenital malformations. Compared to HRI, the trial with NovoLog showed improved outcomes for both mother and child in terms of fewer preterm deliveries, reduced risk of neonatal hypoglycemia requiring treatment, consistently low rates of major hypoglycemia and reduced risks to the fetus. Continue reading >>

Insulin Analogs And Pregnancy

Insulin Analogs And Pregnancy

Diabetes during pregnancy is a major risk factor for poor fetal, neonatal, and maternal outcomes; however, the risk can be greatly reduced by early institution of medical nutritional therapy and insulin treatment. Maintaining maternal glycemia as near to normal as possible reduces the risk of congenital anomalies, macrosomia, neonatal hypoglycemia, and large-for-gestational-age infants. Achieving normoglycemia has usually been accomplished with human insulin. However, the newer rapid-acting insulin analogs lispro and aspart, when compared to regular human insulin, demonstrate both efficacy and safety for the treatment of diabetes during pregnancy. NPH insulin is the only basal insulin that has been studied in pregnancy. There are not yet any published controlled studies evaluating the long-acting insulin analogs for use in pregnancy. Pregnancy complicated by diabetes occurs in ∼ 4% of pregnancies in the United States.1 With appropriate institution of intensive diabetes therapy and maintenance of glucose levels to achieve a lowering of hemoglobin A1c (A1C) levels before and during pregnancy complicated by diabetes, the rate of fetal and maternal complications can be reduced to the rate observed among nondiabetic pregnancies.2 Whether the pregnancy is classified as pregestational diabetes (occurring in women who have been diagnosed with type 1 or type 2 diabetes before pregnancy) or as gestational diabetes mellitus (GDM, occurring when a nondiabetic woman develops diabetes only during pregnancy), the goal of treatment is to maintain maternal glucose levels as near to normal as possible throughout the pregnancy. Pregestational diabetes is a major risk factor for spontaneous abortions and congenital malformations, but the risk can be significantly reduced when hyperglycem Continue reading >>

Insulin Aspart

Insulin Aspart

Insulin aspart is a fast-acting insulin analog marketed by Novo Nordisk as NovoLog/NovoRapid. It is a manufactured form of human insulin; where a single amino acid has been exchanged. This change helps the fast-acting insulin analog be absorbed quickly into the bloodstream. As a result, it starts working in minutes, which allows one to take insulin and eat right away. Fast-acting insulin analogs are considered to act similarly to the way insulin is released in people without diabetes mellitus. Novolog allows for a flexible dosing schedule, which allows patients to adjust their insulin according to any changes in their eating habits.[1] The safety and efficacy of insulin aspart (NovoLog/NovoRapid) in real-life clinical practice was evaluated in the A1chieve study. It was created through recombinant DNA technology so that the amino acid, B28, which is normally proline, is substituted with an aspartic acid residue. This analog has increased charge repulsion, which prevents the formation of hexamers, to create a faster-acting insulin. The sequence was inserted into the yeast genome, and the yeast expressed the insulin analog, which was then harvested from a bioreactor. According to JDRF, insulin aspart was approved for marketing in the United States by the Food and Drug Administration in June 2000.[citation needed] Chemical properties[edit] The components of insulin aspart are as follows: Metal ion – zinc (19.6 μg/mL) Buffer – disodium hydrogen phosphate dihydrate (1.25 mg/mL) Preservatives – m-cresol (1.72 mg/mL) and phenol (1.50 mg/mL) Isotonicity agents – glycerin (16 mg/mL) and sodium chloride (0.58 mg/mL). The pH of insulin aspart is 7.2–7.6.[2] Action time[edit] The onset of action is approximately 15 minutes, the peak action is reached in 45–90 minutes, Continue reading >>

Novolog

Novolog

Also found in: Dictionary, Wikipedia. insulin aspart (in-su-lin as-spart) , NovoLOG (trade name), Novorapid (trade name) insulin aspart protamine suspension/insulin aspart injection mixture , NovoLOG Mix 70/30 (trade name), Novomix 30 (trade name) Pregnancy Category: B (insulin aspart) Pregnancy Category: C (insulin aspart protamine suspension/insulin aspart injection mixtures) Indications Control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus. Action Lowers blood glucose by : A rapid-acting insulin with more rapid onset and shorter duration than human regular insulin; should be used with an intermediate- or long-acting insulin. Therapeutic effects Control of hyperglycemia in diabetic patients. Pharmacokinetics Time/action profile (hypoglycemic effect) Contraindications/Precautions Contraindicated in: Hypoglycemia; Allergy or hypersensitivity to insulin aspart. Use Cautiously in: Stress and infection, which may temporarily ↑ insulin requirements; Renal/hepatic impairment (may ↓ insulin requirements); Must be used with a longer-acting insulin in patients with type 1 diabetes; Concomitant use with pioglitazone or rosiglitazone (↑ risk of fluid retention and worsening HF) Obstetric: May temporarily ↑ insulin requirements; Pediatric: Children <6 yr (safety not established). Adverse Reactions/Side Effects Endocrinologic Miscellaneous allergic reactions including anaphylaxis (life-threatening) Interactions Drug-Drug interaction Beta blockers and clonidine may mask some of the signs and symptoms of hypoglycemia.Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin,phenothiazines, and rifampin may ↑ insulin requirements.Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates, may ↓ insulin req Continue reading >>

Novolog And Pregnancy

Novolog And Pregnancy

It is generally considered safe for pregnant women to use NovoLog (insulin aspart). Pregnancy problems are not likely to occur as a result of taking this drug, as preliminary studies suggest that the medication is as safe as regular human insulin. If you are using NovoLog and pregnancy occurs, be sure to talk to your healthcare provider about any potential risks. Using NovoLog During Pregnancy: An Overview NovoLog ( insulin aspart ) is a prescription diabetes medication used to treat type 1 and type 2 diabetes . It is a rapid-acting form of insulin , usually used to control blood sugar after meals. Animal studies suggest that NovoLog is safe for use in pregnant women. The U.S. Food and Drug Administration (FDA) uses a pregnancy category system to classify the possible risks to a fetus when a specific medicine is taken during pregnancy. Pregnancy Category B is given to medicines that have not been adequately studied in pregnant humans but do not appear to cause harm to the fetus in animal studies. Animal studies suggest that NovoLog is safe for use during pregnancy. However, the drug has not been adequately studied in pregnant women, although some preliminary studies have been conducted (and which suggest that NovoLog is as safe as regular human insulin). Although it was thought that insulins do not cross the placenta, it is now known that some insulins, in some circumstances, may cross the placenta. If you are pregnant or are thinking of becoming pregnant while taking NovoLog, let your healthcare provider know. He or she will consider the benefits and risks of taking the drug during pregnancy before making a recommendation in your particular situation. If you are already taking NovoLog and plan to continue taking it during pregnancy, you should be aware that pregnancy Continue reading >>

Insulin Aspart Use During Pregnancy | Drugs.com

Insulin Aspart Use During Pregnancy | Drugs.com

Pregnancies complicated by hyperglycemia pose an increased risk of birth defects, pregnancy loss, or other adverse events. The estimated background risk of major birth defects in women with pre-gestational diabetes and a HbA1c less than 7% is 6% to 10% compared with 20% to 25% in women with a HbA1c greater than 10%. Compared to human insulin, insulin aspart has not been shown to have different adverse effects or effect the health of the fetus differently. Patients with diabetes or a history of gestational diabetes should maintain good metabolic control before conception and during pregnancy. During pregnancy, insulin requirements may decrease during the first trimester; increase during the second and third trimesters, and rapidly decline after delivery. AU TGA pregnancy category A: Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.US FDA pregnancy category B: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Use is considered acceptableAU TGA pregnancy category: AUS FDA pregnancy category: BComment: For women who are pregnant, and for women who are contemplating pregnancy, intensified blood glucose control and close monitoring of blood glucose is essential. Exogenous insulins, including the newer biosynthetic insulins (i.e. aspart, detemir, glargine, glulisine, lispro) appear to be excreted into breast milk. Insulin is a protein that is inactivated if taken by mouth. If absorbed, it would be destroyed in the digestive tract of the infant. Lactation onset occurs later in women with type 1 diab Continue reading >>

Taking Insulin During Pregnancy

Taking Insulin During Pregnancy

When your blood glucose levels stay raised despite meal planning and physical activity, insulin must be added to your management plan to keep you and your baby healthy. Pregnancy requires that your body produce extra amounts of insulin. Insulin is a hormone that is made by the pancreas. If your pancreas does not make enough insulin, injections can help you meet the need. Your health care provider and diabetes educator will teach you how to inject insulin safely and comfortably. Determining the right insulin and dosage Tip Keep a record of the type and amount of insulin you take. It is important that you know and remember your insulin type every time you speak with a health care provider. Your health care provider will decide what kind of insulin is right for you, how much to use and when you should take it, based on: your weight (which changes weekly) how far along your pregnancy is your meal plan your most recent blood glucose levels Sometimes, you may need more than one type of insulin. Different types of insulin work at different speeds, and your health care provider may combine insulins to achieve the best results for you. Time-action of different insulins Insulins Starts working Peaks Stops working Rapid acting: Humalog® (lispro) NovoLog® (aspart) Apidra® (glulisine) 5 to 15 minutes 1 to 2 hours 2 to 4 hours Intermediate acting: NPH (N) 2 to 4 hours 4 to 8 hours 10 to 16 hours Basal*: Lantus® (glargine) Levemir® (detemir) 2 hours No peak 24 hours *Lantus® and Levemir® cannot be mixed with any other insulin. How to help insulin work best Take your insulin at the same times each day as directed. Talk with your health care provider if you feel sick. Follow any instructions your health care provider gives you. Don't change your meal plan, physical activity, pres Continue reading >>

Insulin Aspart

Insulin Aspart

(NovoLog, Novo Nordisk) Classification: Antidiabetic Agents; Insulins, Human Description: NovoLog is a rapid-acting human insulin analog. It is homologous with regular human insulin with the exception of a single substitution of praline at position B28 with aspartic acid. NovoLog is synthesized using Saccharomyces cerevisiae (baker’s yeast). Pharmacology: Insulins, including NovoLog regulate glucose metabolism by binding to cellular insulin receptors facilitating cellular uptake of glucose and simultaneously inhibiting the output of glucose from the liver. Pharmacokinetics: Type Onset Peak Duration Short-acting   Insulin lispro (Humalog)   Insulin aspart (NovoLog)   Regular insulin (R)  15 min 15 min 0.5 to 1 hrs  30 to 90 min 40 to 50 min 2 to 4 hrs  3 to 6.5 hrs 3 to 5 hrs 8 to 12 hrs Indications: NovoLog is indication for the control of hyperglycemia associated with diabetes mellitus. Dosage: Variable depending on patient needs and response. Contraindications and Precautions: · Pregnancy category: C · Contraindicated during episodes of hypoglycemia · Contraindicated in patients with known hypersensitivity to NovoLog · Dosage requirements may be reduced in patients with hepatic or renal impairment Interactions: Interactions may occur with medications with hyperglycemic activity such as corticosteroids, Isoniazid, niacin, estrogens, oral contraceptives, phenothiazines and thyroid replacement therapy. Insulin requirements may be decreased in the presence of drugs with hypoglycemic activity, such as oral Antidiabetic agents, salicylates, sulfa antibiotics, monoamine oxidase inhibitors, beta-adrenergic blockers and alcohol. Mixing with other insulins: A single study in 24 healthy adult males showed that NovoLog is compatible with NPH h Continue reading >>

What Are The Possible Side Effects Of Insulin Aspart (novolog, Novolog Flexpen, Novolog Penfill)?

What Are The Possible Side Effects Of Insulin Aspart (novolog, Novolog Flexpen, Novolog Penfill)?

NOVOLOG (insulin aspart) Injection DESCRIPTION NOVOLOG (insulin aspart injection) is a rapid-acting human insulin analog used to lower blood glucose. NOVOLOG is homologous with regular human insulin with the exception of a single substitution of the amino acid proline by aspartic acid in position B28, and is produced by recombinant DNA technology utilizing Saccharomyces cerevisiae (baker's yeast). Insulin aspart has the empirical formula C256H381N65O79S6 and a molecular weight of 5825.8. Figure 1: Structural formula of insulin aspart NOVOLOG is a sterile, aqueous, clear, and colorless solution, that contains insulin aspart 100 Units/mL, glycerin 16 mg/mL, phenol 1.50 mg/mL, metacresol 1.72 mg/mL, zinc 19.6 mcg/mL, disodium hydrogen phosphate dihydrate 1.25 mg/mL, sodium chloride 0.58 mg/mL and water for injection. NOVOLOG has a pH of 7.2-7.6. Hydrochloric acid 10% and/or sodium hydroxide 10% may be added to adjust pH. font size A A A 1 2 3 4 5 Next What is Type 2 Diabetes? The most common form of diabetes is type 2 diabetes, formerly called non-insulin dependent diabetes mellitus or "adult onset" diabetes, so-called because it typically develops in adults over age 35, though it can develop at any age. Type 2 diabetes is diagnosed more often in people who are overweight or obese, and who are not physically active. Type 2 diabetes is an illness in which the body does not process ingested sugars (glucose) properly. In type 2, the body usually produces some insulin, but not enough to allow the glucose into the cells for the body to use as energy. In addition, there can be insulin resistance, where it becomes difficult for the body to use the insulin produced. Type 2 diabetes is seen both in men and in women, though men have a slightly higher incidence of developing the dise Continue reading >>

What Is Novolog (insulin Aspart)?

What Is Novolog (insulin Aspart)?

Before you receive DARZALEX®, tell your healthcare provider about all of your medical conditions, including if you: have a history of breathing problems have had shingles (herpes zoster) are pregnant or plan to become pregnant. DARZALEX® may harm your unborn baby. Females who are able to become pregnant should use an effective method of birth control during treatment and for at least 3 months after your final dose of DARZALEX®. Talk to your healthcare provider about birth control methods that you can use during this time. are breastfeeding or plan to breastfeed. It is not known if DARZALEX® passes into your breast milk. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. DARZALEX® may be given alone or together with other medicines used to treat multiple myeloma. Your healthcare provider will decide the time between doses as well as how many treatments you will receive. Your healthcare provider will give you medicines before each dose of DARZALEX® and on the first day after each dose of DARZALEX® to help reduce the risk of infusion reactions. If you miss any appointments, call your healthcare provider as soon as possible to reschedule your appointment. Infusion reactions. Infusion reactions are common with DARZALEX® and can be severe. Your healthcare provider may temporarily stop your infusion or completely stop treatment with DARZALEX® if you have infusion reactions. Tell your healthcare provider right away if you get any of the following symptoms: shortness of breath or trouble breathing dizziness or lightheadedness (hypotension) cough wheezing throat tightness runny or stuffy nose headache itching nausea vomiting chills fever Changes in blood tests. DARZALEX Continue reading >>

Novolog (insulin Aspart) Dosing, Indications, Interactions, Adverse Effects, And More

Novolog (insulin Aspart) Dosing, Indications, Interactions, Adverse Effects, And More

100units/mL (3mL NovoLog FlexPen, FlexTouch, or Fiasp FlexTouch) Improvement of glycemic control in adults and children with diabetes mellitus May administer 0.2-0.6 unit/kg/day in divided doses; conservative doses of 0.2-0.4 unit/kg/day often recommended to reduce risk of hypoglycemia Total maintenance daily insulin requirement may vary; it is usually between 0.5 and 1 unit/kg/day; nonobese may require 0.4-0.6 unit/kg/day; obese may require 0.6-1.2 units/kg/day Diabetes inadequately controlled by diet, weight reduction, exercise, or oral medication 10 units/day SC (or 0.1-0.2 units/kg/day) in evening or divided q12hr of an intermediate (eg, NPH) or long-acting insulin at bedtime recommended; conversely, regular insulin or rapid-acting insulin (aspart insulin) before meals also recommended When used in a meal-related SC injection treatment regimen, 50-75% of total insulin requirements may be provided by an intermediate-acting or long-acting insulin; the remainder is divided and provided before or at mealtimes as a rapid-acting insulin, such as insulin aspart Because of insulin asparts comparatively rapid onset and short duration of glucose-lowering activity, some patients may require more basal insulin and more total insulin to prevent premeal hyperglycemia than they would need when using human regular insulin Dosage must be individualized; blood and urine glucose monitoring is essential in all patients receiving insulin therapy Insulin requirements may be altered during stress or major illness or with changes in exercise, meal patterns, or coadministered drugs If converting to Fiasp from another mealtime insulins, the change can be done on a unit-to-unit basis Patients with hepatic and renal impairment may be at increased risk of hypoglycemia and may require more freq Continue reading >>

Fda Approves Levemir® Pregnancy Category Change For Women With Diabetes

Fda Approves Levemir® Pregnancy Category Change For Women With Diabetes

Levemir® is the first and only basal insulin analog with pregnancy Category B classification ® (insulin detemir [rDNA origin] injection) for a pregnancy Category B classification, indicating that Levemir®, when used in pregnant women with diabetes, did not increase the risk of harm to the unborn baby. To view the multimedia assets associated with this release, please click: (Photo: ) The label update makes Levemir® the first and only basal insulin analog to have this classification. Until this decision, NPH (human insulin) was considered the standard of care for diabetes in pregnancy. Now, Novo Nordisk is the only company that offers a complete portfolio of insulin analogs with a pregnancy Category B classification. The FDA category change was based on a review of a large, randomized controlled trial examining Levemir® in pregnant women with type 1 diabetes. The study compared the safety and efficacy of Levemir® against NPH insulin in the treatment of 310 women. The study found that patients taking Levemir® had similar A1C reduction at gestational week 36 and lower fasting plasma glucose levels at gestational weeks 24 and 36 compared with NPH. Additionally, the study found no differences in the overall safety profile during pregnancy, on pregnancy outcomes or the health of the fetus and newborn. "We are excited that the FDA has granted approval for this new category rating for Levemir®," said Lois Jovanovic, MD, MACE, Chief Scientific Officer, Sansum Diabetes Research Institute in Santa Barbara, California. "For women who are pregnant, diabetes can be extremely challenging; they must be even more diligent and careful when monitoring blood sugar levels than before they were pregnant. This approval provides patients with a long-acting insulin analog option that ca Continue reading >>

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