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Permalink Reply by Jen on February 19, 2012 at 4:35pm

I think if you go low a lot your liver never really has a chance to store up enough glucose to release it at times when you're low, so going low a lot could cause your liver to not be releasing enough glucose as it should.

For me my blood sugar swings on NPH were just way more dramatic than on Lantus and/or the pump. No matter what I did I was either going high or going low.

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Permalink Reply by Gary on February 19, 2012 at 4:51pm

Jen,

I only use NPH at night. During the day I use both R and Humalog depending how they are running. In essence I have no background insulin during the day but R stays hanging around for 5 hours or so. Its really a shame that Smart Insulin more or less is sitting in limbo. If it had worked as suggested it would have been life changing for all of us. I still refuse to give up on a breakthrough treatment down the road. I think it will eventually happen, just a lot further away then I anticipated. I think both of us like many have more then paid our dues and we deserve a betting ending. As a youngster I never invisioned diabetes taking the toll it has on my life thats for sure

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Permalink Reply by Holger Schmeken on February 28, 2012 at 10:17am

@Gary: I think it is a big mistake to use the NPH only at night. The basal should cover your basic needs. This way you can skip a meal or get sick without being forced to eat something. The bolus insulin should just be used to cover the carbs to eat and for corrections. If you cover your basal needs with a part of the bolus it is not the right approach. Basically your regime causes that you have less insulin than you need for at least 12 hours. In other words you are running dry on insulin and all the little bolus shots you are using over the day are an incomplete replacement for the missing basal insulin. This can cause the fluctuation in blood glucose that you do not like. It is a bold step but why not splitting the dosage in two shots 12 hours apart? With some testing of the basal rate you will find out how much more you need to inrease the dosages of the two shots to get even levels. Ok, even in the sense of what is possible with NPH. With two shots of basal you will have to find new I:C ratios that is for sure. Yes, it can fail and it can even cause lows. But I really think it is worth to try something different here.

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Permalink Reply by Super_sally on February 28, 2012 at 5:15pm

I use NPH because of cost (out of pocket) and availability. NPH is also preferred by my endo considering I am pregnant. However, I have been using NPH ever since (and Humalog to cover meals).

I use NPH twice in 24 hours. It's profile seems to work fine for me, and particularly blocks the dawn effect. I take a morning dose at about 7 am and an evening dose at about 10 pm last thing before sleeping. I usually don't eat after about 7 pm and eat very lightly in the evenings so I don't have significant bolus insulin on board by the time I sleep.

I like to go to bed with BS in the range of 80 - 100.

Obviously this gives me some overlap in the mornings if you assume a roughly 12-hour profile.... but I am much more insulin resistant in the mornings and so this works for me. I dont' get overnight lows.

I do get a bit low late morning sometimes. This means I need to either have lunch on time by about 12:30 pm or suck a piece of hard candy to tide me over until I get to lunch.

But this could also be becuase I need quite a lot of Humalog for breakfast and this is the end of it's effect.

The trick is to get the basal rate right, so that your levels are pretty stable even if you don't eat. This can be achieved with a bit of experimentation.

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Permalink Reply by acidrock23 on February 19, 2012 at 5:34pm

I also had pretty good results w/ NPH consistently whenever I'd drink a ton of hard liquor. Beer wouldn't do it, just the hard stuff. It probably took a dozen years off my life. Oh well...

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Permalink Reply by Super_sally on February 19, 2012 at 5:28pm

I use NPH for my basal. I take my night-time dose before sleeping. Usually around 11. It seems to work perfectly for me as far as it's peak action and stopping the dawn phenomenon and I don't get overnight lows. But I need my next dose of basal around 8 am latest, else I'll start rising above target.

Seeing it works so well for me, I've no intention to change.

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Permalink Reply by Holger Schmeken on February 28, 2012 at 4:17am

Do you take NPH just once per day?

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Permalink Reply by Super_sally on February 28, 2012 at 5:18pm

Answered above. Twice a day. Currently 28 units at 10 pm. And 30 units at about 7 am. Before pregnancy dose was a lot lower.

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Permalink Reply by Holger Schmeken on February 29, 2012 at 2:43am

@Super_sally: Gary wrote "I only use NPH at night." so I think you have got that wrong.

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