Use of Insulin Glargine During Pregnancy in a Type 1 Diabetic Woman

The patient was a 37-year-old registered nurse recently followed during her second pregnancy complicated by diabetes. Type 1 diabetes was diagnosed at age 9 years. She was initially referred to us for management of her first diabetic pregnancy in June 1998 at 10 weeks’ gestation with twins. She was on a multiple daily insulin injection (MDI) regimen with human regular insulin (three times daily before meals) and NPH insulin at bedtime. Her initial HbA_1c at the time of referral was 7.6%. She was free of any clinical signs of diabetic retinopathy or peripheral neuropathy, and her urine microalbumin tests were negative. She had a prior history of hypoglycemia unawareness with recurrent episodes of severe hypoglycemia.

She was converted to lispro (Humalog) insulin before the evening meal, and her glycemic control was progressively improved throughout the remainder of her pregnancy, with sequential HbA_1c results of 7.2, 6.1, and 5.8%. She was found on ultrasound to …