How much fast acting and long lasting do you take on DR. Bernstien?

Just curious, I have been on this diet going on 3 months. So far I can’t complain. However, it would seem that insulin use really should be down but I don’t feel like mine is. I am still chasing my Dawn freakin Phenomena and can wake up as high as 265 BG. Then it seems like for the next 6 hours I am constantly bolusing up to 5 units every 2-3 hours Humalog and taking 2-3 Units of NPH. My DP seems better if I take my dinner Humalog 5-7 units around 5-6pm my NPH 5 units at about 8-8:30pm set my alarm for 11pm to make sure I am not low many times I will be in the 80-95 BG range so will set my alarm again for 12:30am-1pm. Usually I will be around 189BG then I take more Humalog 5 units and 3-5 NPH. Then I set my alarm for 3:30am and end up taking at least 3-5 units more Humalog and I some times take 1-3 units NPH. By the time I get up for the day at 5am I am usually around 132BG once I was at 92! That was two weeks ago. I would then take 5 units of Humalog for Breakfast of the 1 wasa cracker and tsp. Peanut Butter but two hours last would be at 160-171 BG range. So then I take more Humalog.

I need help. I am afraid to take more Humalog at one time, and afraid to take more of NPH at one time. Over the weekend I was taking my Humalog for meals and then 3 hours later an extra 2-3 units with 2-3 units of NPH kinda all day long. I was having lows 6 hours later. Had a hard time getting them to stay up. Took over an hour to get them to raise… By then I ate 2 packs of Smarties, 1 Glucose tablet and 2 spoons of Peanut butter and was at 189 BG. Then I had to chase it back down with more insulin. If you have any idea I am open to suggestions. DR. B makes it sound like he takes 1-2 units of this and 1 and a 1/4 unit for that, and here I am taking a ton.

NPH is a horror! It’s very peaky and unpredictable. Have you talked to your doc about using Lantus or Levemir for your basal instead? It’s really hard to get boluses right for meals when your basal is unpredictable.

I’m sure other people will have a lot more to say.

Thank you Natalie for your reply. I was using Lantus for the last 5 years. Since I have been with out insurance for the last 4 years I don’t have a doctor to consult with I started NPH in February 2011 because it is way cheap compared to Lantus and I guess a vial lasts longer than 28 days. It’s interesting because I read alot about which long lasting is better, and I am so confused by now.

Thank you!

I’ll keep this short: I’m utterly ashamed that a nation as rich as ours can leave people like you unable to get the kind of insulin you need. :frowning:

Low carb diet should help your control. I agree with Natalie its diffcult to control your bg with NPH. Its obsolete. Lantus if affordable is a much better option.

Yolanda I wanted to reply, even though I am not a low carber, since there has not been much of a reply . I used NPH for quite a while due to no insurance like you. It suck’s I know.

Most manufactuer’s of NPH insulin state that once the vial is punctured it should only be used for 14 days. (I admit I would use it longer than the 14 days. I never really knew how much that impacted my blood sugar because I did not have enough money to buy a whole bunch of strips either)
Once a Lantus vial is punctured it should be used in 28 days.
Once a Levemir (similar to Lantus) vial is punctured it should be used withing 45 days.

Have you tried getting insulin for free from NovoNordisk or Sanofi Aventis using their patient assistance programs (Sanofi’s income guidelines are more generous)? If you haven’t checked on it you can get more info from needymeds.org

I use NPH. NPH vials once opened actually don’t list a time before they should be thrown out, but 28 days is a reasonable guideline. NPH pens like the Humulin N list a 14 day (2 week) life once opened.

It is really hard for me to give you specific advice, but I would suggest to you that under Dr. B’s diet, one should expect to have a basal/bolus ratio that is “heavily” weighted to basal. You might actually need 80% of your total daily dose from basal. I suspect that your NPH levels are way too low and you attempts to constantly take humulog just are a poor fit. It would be good to do some basal testing.

Interesting! My basal/bolus ratio is 62/38. But then, I’m not doing as low carb as Bernstein recommends; I’m averaging about 60g a day. I had thought there was something wrong, because people on a “normal” diet usually get 50/50. Glad to know that little fact!

I wonder why there would be much of a difference? Perhaps people are more apt to be carrying around a pen vs vial thus affecting stability of insulin?

If you carefully go through the basic model presented in books like “Using Insulin,” it assumes a carb intake consistent with ADA guidelines (45-65% of calories from carbs). If you have your ICR and ISF correct under that model but shift to a low carb diet, your basal will stay the same, but your insulin used to cover carbs drops markedly (as does your TDD). Hence the shift away from 50/50. Bottom line. If you do low carb, then do basal and bolus testing to establish your control parameters and expect your TDD to go down and you basal/bolus ratio to shift.

As to why pens last a shorter time, I think MossDog is right, lots of people carry around their pen in a pocket, a really “marginal” temperature (hardly < 86 deg F) and then I think a lot of people leave their pen tips possibly contaiminating the pen. I admit to making this offense.

Well, I can’t say I follow Dr Bernstein 100% but I do enjoy the benefits of low carb on most days. Sometimes thought the low carb makes my liver dump and I battle that all day. I find that taking small amounts of novolog and lots of water really helps me. I hate taking corrective boluses because I think it is the reason I can’t lose weight. I am trying my hardest to battle middle of the day highs with water and walking. Of course those highs can’t be the 300’s or even 250 range.

I always have to be out of bed by 5:30am due to DP. If I sleep in my BG is 250-350 for sure. I have to get up, get moving, and most mornings take a couple units of Novolog.

I use vials. I used to use the pens but the jammed and leaked and I hated them. So I use vials, it is more of a hassle but I am used to it now. At least now I know I am getting the drug where before my pens would jam and I though I was getting insulin when I was not. It was very frustrating for me. I am much better now. :o)