Insulin Analogues in HIP - Indian Experience ABSTRACT – Hyperglycaemia in pregnancy (HIP) is associated with higher risks of adverse pregnancy outcomes, and could be because of pre-existing diabetes, or insulin resistance caused by pregnancy. Indian guidelines recommend initiating insulin therapy when lifestyle modifications are unable to adequately control hyperglycaemia. Newer insulin analogues are now being used more frequently in pregnancy since they are safer and could provide a glycaemic profile similar to non-diabetics. Insulin aspart, a short-acting analogue, has sufficient evidence for its use in pregnancy, and a study by Deepaklal MC et al, further reinforces the safety of aspart in gestational and pregestational diabetes. Premixed formulation of aspart, containing a protaminated crystallized component, was studied by V Balaji et al, and was concluded to be non-inferior to premixed human insulin in efficacy and safety. Another short-acting insulin, lispro, was also concluded to be a safe and effective option in HIP by Deepaklal MC et al in his retrospective study in GDM. There is no adequate data for use of glulisine in pregnancy, and it was considered FDA category C. Insulin detemir is the only long-acting analogue that can be considered for use in pregnancy in India. Insulin degludec, an ultra long-acting insulin is not approved in pregnancy yet, but the recent EXPECT study to assess efficacy and safety in pregnant women with T1D indicates non inferiority of degludec with detemir. Most studies on glargine are small and retrospective. Glargine was previously considered FDA category C, now the Indian label guidance classifies under “No clinical data”.