Be in control with Humulin-R and -N

We are blessed to have a new member, Dyepez09, who needs help from this community in getting dialed in with good control using Relion R and N insulins ($25/bottle @ Walmart). She needs the collective wisdom of this community in strategies for dosing, carb counting, testing to establish basals, carb and correction ratios.

So, please add your advice to this discussion so we can help her get up to speed and be successful.

Things I can think of we need to cover:

  • How to figure out ratios
  • How to successfully/effectively carb count
  • Dosing strategies, accounting for the onset and duration of action of Humulin-R
  • How to figure out basal needs
  • How to convert basal needs to Humulin-N dosing regimen
  • Tips on basic kit to keep with her at all times
  • Not open for discussion: She should use skittles to treat lows :-) :-)
  • Travel tips
  • Pre-bolusing with Humalin-R
That's my first cut at a list... please add to it, and also please add your advice and experience in whipping this demon and getting control!

Just a little correction- right now Walmart's Relion insulins are Novolin R, Novolin N, and Novolin 70/30.

My personal experience is that I need less than a 15 minute prebolus and more than that is a problem, with Novolin R. But that's me. I also sometimes break my mean up (about three quarters, one quarter) and eat the second part of it 2-3 hours later. Particularly for breakfast.

I know that when I was on R and N (which was in the 80s, and I was a kid, and a lot has changed since then), I was pretty reliant on snacks (between breakfast and lunch, between lunch and dinner, after dinner/before bed) to hand the peaks from me, NPH would be the tricky thing here, for me. I think it might be tricky to think of it in terms of "basal". It's too short acting for that, in my opinion.

I think as with everything it will be trial and error, probably take a lot of testing (although I know there might be a limit on the number of strips available). Have lots and lots of Skittles around!


Here is a previous discussion that talks about Humulin R and NPH:

My first insulins were N and Regular, and I had the problem of too many lows.

I found I had good basal coverage with fewer lows from the N-peaks by taking the (long-lasting) N three times in a 24 hour period. It can be hard to remember three shots, but a whole lot better than dealing with lows.

The other thing I would suggest is to figure out exactly how long the Regular stays in your system so that you don't unknowingly stack your boluses and corrections. That is, take note of how much Regular insulin you have on board (IOB) so as to give your insulin on board a chance to act.

Finally, you will have a better shot at getting the R correct and avoiding too high spikes by eating low-carb. Best luck.

2 books you should try:

Using Insulin bu John Walsh

Think like a Pancreas by Gary Scheiner

I was on Novolin R and Novolin N for a long time. A good A1c is possible but the risk of lows is very high. With the two shots of Novolin N (NPH) per day I had two activity peaks around lunch and 3am. This makes it very likely that the I:C in these times will reflect the peak: 1 unit of insulin will cover more carbs then. To keep me stable at night I ate one to two wasa crisp breads before bed. I think 15 minutes for pre-bolus time is good. We should not forget that these insulin come as U40. Thus they unfold their activity a little bit faster than regular U100 insulins. I would say it is manageable although unforeseen/unplanned activity will be a problem: skittles, juice, and chocolate (for the night after stressful days) will be your friend. This must be paradise, right!?

I'll resurrect this post by stating I've been using the Lantus Solostar pen since July and shortly after that the Humilin fast acting pen. Due to the cost of the insulins and new insurance that won't cover their high cost, I'm going to talk to my doctor about switching me over to the Walmart Novilin brands because they are so inexpensive.

I did an internet search but it's not really giving me any info. Which is the long lasting and which is the short acting?

I've been diagnosed with diabetes since age of 23 and now am 50. I had contolled it with diet and exercise for some time and then the oral meds and now after having super high A1c finally went on insulin this past summer.

Thanks for any help. This is my first post here :)

Hi Merianb: The R is regular insulin, or the faster acting of the two. The N is NPH, or the slower acting. I used both of these before the insulin analogs came along (Humalog fast acting in 1996 was the first analog). R can be used to cover meals, N can be used for the basal insulin. As others mention, R and NPH do increase the odds for hypos, but many of us used them for years with success. Is there any chance you can get an appointment with a CDE who can help you with the use of these insulins? And also, "Think Like a Pancreas" and "Using Insulin" are great books that can help you. Best of luck! Thanks for posting!

I used R and NPH for the first six or so years of diabetes, and then used R and Humalog for another ten years before switching to Lantus and Humalog and then finally the pump.

I attempted to count carbohydrates during my later years on NPH and found it difficult because it was impossible to tell what was being covered by the peak in NPH. At the time I took two shots of NPH a day, one in the morning and one before bed. (During the first eight or so years of diabetes I took NPH before breakfast and dinner, but this caused numerous nasty lows, and changing it to bedtime fixed this.) I had to eat snacks between meals and before bed to accommodate the peak. I could not skip or even delay meals (even by only half an hour) without going very low because of the NPH peaks. Using R, I took it about half an hour before eating. Trying to eat out at restaurants (which usually meant a delayed meal) was a huge ordeal.

I had a good A1c while growing up (in the low 7s usually) but, like Holger said, had many, many lows to pay for it. I think taking NPH three or four times a day might smooth out the peaks and make control easier. When I was on NPH I didn't take any insulin at lunch because this meal was covered by the NPH peak. This peaking action (that, according to research, can vary by something like 50%!) is the huge drawback to using NPH as a basal insulin. It's like getting random extended boluses at various points in the day, which is why snacks are usually needed.

Correction boluses might be difficult because of how long R lasts in the system (something like six to eight hours), making it very easy to stack insulin.

Sorry I sound so negative. I just don't have any positive memories of R or NPH in comparison to MDI or the pump. But there are some on this site who do manage to somehow gain good control and even flexibility while using these insulins. I suspect for anyone diagnosed as an adult who manages this, that their pancreas might be helping to smooth out some of the rough edges. But if this is the case and it works for someone, then that's great!

When I started insulin three years ago it was with the Walmart Relion NPH and R insulin. They only come in a vial, so you will have to switch to syringes, but I never found it a problem. I actually find syringes hurt less and are easier to use. Walmart also has very affordable syringes.

NPH has what might be called an intermediate profile, it lasts at best 10-16 hours. This is compared to Lantus which claims it lasts 24 hours. Thus NPH requires at least two injections/day and you may find you do better with three per day. NPH can have a peak for some people, and this can cause problems, the profile of NPH is clearly not as flat as Lantus.

Regular (R) actually works quite well for low carb diets. I found that the only issue is that you really need to inject earlier, 30-60 minutes before eating. And since R can last more than 5 hours, you have to watch for hypos 3-6 hours after a meal. It can be difficult timing and dosing R to keep post meals blood sugar spikes manageable and still avoid hypos. A good list of the basic profiles of these different kinds of insulin is provided by the NIDDK.

And finally a note about NPH/R, they can be mixed. Some argue about the effectiveness about mixes, but I found that I could time my NPH to occur at a meal and reduce the number of daily injections. You need to remember to draw in the R first and the NPH last. I also took extra care to properly mix my NPH, it is a suspension, I always rolled it at least ten times and turned it at least ten times. Failing to mix NPH can make it highly variable.

I have the book "Think like a pancreas" and started reading it more intently last night and I ordered the other book.

I was on 30 units of Lantus each evening and 4 units of Humulog at each meal. My doc wants me to start with N 20 and R 8 in the morning and then N 7 and R 7 before supper each evening and then I'll keep testing to see where the corrections need to be made. I still have 1.5 pens of humulog if I can't seem to get the fast acting working correctly fast enough for my patience.

A CDE would be out of the question right now due to finances. I have seen them in the past and my doc is working with me through emails so I don't have to pay for a visit to him. He's a great endo and I have full faith in him :)

Thanks for that advice!

Not so negative because your response helped me to understand why my doc said to only take in the morning before breakfast and the evening before supper.Was wondering about the mid day when I've been used to taking the humulog

This would be great, however Indiana's governor passed a law this past June that prohibits any insulin whatsoever being bought without a prescription.