What time do you take your bedtime injection? I usually take mine around 9PM but wondering if there may be a better time to take it? I never understood how Lantus could be effective at night time being it releases at an even keel so how does it cover the liver dump around 3pm or so? For that reason and the cost I've stuck with NPH and most of the time I seem to do OK with it. I have a feeling after these severe low Incidents they are gonna suggest Lantus. I guess if it prevented the night time lows I'd opt to use it despite its enormous cost.
I found that NPH worked best when I'd take it at 11:00 or 12:00 midnight. Perhaps this became a bit of an issue when I stopped staying up that late all the time?
I am currenlty on NPH and badly in need of a change. I can't take Lantus so my options are somewhat limited. I had a low earlier today that required medical help. Meeting with my doctor soon to try to find an alternate solution.
Holy Banting Batman! That makes your amazing races last fall even more impressive!
Wow I did not think anyone still used NPH. I used that in the early 90s. It was miserable. I could never time it right and exercise would drastically alter its effect. I switched to Ultra Lente insulin in 1994. It changed everything. I finally had a grip on my diabetes. It wasn't perfect but it made things much better, It is a long acting insulin that has a 12 hour life as opposed to the 24 hour that you get with lantus. Maybe if you cant take lantus , you could tolerate utlra lente.
When lantus came available, I went to my doctor to possibly switch, but he convinced me to switch to a pump. I've been on one ever since. I really could not imagine going back to injections, Esp NPH. I think I nearly died 10 times during those days.
On a pump you can program your rate to combat the predawn phenom. My basal rates are so fine tuned that I can not even see a blip on my CGM during the night anymore. It is just a flat line across somewhere around 100 mg /dl.
@Brian: I highly recommend to switch to Levemir. With NPH you are already used to take two shots per day. This splitted dosage works best and has a very even reaction pattern.
Levemir. My 9:30 shot of Levemir takes care of the Dawn Phenom. perfectly. Perfectly! I keep experimenting with my daytime shot(s).
I used NPH / R in the 80-90's, before going on the pump. Never used Lantus or Levemir.
I recall a night time NPH around 10-11pm, but usually also had a small snack to prevent lows. Was also running fairly high in those days, with A1C in 8-10 range, and only 3 BG tests per day. But that was 'standard' practice back then.
I took both NPH and R in the morning, then R only to cover dinner. No injection at lunch, which had to be 'on time', to match the morning NPH peak, or I would go low. Didn't even know about counting carbs then. Pretty much the same dose every time, with a 'sliding' scale correction based on BG.
Gary - I currently have an extra bottle of Lantus, as backup in case of pump failure. But it expires in May. If you're interested, I'd send it to you. Please PM me.
When I was on NPH I originally took it at breakfast and around dinnertime, but later moved the evening shot to bedtime. I didn't have any more severe lows once I moved NPH to bedtime (I still had morning lows, just not the needing-assistance-from-someone-or-calling-911 kind).
Once I switched from NPH to Lantus I suddenly "discovered" that I had quite a bad dawn phenomenon. Now that I'm on the pump it's not usually a problem, but on Lantus the only way to wake up below 200-300 mg/dl was to get up every night at 3:00 AM (when my BG was still normal) and take a few units of Humalog. If I ever went back on Lantus I would try something like taking a few units of NPH before bed to see if that helped without having too big of a risk of lows.
Have you tried Lantus or Levemir and using carbohydrate counting at all? Given all your problems with feeling variations in blood sugar, I'm kind of surprised you're taking NPH. I noticed a HUGE difference in how I felt on MDI compared to NPH; it even had a huge impact on my functional vision because the fluctuations in blood sugar cause my vision to go blurry if it's bouncing all over the place (I'm legally blind so even a "minor" fluctuation in my vision can make the difference between being able to read large print and not being able to).
Well its not the insulin that causes the distress its the glucose levels and all insulin types with not enough causes Hyper and too much Hypos. It makes no sense to me for Lantus to cover the Dawn so I don't even see how people use it unless not everyone gets the Dawn factor. When I get severe lows at night I am not sure if its because I am trending low after my night snack from my humalog dose and keep sinking while I am asleep or more due to the fact of my liver sometimes not spilling enough glucose to counteract the NPH. If the latter is the problem there really isn't much I could do because I have no idea what is going with my sugar throughout the night. If I am trending low before I hit the sheets I could rectify that to some degree. My mom keeps telling me I need to keep my sugar high enough at night so that this will never happen but If I push my level up in the 120 to 140 range I am going to be irritable as hell. Interesting but I never seem to be bothered with my vision unless I get really low.
There's peaks in Lantus too, you just have to find them and use them to your advantage. The peaks in Lantus are supposed to be more predictable than N I think?
I remember when it came it the verdict was it released insulin for a complete 24 hour period at and even keel. I am wondering if I should take my NPH a little later and maybe even knock off a few units? That way if I am ok when I go to sleep at least I'll fall asleep.
When I got my pump, the doc explained "NPH has only a 53% chance of peaking when it's supposed to" so if it peaks early, you get a massive "rush" and, if it peaks late, you get a high that is "mysterious", treat it and then the peak hits along w/ the CB and you are yutzed up again. I skipped Lantus, although the doc had recommended it, thought maybe it would smooth things out but, of course, I knew ****everything****!