NPH and severe lows

Hey guys. I’m type 1 and 15 weeks pregnant. We don’t have very many educated / knowledgable endocronologists out here, so I’ve been researching anywhere that I can and talking to any veteran type 1 women with babies.

I’ve experienced 3 insulin shock comas in the past 2 weeks due to switching back to NPH. I was on Levemir with a 6.8% A1c, but the pregnancy study test results aren’t published for Levemir until 2012, so my endo took me off and put me back on NPH.
I’m allergic to the pump catheters, causing me to go into many bouts of Dka while on the pump.
Which leaves my only options of NPH with Apidra for food/ corrections.

My goal BG is between 60-120. Most of the time I am between that range, but I do have random 250s that I quickly correct and am hoping to stop from happening in the future.

I’m taking 3 shots of NPH. One at 8am, noon, and 6pm. The dosages for these injectsion of NPH are: 34, 28 & 13. If I change any of these dosages, I’ll be battling 300s the following day. I’ve tried to adjust the last NPH shot to 12 units instead of 13, but was rewarded with very high numbers the better half of the next morning.

The problem is, though, that every single night I wake up at 3am with a BG of 34. Three times, I didn’t wake up at all and my husband had to nurse me back to life with cake frosting.

Do any of you have experience with NPH and having these lows? And not being able to adjust the dosages because if you do, the highs are even more scary?

I can’t use any pumps, Lantus and Levemir are not approved with pregnancy. It seems to me that NPH is my only option?

Hi there,

My daughter was born in August and I must say, I do not miss those lows at all… before getting pregnant I switched off of Lantus and went to NPH… this only lasted a few months and because of the lows, I went to the pump (sorry to hear this is not an option for you). I had been dragging my heels on getting a pump but my endo. confirmed that NPH or pump are the two safest options for pregnant women. While on the NPH, she told me that taking many shots of NPH throughout the day is the best bet while pregnant so that you’re not taking as much and therefore that spike won’t be as bad. Not sure if it is an option for you to take more than 3 shots/day… I know that it is not fun to have more injections than necessary though out the day, but it is all worth it in the end (at least that’s what I told myself constantly throughout my pregnancy). Good luck :slight_smile: K

Sorry – I don’t know about NPH!

I just wanted to ask if you tried Sure-T, which have a metal catheter. I am using these during pregnancy and I know that they are designed for people who are allergic to the teflon catheters.

I’m surprised that they have you on NPH 3x a day, but not surprised that this routine is causing major lows. My guess is that some of your doses are over-lapping.

In pregnancy, I was on NPH once at night and “Toronto” or “Regular” insulin for boluses. That worked out quite well, but it has a longer duration than novorapid (or novolog). I had to eat on a regular schedule and have snacks. Regular insulin is the first insulin that was ever invented, so they know that it is safe for pregnancy.

On another note – I just started on the pump a month ago and was super allergic to the infusion sets. I found that putting a barrier on my skin between the cathater tape stopped me from having a reaction. I use Tegaderm Film by NexCare. I have to special order it from the pharmacy because no one has it in-stock.

Good luck!

What time do you go to bed? Would you maybe be able to eat a little somthing with some protein or fat in it to help sustain you through the night?

I’m 7 weeks now and on a pump, but even with that I’ve been advised to try and eat a late-night snack to ward off super-lows early in the morning since my fasting bg is supposed to be on the low end.

I haven’t been on NPH in years, but I do remember that the timing of it’s peak would somtimes correspond with my short-term insulin and cause crazy lows. Maybe that’s what’s happening to you at 3am?

I also have a snack before bed every night (20g carbs), which my doctor recommends in order to prevent fasting ketones in the morning.

So scary!

I was on a pump during my pregnancy, but I’m back on NPH/Humalog for the time being.

NPH has a peak time of 4-9 hours and with your 6 pm shot, that would put the end of the peak right at 3 AM. It seems to me that your shots are all bunched together. I was advised to take them a full 12 hours apart, (my schedule is 2x day, once at 1 PM and 1AM - I go to bed late).

What is the reasoning for all of your shots to be within 9 hours of each other? I am thinking that Kelly was right on. Your peak from the 6 PM shot is working while there is still active NPH in your body from the earlier shots. Have you tried to keep the same dosages but spread the shots out?

Definitely consult with your endo to see what they recommend. That is a scary thing to have a crashing low every night. Good luck and keep us posted!!

My endo believes that Lantus and Levemir are fine for pregnant Type 1s. She says that they put Gestational Diabetics on NPH because those women have no experience taking insulin, but that if you already know you can achieve control on your basal insulin of choice, you should be encouraged to continue taking it.

I wouldn’t go back to NPH for anything, but I’ve been on a pump for over a decade. I’ve never tried the other long-actings, but my endo gave me a bottle of Lantus during my pregnancy to have as a backup for my pump. She felt very strongly that it was a safe option.

Really? My endo told me that studies found that Lantus interferes with the baby’s growth hormone. He said the Levemir studies with pregnant women wouldnt be out until 2012. Scary.

Hi Lisa! My endo was hoping that if I take multiple injections throughout the day, that the peak would seem more like Levemir. When I was on Levemir, even though it’s a 20-24 hour insulin, I took a shot every 12 hours with it. When I was on NPH back in 1998, I was taking it every 12 hours too, but now that I’m pregnant, my endo is trying to even out my basal insulin so that it is more seamless.

I gotta tell you, I did not miss NPH before, and I certainly would do anything to go back to Levemir. I miss the control that I had with it. Last night, I went into insulin shock in the middle of a sentence. I just blacked out and kept looping back to saying the same thing over and over again. My husband, luckily, recognized what was happening and got me back on track.

I’m getting to the point of not trusting my body anymore. I hate it.

This baby better love me. :slight_smile:

Hi Rebecca! I am actually able to eat a 1/2 cup of ice cream, or an apple, or a banana before bed without taking any bolus shot to cover. This only sometimes keeps me from a coma. I used to eat a slice of cheese before bedtime before I was pregnant- and it used to help.

Congrats on your pregnancy!

Thank you for the info! I wasn’t allergic to the catheter tape, it was the catheter tubing. I have dots all over my stomach. When I used to take the infusion set out after only one day, the insulin would shoot out of the hole. The hole in my stomach was always yellow rimmed and puffy- so definitely infected from the tube that goes under the skin.

I’m going to look into the new infusion sets that are out there and see if I’ll be allergic to them still. There were a couple of different things that made me come off the pump (allergy to catheter tube plus insulin resistance to the short acting insulin), but I will do just about anything to get off of NPH at this point,. :slight_smile:

I didn’t know the SureTs were made of different materials than the other infusion sets! Thanks for the info! I’ll look into it and see if it can help me get back on the pump. At least back on the pump for the remaining 5 months of my pregnancy.

Hi Kristina. I’m taking close to 15 shots a day right now, so what’s a few more? I was thinking about cutting the dosages and doing more of them before, but I chickened out. I will plot out a dosage chart tonight and see if I can do more, but smaller shots. Thanks! And congrats on your healthy baby!

I just googled Lantus and pregnancy and found an interesting case study where they wrote:

“Despite the lack of safety data in pregnancy, we made the decision to substitute evening glargine for her bedtime NPH insulin. It was deemed that the risks of repeated severe hypoglycemia and the potential for repeated glucagon injections, with resultant elevations in serum ketone levels, would likely have deleterious effects on the mother and fetus.”

So it sounds like a crapshoot between which risks you’re more concerned about. =/

I stayed on a pump throughout the pregnancy and have still never had to use the Lantus in my fridge, so I’m not necessarily arguing that it’s safe - just that my endo seemed convinced that it was.

How scary bless your heart!! You must be a nervous wreck! I am an insulin newbie on Levemir and Humalog and TTC again since my diagnosis a year ago and I asked my endo if I would be able to stay on my current insulin regimen when I become pregnant and he said it has not been approved for pregnancy because it has not been studied enough yet but if I were to become pregnant I would stay on Levemir and Humalog.