Stupid question about basal (NPH) insulin

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Permalink Reply by Sarah on October 26, 2009 at 2:42pm

It shouldn't... but a very real possibility is that you're going low while you sleep, and you're unaware of it... depending on your dose, you may need a snack at bedtime to prevent that low.

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Permalink Reply by Terry O'Rourke on October 26, 2009 at 4:48pm

Kelly -- I agree with Sarah. You may very well go low during the night while you sleep. You may want to monitor your night-time BGs once in while by setting an alarm for every two hours. How else will you know that your insulin matches your blood glucose during the night.

It's been a long time since I used NPH insulin but I seem to remember that it peaks at about 6 hours and lasts about 12; check the insulin package insert to be sure. As far as whether the insulin acts differently at night than during the day, I would say yes. The difference between the two is primarily due to the increased activity level during the day.

Your background metabolism also cycles through different ranges as the liver changes its glucose output during the day. In my case, I use more insulin from 5 a.m. to 8 a.m. than I do the rest of the day.

Have you ever considered a continuous glucose monitor? It can wake you up in time to treat both lows and highs. Just a thought.

BTW, when it comes to your health - there are no stupid questions! Good luck adjusting your insulin.

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Permalink Reply by Kelly on October 26, 2009 at 5:42pm

Thanks for your help I will definately look in to whether or not I'm going low at night. I haven't gotten a lot of education on insulin use, so all this info is helpful.

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Permalink Reply by Sarah on October 26, 2009 at 8:15pm

Is there a reason you're on NPH and not Lantus or Levemir? I'm just curious, not judging.. but I wouldn't be on NPH alone if I had a choice (that said, it was always very useful for me on MDI to control my DP, but that was in addition to Lantus).

You should consider getting Gary Scheiner's book Think like a Pancreas to learn more about insulin.. IMO it should be required reading for anyone using or considering using insulin.

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Permalink Reply by Kelly on October 27, 2009 at 8:58am

Hi Sarah,
My D was caught in pregnancy and I've been insulin because I was breastfeeding. My doc put me on NPH morning and night and that was a nightmare so I had Toronto left over from pregnancy to manage my mealtime sugars. i think they've only taught me what I need to know bc they didn't expect I would still have diabetes after the birth. I'm working on getting an appt with an endo.
Thanks for your advice!

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Permalink Reply by Theodore Quick on November 13, 2009 at 1:27pm

Another factor that many never hear about. NPH may have widely varying activity schedules. Most often happens after long term use, but has been know to happen to some people right from the start. That's part of why Lantus and Levemir were created in recent years, they act fairly steadily for 24 hours or so (perhaps less for some) without much varation.

I used to have an awful time on NPH, and found that Lente, with a stated schedule much like NPH, but found it was much steadier for ME. I got to do a lot of experimenting in the 53 years I've been a Type 1 diabetic, much of which was befoe we could even dream of glucose meters. Things were a bit harder in 1956....

Anyway, I don't know if Lente is even available anymore, but Lantus or Levemir are a lot better anyway. I never used either since I've had insulin pumps since 1993, so never had the chance to use them.

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Permalink Reply by Ruth on November 14, 2009 at 9:27pm

I'm with Theodore...I had a terrible time when I was on NPH. The action was quite unpredictable, and I had two very serious lows and passed out while driving...this after testing okay just before getting into the car. My doc switched me to a pump, which has made all the difference in the world. But even if I couldn't have a pump, I would never go back to NPH. Lantus and a rapid-acting insulin would be my regimen of choice rather than NPH.

Ruth

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