Humulin dosing question

Hey all,

I usually use novolog in a pump but ran out of pump supplies and could only get humulin N as a long-acting stop-gap until new supplies arrive. Any suggestions for how to convert my usual daily total basal of 14 units to injections? Divvy it into 3 shots of about 4 units each, every 8 hours?

Thanks for any help you can offer!

That’s a tricky one. I think someone here commented on using Humulin R in a pump a while back but I don’t know if anyone has any hard data on how to use either one with a pump. Not exactly recommended. A lot would depend on what your pump lets you do–I don’t know if mine would let me schedule what would effectively be 3 boluses over a 24-hr period and a zero basal in between, which is I think what you’d have to do with N. N is evil as far as I’m concerned but if you’re stuck with it, it seems like it might be a lot simpler just going with injections until you get your regular supplies. I’d be particularly worried about overnight. Do you have a CGM, and if so is it loud enough to wake you when you’re going low? That NPH crash can be nasty.

I should add that 14 units of Novolog (or Humalog) is in no way equivalent to 14 units of N–they’re just not designed to do the same thing. Pump aside, I’m not sure how to figure that one out, even just using it the conventional way. I’d try to research that first. Do you have an endo you can ask?

Definitely take a conservative, cautious approach on this stuff until you know how your body is reacting. Have you used N before? I was on it for 20 years and It can be tricky stuff.

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Hey blinberg,

This is something you just have to learn by doing. Your plan is a great start, the peaks can be tricky so be sure to keep some glucose on hand at all times. Things to consider are the action times which are:

Start - 1–3 h
Peak - 4–9 h
Ends - 14–20 h

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not to make light of what must have been a stressful, panic laden time, but

WHY DO THESE THINGS ALWAYS HAPPEN ON THE WEEKEND? At least, that’s when they always do in my experience. hope you get back on your normal routine soon.

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@DrBB, @karen57 and @MarieB, thanks so much for your responses! I actually posted that question, but was having trouble with my account at the time so I used my girlfriend’s account. No trickery intended!

Marie… no kidding! These things ALWAYS happen on the weekend, late at night, during a holiday… Katerina (aka blinberg) and I went to the hospital today, where I got a doc from urgent care to prescribe me Lantus. I’ve used that one more recently (I’ve used Humulin N, about 1,000 years ago, and had no recollection how to dose it). So now I’m on my old MDI plan using Lantus and Novolog, and so far it’s going pretty well. I am relieved not to have to brave the Humulin that I got over the counter last night.

Thank you all for your help!

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And for some reason I thought you were asking about using N in a pump, so, um… never mind.

Glad you didn’t have to use that nasty stuff in the end anyway!

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I knew you’d figure something out. It’s like the perfect storm of unfortunate circumstances, I’ve been there. I ran out of cartridges once and drove 2 hours to bar owned by the father of a Accu-chek rep, where she had left a box for me. I flew to San francisco and forgot my insulin and had to figure out a way to get walgreens to sell me some. after another trip where I forgot my insulin and got the concierge to find me a pharmacy that would sell me a bottle of humalog for $150, I asked my PCP to give me a undated scrip for it, which I keep in my wallet. honestly d is such a royal pita on a normal day, but this stuff just about breaks your spirit.

BIG HUGS!

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By this point my memory is more ambiguous than not about whether I have ever used R with a pump. I am pretty sure I either did this when I started or that at some point I failed to get a script and ended up buying R over the counter & using it to tide myself over. :confused:

Whatever the reason for it, I do have a … belief (?) that R in a pump is not as bad as we all seem to fear these days. I keep wondering, how bad could it be? I’m half tempted to spin off a separate thread asking about this to see if anyone else has clearer memories than I do.

I would expect the biggest problem with R would be that the boluses would be frustratingly wonky. It takes longer to begin to take effect and persists longer than the analogs. But if you have a CGM and patience, you could pre-bolus and stay on top of your BG that way.

I think one could do “well enough”. Certainly people did use it in pumps before the faster versions were available, no?

Basal would also, of course, need watching especially at the beginning. But I am not sure how noticeable the difference between faster insulin and R would be for doses a fraction of a tenth of a unit which a pump’s basal is delivered in these days.

I would also expect there would be a “pipeline” effect for basal. There might be a noticeable lag at first, but once the initial basal delivery started infusing, any delivery lag should be diminished for the rest of the basal. Aside from possible delivery rate changes, basal with R might not be that different from “whatever-log”? Maybe? Perhaps?

A part of me actually wants to try it so I can find out. <sigh /> How crazy is that, eh? :fearful: :scream: :confounded: :smirk: :slightly_smiling:

My episode was just a month ago on my way from Boston to the Cape for my granddaughter’s birthday. Suddenly hearing my Medtronic beeping and realizing oh crap, I forgot about that low reservoir warning and now it’s just run totally dry. I always carry an extra infusion set in case of a rip-out, but not a reservoir, and I often carry a Novolog pen for just-in-case on longer trips, but not this time of course. Managed to locate the # for a RiteAid in the town next to my daughter’s and call them en route (yay smart phones), but of course they didn’t have any pens. They had Novolog in vial, and fortunately my scrip was ok for a refill, but the only syringes they had were the teeny ones with the short needles for little kids. Hey, they work though. Been enough years since I had to manually inject that I actually ended up using my pump to calculate the dose. But leave it to the big D to turn a happy trip to my grandkid’s b’day into a major pita episode just because of a simple lapse of memory. Only the most recent example of so many over the years.

If memory serves me, Humalog was the first rapid acting analog insulin on the market, appearing in 1996. I switched to it as soon as it was available.

I started on a pump in 1987. One of the issues with Regular insulin is that some formulations reacted with the infusion set plastic and caused set occlusions. I know I used an insulin put out by Novo called Velosulin, a “buffered” Regular that added something to mix to play well with infusion set plastic.

My pump tactics and understanding of how things worked were pretty crude in those days. I had a basal profile that worked reasonably well but I never tested it and I’m sure it was much less than optimal. I remember that I pre-bolused by about 30 minutes and many times that was not nearly enough. Long pre-bolus times could be dangerous. I fell asleep once after pre-bolusing and ending up seizing and waking up to science fiction drama.

I’m sure there were people back then who used Regular in a pump much better than me but none of us had CGMs, a major piece of the puzzle. I think if I had to use Regular in a pump now, I could make it perform much better than I did back then. Basal rate changes, for example, would have to be made about 3-4 hours before needed.

I think I recall reading about this back “in the day” though I can’t recall the complete context. The information was part of an explanation about why buffered insulin was not required “any longer” (circa mid-1990s) but it also touched indirectly on why the tubing used for pump infusion sets has two layers.

There is an inner layer/tube which is made of a material which does not react with the insulin. But apparently that material must not be very durable, because that non-reactive tubing is nested within another protective plastic tube.

Of course, I have never gone back and tried to verify those things I think I know. I suppose I really should do that some day.

When I first started pumping, I was using the older Lily Regular insulin in the pump. I did not use Velosulin as Terry mentioned. It worked fine for me, and didn’t switch to Humalog until several years later. Back then, without CGMS, I ran much higher BGs than I do now, and did not have visual feedback on when the bolus was starting to work, but it was certainly much slower than Humalog or Novolog.

Personally I would probably use R in the pump, instead of using NPH injections again. Especially since I also have Afrezza.