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[IP] Humalog and Pregnancy (was RE: insulins)



Tara (and everyone else),

I did the research a while ago and am trying to piece together my sources
again.  My Endo confirmed my understanding, and I was able to re-find the
following on the web.  While some of this info is a little dated, I was
looking into this in about September 1998.  I am unaware of any updates and
would welcome any new info.  I would like to try lispro.  I am listing the
document name when applicable, the address, and the snippet that applies.  I
think #4 is the most technical one, and the one upon which all others seem
to be based.  You can read Lilly Research's response in this item as well.

1) ADA January 1999 Clinical Practice Recommendations, S87 Continuous
Subcutaneous Insulin Infusion
http://www.diabetes.org/DiabetesCare/Supplement199/S87.htm
Insulin for pumps
The rapid-acting insulin analog lispro is an appropriate insulin for insulin
infusion pumps. The stability of this insulin in both MiniMed and Disetronic
pumps has been confirmed. Two controlled trials demonstrated improved
postprandial glucose control with rapid-acting insulin as compared to
short-acting insulin (regular) when delivered immediately before a meal by
CSII. Lispro is not approved for use in pregnancy.

2)Diabetes Monitor - Planning a Pregnancy
http://www.diabetesmonitor.com/planpreg.htm
If you are presently taking Humalog insulin: we are presently not
recommending using lispro insulin, either in a pump or by injection, when
planning pregnancy. There are no studies indicating whether Humalog is safe
during early pregnancy, and there are two reported cases of women on lispro
insulin who had pregnancies with problems despite excellent glycohemoglobin
values. (Whether these problems were due to the lispro, or to other causes,
was undetermined.) Rearranging the insulin program, going back to Regular
after getting used to lispro, is clearly a problem for most patients. I
stress to my patients the importance of making the switch before conception
when possible. 

3)
http://www.childrenwithdiabetes.com/d_0j_100.htm
On October 2, 1997, The New England Journal of Medicine published a letter
to the editor about possible adverse fetal effect of insulin lispro and a
reply by a spokesperson for Lilly Research Laboratories. This letter was
based upon two pregnancies with problems, neither of which can be clearly
ascribed to lispro insulin [HumalogŪ brand]. We publish this hyperlink
because it is important for our readers to know that there are cases of
diabetic women with excellent glycohemoglobin values who may have problems
with their pregnancies. Whether these problems are due to the lispro, or to
other causes, is unknown. (We have also answered a question from a reader
about this problem.) 

4)The New England Journal of Medicine -- October 2, 1997 -- Vol. 337, No. 14

Possible Adverse Fetal Effect of Insulin Lispro
http://www.nejm.org/content/1997/0337/0014/1009.asp
<snip>
The report of the two infants with congenital abnormalities raises the
possibility that insulin lispro has embryotoxic actions. We cannot rule out
other potential causes of the abnormalities in these babies, (2) but we do
not believe that suboptimal glycemic control contributed to the poor fetal
outcome. 
<snip>


Ellen Compell (Age 30)
Type II, Pumping since Dec. 1998
MiniMed 507C
email @ redacted <mailto:email @ redacted> 

-----Original Message-----
From: Tara Dufour [mailto:email @ redacted]
Sent: Monday, April 05, 1999 10:34 AM
To: email @ redacted
Subject: RE: [IP] insulins


Do you mind if I askwhere you got your sources from?  I am prenant and into
my second trimester and have been using Humalog for 2 years now and have
never heard of anything regarding birth defects. I am confident that my
doctor would have informed me of this when I first told him I was pregnant
if this were the case.

>Velosulin is what I use.  It is basically buffered R.  It is also the only
>insulin that women either pregnant or planning pregnancy should use because
>of unexplained birth defects when some women used Humalog.
>
>Thanks,
>
>Ellen Compell (Age 30)
>Type II, Pumping since Dec. 1998
>MiniMed 507C
>email @ redacted <mailto:email @ redacted>
>
>
>-----Original Message-----
>From: Tara Dufour [mailto:email @ redacted]
>Sent: Monday, April 05, 1999 8:47 AM
>To: email @ redacted
>Subject: Re: [IP] insulins
>
>
>What is Velosulin? I've never heard of it. Does it work the same as Humalog
>as far as action and peak times?
>
>>Yes, Humalog fits pump useage very well. Some people find that the Humalog
>>doesn't
>>work well for more than about 2.5 days, so it's recommended that you mix R
>or
>>Velosulin with it in a 5 to 1 ratio to keep it stable for longer periods.
>>Seems to work well for most.
>>
>>Ted Quick
>>email @ redacted
>>----------------------------------------------------------
>>Insulin Pumpers website http://www.insulin-pumpers.org/
>>for mail subscription assistance, contact: HELP@insulin-pumpers.org
>
>
>Tara Dufour
>Hargreaves, Charbonneau & Associates
>
>
>----------------------------------------------------------
>Insulin Pumpers website http://www.insulin-pumpers.org/
>for mail subscription assistance, contact: HELP@insulin-pumpers.org
>----------------------------------------------------------
>Insulin Pumpers website http://www.insulin-pumpers.org/
>for mail subscription assistance, contact: HELP@insulin-pumpers.org


Tara Dufour
Hargreaves, Charbonneau & Associates


----------------------------------------------------------
Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org
----------------------------------------------------------
Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org