you can also try to ask your question at the American Diabetes Associations
message boards. good luck wish i could help more.

http://community.diabetes.org/n/pfx/forum.aspx?nav=messages&webtag=adatype2

Lynn, I believe any insulin would be better than none. Don't
cut the carbs, treat the consequences instead. The last
month or so of pregnancy puts an enormous amount of pressure
on the pancreas. Having said that the major problems caused
by high bg's in pregnancies are not a factor at this point.
The problem you may encounter if bg's are too high at this
stage is baby gaining extra weight. What exactly are your
bg's running at? I would still opt for the insulin, you
don't need the worry of trying to keep excellent control
with the big job ahead in a few weeks ;) All you need
insulin for at this stage is to assist with some bg
lowering, not tight control.

Hi Lynn,

I've never had GD but I have used NPH and I agree with your assessment
that it is the insulin from hell!  Last time I used R it was available
without presciption but you should never just arbitrarily switch
medications without conjsulting your doctor, especially with insulins
as they all have different release and duration times.  What I would
suggest to you is to express your concerns to your doctor and ask to
switch to a different kind of insulin and if he reuses then I would get
a second opinion from another doctor, preferably an endo.  Good luck.

Best,
Kurt
T1 using Humalog and Lantus

   NPH is the insulin from Hell for people who must shoot exactly as much
as they need. . .no more,  no less.   That's me and every other T1 in the
world.    The problem is the variability of NPH.    Fast today,  slow
tomorrow,  medium next Tuesday.   That means that the large doses needed for
T1 can cause random hypos.

Folks like you do not shoot "exactly as much as they need,  no more,  no
less".    You use insulin as a supplement.   You deliberately shoot "too
little"    That means the "from Hell" aspect rarely applies.

Rule of Thumb:  "Exactly as much" as a non-pregnant T1 needs = ~ 0.2
units/day/kg body wt.   A late term pregnant T1 can easily require 2 times
as much,   Late term pregnant T2 women can easily require twice as much
again.     That means if she weighed about 110 lb,   the rule of thumb for a
late term pregnant T1 woman would call for somewhere around 20 units per
day.   It looks like your doc is starting low.

One key to avoiding the "from Hell" aspect. . .instead of trying to get by
with one or two big doses during the day,  split the total daily dose into
several doses.   I was splitting it into 4 doses when I switched to a more
modern insulin.   Someone like you,  who deliberately shoots "too little"
might get away with 2-3 doses/day.

All of these multiple doses assume you are really concerned about going low
or going hypo.

More doses = lower chance of hypo;
Fewer doses = greater chance of hypo.

In the U.S.,  NPH is not a prescription insulin.   Neither is Insulin R.
You walk into Wal-Mart,  plunk down your money,  and walk out with either
insulin.   Of course,  No prescription = No insurance reimbursement.   IIRC,
Wal-Mart Insulin R is less than $20/vial.   Don't know about NPH prices.

However,   folks in your shoes will likely end up using Insulin R about the
same way as NPH with the proviso that you inject even more often during the
day.   Nothing wrong with that.    Guy once stabilized himself during a
period of severe problems by shooting a small dose of Insulin R every few
hours,  night and day.   IIRC,  it was every 3 hours over the entire 24
hours.   A royal pain but it worked fine.   You're not T1 so you might get
by with a few less.

However,   as far as controlling FbG,   NPH is one of the better insulins so
long as you don't have to shoot too-big a dose.  Just keep the dose small
enough so that you don't go hypo at 3 a.m.,  (umm. . .you have to test at 3
a.m. for best results).

FWIW,  I had the best results controlling FbG with NPH when I shot as close
to midnight as possible.   That meant that NPH was most likely peaking after
3 a.m.,  i.e.  "after" our time of least need for insulin and "during" our
time of maximum need for insulin to control FbG.

Insulin supplementation is generally a fine idea for any T2 at any time.  It
will not do "more harm" so long as you keep the doses within reason,   that
is,  deliberately shooting "too little" and thus relying on your
still-active T2 beta cells to fine tune your sugars.

One trick with NPH,  shoot a small dose 3 hours before a meal.    That puts
the most common NPH insulin peak into the middle of the Post Prandial bG
peak.   Then shoot a small dose around midnight to put the most common peak
into the early morning hours.

The more conservative docs don't like using analog insulins on pregnant
ladies.    Insulin R and NPH are as close to "human" insulin as the pharma
companies can manage.

Regards
 Old Al

It's a start. It has a mild peak at approx 4-8 hours. Others here will
badmouth it but it and Regular kept me alive for several decades, so I
don't see the harm in the vile sense you're talking about.

With any insulin hypoglycemia is a risk. NPH's peak is more prolonged
and mild than regular and this makes it in a way the most benign for
hypo risks. The one gotcha is the middle of the night, but actually any
long-lasting insulin might undesirably peak there.

It's not really the type of the insulin, but how skillfully it is used.
If your docs are very comfortable with NPH, it's a fine place to start.

Both Regular and NPH are non-prescription in all of the US.

No, don't go without any. Won't do you any good.

It is not as hip as the other long-duration insulin analogs, but it may
also be true that the long-duration insulin analogs were not yet
officially tested for use by pregnant women.

Tim.

[Default] On Wed, 29 Nov 2006 14:22:37 -0500, "Lynn"
<noemail@noemail.com> Maniacally Screamed the following like a drunken
"Lynn" <noemail@noemail.com> into the madness of usenet:

If you want this baby, you need to follow your doctors advice on this
one.  Diabetic Pregnancies are high risk and need high risk teams to
help manage them.  Anyone online giving you advice to do something
against your instructions would be a fool.

The approach to add insulin slowly and cautiously is the correct one.
The doctors do not want to add too much insulin too fast sending you
hypo by mistake

Take it slow and follow the diabetic pregnancy specialist's advice. If
you don't have one, contact http://www.diabeticmommy.org and find out
which types of doctors you should be seeing.

Hello Lynn,

First of all, congratulations on your upcoming birth.

I was diagnosed nearly 25 years ago and have been on various insulins
the whole time.  It is manageable but you must take extreme care and
this would be far more to ask of what is a hopefully temporary problem
in your case.  I also have a friend that just was diagnosed with GD
8 weeks before her due date.  They gave her insulin, though I don't
know what was prescribed.  She was scheduled for a C-section and
didn't make it to term due to an insulin induced low that wasn't
taken care of before she went in for a non-stress test.  They had
to get the baby out 9 days earlier than planned.  Mother and
son are doing fine.  The GD went away immediately after the birth.

My advise is to cope as best as you can without the insulin.  If your
Bg is high or you can't cope for another month use the insulin and
dose that was prescribed.  Check your Bg's to make sure you are fine.

Do not use any faster acting insulins.  NPH doesn't have any long
term problems, nor short ones.  It is far more manageable than
Regular or any other shorter acting insulin.  The dose should be
small as you only want to help your blood sugar to stay lower
for the coming month.  You still need the willpower to help
eat right, check your sugars, and have a healthy baby.

The reason that Regular, fast acting, and too high a dose of
NPH are a hazard is that you may recover from a problem but
the baby will have a harder time.  You want a blood sugar
in the range your doctor wants and if NPH will help try it.
Just make sure to check your sugars and make sure you aren't
low or high.  Stay in touch with your doctor and if you go
low get food or get help immediately.

Good luck to you and your child,

David