This weekend I switched my long lasting insulin from Lantus to NPH. I have been having trouble with Dawn Phenomena on Lantus and Gerri commented to me that maybe it was losing strength because Lantus is only good up to one month. I don’t have insurance so can’t get more to switch it out. I mail order to get insulin like my Humalog. So I decided to switch to NPH since no prescription is required. Long story short, I am doing great on NPH. I am having low BG’s in the mornings a couple hours after breakfast but I don’t care. The rest of the day is going well. I am a little afraid to get low BG at night so am taking it slow on the dosage. I am doing DR. B so carbs are super limited to veggies only. Any body else switch long lasting insulins and experienceing low BGs and how are you handling them?
Glad you’re doing better. Lantus does expire quickly & one of the reasons I prefer Levemir. Lows are pretty common with NPH.
When do you take your NPH? Spliting the NPH into multiple doses can certainly help even out peaks. If you take NPH in the morning, but have good morning numbers, perhaps you could delay you morning NPH and move the peak to lunchtime.
I’ve ended up with a similar regime to Alan, but I have a wicked case of Darn Phenomenon, so my evening dose is actually 50% more than my morning dose and I may actually have to lower my morning dose. One advantage of NPH is that you do have more opportunity to employ multiple doses to vary your basal rate over the day to meet variable needs.
Thank you Alan for your help. I checked on line for Levemir in Canada and it’s a bit more than Lantus. I appreciate your advice on how to use NPH and what snacks to use it with at night time.
I usually wake up at 5am and byn 5:30am start taking all my insulin. I guess I will just have to play with the dose till I can get it right.
Thanks bsc, for your reply. I split my evening and morning does. This morning I took 8 units of NPH at 6am and by 9:30 had a BG of 66. At night maybe I will only take 5 units of NPH. and see how it works. I usually take my Humalog with my dinner right around 6-7pm and my long lasting between 8-9pm.
Do I understand you correctly, I understood from your comment that I can take multiple doses of NPH through out the day if I need to?
It’s just hard to figure out how much insulin to take day or night, even when eating on DR. B and following strict guidelines. Some day I really do hope to be in his target range and have it all figured out. At least I am consecutively running my sugars in the 100’s. Like today I am 111-119 all day!
Thanks Gerri. Your the reason I changed my long lasting insulin. How have you been doing with your sugars? Are you finding it easier and easier as time goes on to stay on DR. Bernsteins diet?
NPH has a peak that lasts from 4-12 hours. If you take your NPH in a split dose every 12 hours, in an idealized world you would cover your basal needs for 24 hours. But NPH is not flat. In your case, you are just starting and it appears your NPH peaked early caused a slight hypo. So your morning dose may well be a tad high. You are taking a split dose, but it may also not be fully evenly split (you take it at 6am and 8-9pm), so you might correct that. You can also further split your dose (into 3 or 4 injections) if you need to even things out even more. With NPH you can actually mix it with Humalog for your bolus and perhaps get a more even response. But before you do that, you should figure out what your basal levels of NPH are.
Levemir may be a bit more expensive, but a vial also lasts 6-8 weeks.
I have gastroparesis, so BG is fequently all over the place. With high carb, it would be far worse. After the first couple of weeks on Dr. B’s diet, my carboholic cravings went away. It’s been over 2.5 years & I don’t even think about it any more. It’s just the way I eat now. Keeping meals varied helps a lot. If I had to live on protein & steamed vegetables, which is what people think low carb is, I would have given up from boredom.
Dr. B has his points. He also says not to inject more than 7U at a time. Another rule I break, I am just a bad boy. At least I’m not reusing syringes. I’ve been fortunate, you have cautioned me about the NPH peaks, but I’ve not had any problem. You may have a point on the mixing, I had been taking my NPH at 6am and 6pm, but I was unable to get my morning numbers down. While I now know that my overnight basal needs are significantly higher than my daytime needs, perhaps mixing did not help.
My major problem is the R, just as you note, it easily lasts more than 6hrs. If I dose my R to cover the meal and bring me down to preprandial at 3-4 hours, I just set my self up to go low at around 5-6 hours. I’ve not figure that one out.