For those on MDI that may still be using NPH

What time do you take your bedtime injection? I usually take mine around 9PM but wondering if there may be a better time to take it? I never understood how Lantus could be effective at night time being it releases at an even keel so how does it cover the liver dump around 3pm or so? For that reason and the cost I've stuck with NPH and most of the time I seem to do OK with it. I have a feeling after these severe low Incidents they are gonna suggest Lantus. I guess if it prevented the night time lows I'd opt to use it despite its enormous cost.

I found that NPH worked best when I'd take it at 11:00 or 12:00 midnight. Perhaps this became a bit of an issue when I stopped staying up that late all the time?

I am currenlty on NPH and badly in need of a change. I can't take Lantus so my options are somewhat limited. I had a low earlier today that required medical help. Meeting with my doctor soon to try to find an alternate solution.

Levemir. My 9:30 shot of Levemir takes care of the Dawn Phenom. perfectly. Perfectly! I keep experimenting with my daytime shot(s).

When I was on NPH I originally took it at breakfast and around dinnertime, but later moved the evening shot to bedtime. I didn't have any more severe lows once I moved NPH to bedtime (I still had morning lows, just not the needing-assistance-from-someone-or-calling-911 kind).

Once I switched from NPH to Lantus I suddenly "discovered" that I had quite a bad dawn phenomenon. Now that I'm on the pump it's not usually a problem, but on Lantus the only way to wake up below 200-300 mg/dl was to get up every night at 3:00 AM (when my BG was still normal) and take a few units of Humalog. If I ever went back on Lantus I would try something like taking a few units of NPH before bed to see if that helped without having too big of a risk of lows.

Have you tried Lantus or Levemir and using carbohydrate counting at all? Given all your problems with feeling variations in blood sugar, I'm kind of surprised you're taking NPH. I noticed a HUGE difference in how I felt on MDI compared to NPH; it even had a huge impact on my functional vision because the fluctuations in blood sugar cause my vision to go blurry if it's bouncing all over the place (I'm legally blind so even a "minor" fluctuation in my vision can make the difference between being able to read large print and not being able to).

Holy Banting Batman! That makes your amazing races last fall even more impressive!

Well its not the insulin that causes the distress its the glucose levels and all insulin types with not enough causes Hyper and too much Hypos. It makes no sense to me for Lantus to cover the Dawn so I don't even see how people use it unless not everyone gets the Dawn factor. When I get severe lows at night I am not sure if its because I am trending low after my night snack from my humalog dose and keep sinking while I am asleep or more due to the fact of my liver sometimes not spilling enough glucose to counteract the NPH. If the latter is the problem there really isn't much I could do because I have no idea what is going with my sugar throughout the night. If I am trending low before I hit the sheets I could rectify that to some degree. My mom keeps telling me I need to keep my sugar high enough at night so that this will never happen but If I push my level up in the 120 to 140 range I am going to be irritable as hell. Interesting but I never seem to be bothered with my vision unless I get really low.

There's peaks in Lantus too, you just have to find them and use them to your advantage. The peaks in Lantus are supposed to be more predictable than N I think?

I remember when it came it the verdict was it released insulin for a complete 24 hour period at and even keel. I am wondering if I should take my NPH a little later and maybe even knock off a few units? That way if I am ok when I go to sleep at least I'll fall asleep.

When I got my pump, the doc explained "NPH has only a 53% chance of peaking when it's supposed to" so if it peaks early, you get a massive "rush" and, if it peaks late, you get a high that is "mysterious", treat it and then the peak hits along w/ the CB and you are yutzed up again. I skipped Lantus, although the doc had recommended it, thought maybe it would smooth things out but, of course, I knew ****everything****!

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.


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

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...

Wow I did not think anyone still used NPH. I used that in the early 90s. It was miserable. I could never time it right and exercise would drastically alter its effect. I switched to Ultra Lente insulin in 1994. It changed everything. I finally had a grip on my diabetes. It wasn't perfect but it made things much better, It is a long acting insulin that has a 12 hour life as opposed to the 24 hour that you get with lantus. Maybe if you cant take lantus , you could tolerate utlra lente.

When lantus came available, I went to my doctor to possibly switch, but he convinced me to switch to a pump. I've been on one ever since. I really could not imagine going back to injections, Esp NPH. I think I nearly died 10 times during those days.

On a pump you can program your rate to combat the predawn phenom. My basal rates are so fine tuned that I can not even see a blip on my CGM during the night anymore. It is just a flat line across somewhere around 100 mg /dl.

@Brian: I highly recommend to switch to Levemir. With NPH you are already used to take two shots per day. This splitted dosage works best and has a very even reaction pattern.

Do you take NPH just once per day?

@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.

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