Medications for Diabetes

Oral medications

Women with pregestational diabetes who have been taking oral medication for blood sugar control usually need to discontinue the oral medication and begin insulin (injections) therapy during pregnancy.

This is because it’s not yet been determined if oral diabetes medications are safe for pregnant women, particularly in the early part of pregnancy when the fetus is still forming (organogenesis). Early generation sulfonylurea drugs had the potential to stimulate the fetal pancreas, which would lead to high levels of insulin in the fetus, which caused concern over the potential harm to the fetus. It is difficult, however, to distinguish the effects of an oral medication from those of poorly controlled diabetes and high blood sugars.

Insulin

Most of the time, a combination of fast and long-acting insulin are prescribed during pregnancy. Fast-acting insulin is given before meals while long-acting insulin provides a small amount in the bloodstream at all times. The specific insulin type will be individualized according to the patient's needs but the most common regimen combines a fast-acting (clear) insulin such as Humulin R (Regular) or Humalog® (Lispro) with an intermediate acting insulin, NPH (cloudy).

* Humalog® and NovoLog® should be given 0-15 minutes before meal.
** Regular should be given 30 minutes before meal.

Insulin pumps

An insulin infusion pump can deliver insulin in very tiny amounts. It is about the size of a pager and is attached to the body by a long thin tube. Pumps are relatively expensive but some insurance companies are now covering their cost.

Insulin pumps are rapidly becoming more available to women with pregestational diabetes. Only fast-acting insulin is used in the pumps and at present only Regular and Novolog® have been FDA approved for use in pumps, however, some health care providers have used Humalog® with good results. Use of a pump enables more precise insulin dosing.

The insulin pump usually combines different types of insulin and insures controlled basal levels of insulin by administration of exact dosages in a continuous fashion. It also provides the boluses of insulin necessary just before a meal or snack.

Insulin pumps can be particularly helpful in the management of women with diabetes during the first trimester when pregnancy is often complicated by nausea and vomiting (unpredictable food intake). Although the experience with pump therapy during pregnancy is still limited, it offers a theoretical benefit and should be seriously considered in select patients.

Patients with the following characteristics me be candidates for the pump:

• If there is a tendency to have hypoglycemic episodes or wide glucose level fluctuations despite compliance with diet and insulin dosing recommendations.
• Hypoglycemia symptoms do not occur until the blood sugars are too low for appropriate intervention.
• Problems with "hyperemesis gravidarum" (nausea and vomiting of pregnancy) create high risk when taking a large amount of insulin and being unable to keep food down. A pump makes it much easier to adjust the insulin infusion immediately.
• More flexibility in the insulin regimen may be needed due to irregular work shifts or travel.
• Patient dissatisfaction with daily injections. Most insulin pump infusion sets only need to be replaced every 3 days.

Potential complications with insulin pumps

Pump therapy is as safe as multi-dose insulin when recommended procedures are followed. Potential complications peculiar to pump therapy include undetected interruptions in insulin delivery (which may result in ketotic episodes) as well as infections or inflammation at the needle site. These complications are extremely rare. In general, the benefits of pump therapy far outweigh the potential risks in most patients.