Hi all - I have a question pertaining to Humulin N.....basically, how do you use it??

The situation is this: I'm in Sweden for a year and unfortunately don't qualify for social health benefits while here, and of course the overseas insurance that I managed to beg into actually accepting me before leaving California will cover nothing even mildly related to diabetes. I can't wait until I fall down and break a finger and they try and blame that on low blood sugar or something so they don't have to pay out...I hate US insurance. But that's another story.

Anyways before I came here my wonderful doctors and the people at the diabetes research center I participate at gave me a ton of samples and about-to-expire insulin pens and vials, and among all of that is two packs of Humulin pens. Since diagnosis I have only ever used Novolog and Lantus, so I don't really understand how Humulin works. I don't think its a fast-acting insulin.....but its not as slow as Lantus, right? Is this one of the insulins that people often take when they are on the kind of schedule where they inject twice a day, or is that 70/30 that I'm thinking of?

I try and be up-to-date on diabetes and everything it entails, but looking into the use of other insulins has really never come up with me! Thanks so much in advance for any advice on how to use this. I really hope that I can somehow use it as a non-basal insulin, because bolus insulin (novolog and humalog) are the types that I'm lower on over here....and God only knows what its going to cost me to buy more w/o insurance. :/

Jen

Tags: humalog, humulin, insulin

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Humulin N = Basalinsulin = NPH Insulin = two shots every 12 hours to cover your basal needs. You need an additional insulin to cover your meals.

The NPH insulin has a peak four hours after injection. It can not be compared to Levemir. It is more a long stretched version of regular insulin. This means you will need to snack in between. Combined with regular insulin this will get worse because you will have too much active insulin in your system.

I am on Levemir now and I would never return to NPH that is for sure. So for me the trip to Sweden would be over right now.
When I was on NPH (years ago), I took three shots of it in a 24 hour period to reduce the severity of the peaks. Whether you take two or three shots, If you can somehow time those peaks in the daytime to when you would naturally eat, so much the better.
"Humulin N" is a brand name for NPH, a kind of insulin that has a delayed response by having zinc added. NPH can work pretty good as a basal insulin - I did this for a couple of decades.
"Humulin R" is a brand name for good old "Regular insulin".
All the major insulin selling companies have their own brand names for NPH and Regular. Don't get too much wrapped up in the brand names, it's about the same no matter who sells it. They are very old-school types and have been fairly standard for the past 60 years. About 20 years ago most of the production shifted from insulin made from pork and beef (animal) pancreases, to genetically engineered human insulin, and this is where the "Humil" (e.g. Human) part of the "Humulin" name comes from.

I found it worked pretty well, with 4 small shots a day. e.g. for most of the 20 years I did MDI with NPH as my basal, I took 5 units every 6 hours, 4 times a day.

NPH is not at all a "flat" insulin, it has a really broad long peak about 3-8 hours after injection.

Curves of various types of insulin found at http://www.endotext.org/diabetes/diabetes20/ch01s06.html


And remember those curves are idealized curves. For example they show "glargine" (e.g. Lantus or Levemir) as ramping up and then being perfectly flat out to 24 hours. It is not at all perfectly flat out to 24 hours!!!

By stacking small doses of NPH every 6 hours, the overall effect is quite flat. In some sense I feel that 4xNPH for basal, has superior flatness to 1xLantus every day. Right now I do Lantus twice a day (12 hours apart) and that's not bad but sometimes I feel 4xNPH was superior.

A very old fashioned (e.g. before MDI) way of using NPH, was by taking a shot of NPH+regular in the morning. The regular peaked an hour or two after the shot (sort of like a bolus to cover breakfast), the NPH peaked 5 hours after (sort of like a bolus to cover lunch), and the overlap of the activity curves between the broad peaks kind of worked like a basal. The peaks were not very sharp and the basal not very flat. And then in the evening before supper there was another NPH+regular shot, the regular to cover supper and the NPH as sort of a basal. Because of the broadness of the peaks snacks were often necessary in between meals to keep bg up, and "eating to the insulin" could cause weight gain. This wasn't the worst regime in the world but I did a lot better after I switched to more of a MDI type regime (using the same R+N but more shots) in the mid 80's.
Wow, I have not seen this chart for years. What a flash back.
I'm Swedish, and I can try looking into what applies to long term visitors in Sweden. If you're in Sweden as an exchange student you *should* be covered by the public health care system we have. I can try looking into it, and maybe ask around a bit. An insulin dependent person should not have to go without insulin! Oh, and the price for Lantus in Sweden is 394 Swedish kronor for a 10ml vial or 582 kronor for 5x3ml cartridges. All you need is someone to prescribe it for you.
As for the rapids, all of them are available on prescription in Sweden and the cost for Novorapid (Novolog) is 250 kronor for 10ml vial and 353 kronor for the penfills. So should you have to pay for your insulin yourself, it does cost less than in the USA I think.
Do get yourself to a GP and ask more, and get a prescription for your insulin in Sweden.
As for the Humulin N, it's a basal insulin taken 1-3 times per day so it won't do you much when it's rapid you need :S
Hi Jennie - Thanks for all the info! The problem here lies in that I have no personnummer.......see I know everyone else will read that and say oh ok, whatever, what's that, but I know you will immediately feel my pain. ;) Its a loop in the system, because of the fact that I'm technically here 11 months which is less than one year. I can't tell you how many people I've had to explain this to and they just don't get it, think I'm joking, they say HOW CAN YOU LIVE w/o a personnummer?!
Haha..well, its hard....and especially for medical stuff. I was going to have to wait months and months to even get an appointment, which would be something like 2000SEK itself, and most doctors don't want anything to do with you if you're not in the system.
So....oh well. Any spare insulin lying around that you want to sell on the black market to a needy foreigner, let me know! ;) I'm in Stockholm, where are you in Sweden?
I would, if possible, pay for the lantus insulin if you can. When I was first dx I took NPH and when Lantus came out it was a different world for me. I hated NPH. If you take it, be prepared for less tight control, less ability to eat normally, and for me, many crashes and more lows. I am sure some people like NPH, but I would NEVER go back. It is an older insulin and IMO, not nearly as good as the newer ones.
I agrre with Hope...pay for the Lantus if at all possible, and stay away from NPH. I was on it for years, and it was awful. Two major problems...first, the onset of action and peak action are not as stable as the charts would have you believe, so I never knew for certain just when it was going to peak. I had a lot of severe lows on NPH, and that led to the second problem, which is that NPH definitely causes hypoglycemic unawareness. The final straw for me was when I left my house with a bg of 125, having just eaten a snack, and crashed my car less than 30 minutes later with a bg of 21. That's when I got a pump and went on humalog, and my hypo awareness came back within a month and has remained quite good for the past 8 years.

So if you can find a way to swing it, stick with your regular insulins and regular routine.

Ruth
Oh the NPH horrid stuff. I finally ended up splitting the daily dose into 6 shots every 4 hours to do the basal function. I think total daily dose of NPH was approximately equal to total lantus. You need something fast for meals.
I use and have been using NPH just for my night time shot my whole life. I take 24 units usually at 9pm to handle the early morning dawn crap which is kind of inconsistent as lately I have been waking up high anyway. I may need to increase my units but it usually works OK. I don't use it during the day. Humalog only for the most part although sometimes I sneak in a few units of regular to help the after breakfast spike. I rarely ever sink low.
Holy cow - thank you everyone for this information, and I'm so sorry that I'm just getting around to replying! I thought this site was gonna email me, maybe it sent to my spam....

Anyhow Im just checking up now because I've finally gotten to the "bottom of the barrel" and I'm having to use the Humulin N....and yes, I see what you guys are saying about the peaks. It sucks. I certainly miss my lantus. :(

One other question, if any of you are kind enough to help again - I'm actually on my way home next week for a short trip to pick up insulin. I have the option of paying out the wazoo to get doctor appointments and Rxs to refill my Novolog cartridges and Lantus sans insurance (ugh, I cringe) but I am finding that another option lies in the great massive lowprice devil that goes by the name of Walmart. Apparently they sell Humulin N, along with R and L, for $20 a vial. WOW. That's so cheap that it makes me wonder if its worth it to switch to that stuff, only problem being that I'm not entirely sure how "that stuff" works....not sure at all, actually.

Any words of wisdom from you wonderful sages out there? :D Tim I like your chart, are any of those other colors relating to R or L?
one other thing about NPH that they told me when I got my pump is that NPH has only a 53% chance of peaking when it's supposed to? So if you look at Tim's chart, you are sort of "rolling the dice" on when the peak will actually hit. After things smoothed out with the pump, I sort of looked back at my memories of N and that fact explained a lot of bizarro stuff? You run up (because the peak is late...) correct and it comes screaming down (peak+correction) or it hits early so you treat the low (caused by the early peak) and then it doesn't cover lunch quite the same way it's supposed to. Good luck with the experiments!! Another thing that I tried, very experimentally after rereading Bernstein in the month or so before I got my pump was to split the shots (I was about 30U/ shot...) into 7U increments? It took 4 or 5 shots to do but it seemed to smooth things out. He explains that the bigger bubbles have problems being absorbed smoothly.

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