I don't mind you asking at all. I suppose the reason I do things this way is that when I was diagnosed (about 18 years ago) my first endo put me on this combination and schedule and I've stuck with it ever since as I feel it works pretty well for me. My last A1c was 6.7 which was up slightly from the previous 6.5, and it seems to stay between 6.4-6.9. So not much variation. HOWEVER, I'm not too fond of the A1c as a measurement of how well ones blood sugars are managed as it's merely a number that reflects the over all average, and I've gotten a "good" A1c with sugars all over the place. My Dexcom has drastically cut down the number of lows I experience along with helping me correct highs sooner, so I'm much happier with a 6.7 with a relatively level control and few lows than I was with a 6.5 with lots of lows along with highs for example. But anyway, a typical day usually goes: Wake and take Humalog & NPH with breakfast at 7am, small snack with some carbs 3 hours later around the time the NPH kicks in, about 10am. Three hours or so after that I might have another light snack (around 1pm) with very little carbs (something like meat/cheese/veggies). This usually holds me over sugar and hunger wise til dinner which generally needs to come by about 7pm because by that time my sugar will typically start to rise given that the NPH from the morning is losing it's effect. So with dinner I take Humalog to cover any BG correction required plus whatever I eat, and the NPH to cover yet another snack before bed and BG through the night. By the time I wake the next morning around 6:30 my sugar is climbing, if I haven't already been awoken by Dexcom and corrected for a high before then, since sometimes this happens around 4:30am due to what I'm thinking must be a combo of previous night's NPH wearing off along with the lovely Dawn Phenomenon. At least that's my theory. I have considered taking a more steady, long-acting at bed time but if it comes to changing my routine - especially incorporating more than 2 shots per day on the regular - I'd rather try out a pump.
And of course that is an example of a typical day, when all goes well. There are other days where I take correction doses of Humalog (sometimes combined with NPH). For example if I have a lunch that is heavy on carbs (it's rare, but sometimes I want carbs, dangit). Or if I didn't take enough to cover my meal, or if I wake with rising sugar early in the morning, or if any of the other factors that raise sugar are in play.
I'm actually surprised that people are surprised I take this combo! Haha It's so interesting to me learning about how others manage their diabetes :)
I started in '78 with a number of insulins, some of which I was allergic to. I wasn't on NPH long as I was allergic, and I am allergic to beef insulins. I had to switch doctors early on as the first Dr couldn't recognize that I was describing a severe allergic reaction. The next doc but me on Purified Pork (no more beef) and that did the trick by the second day off of beef. My very first day on insulin (with very little instruction) was scary. I got low around 10AM, at work and had no idea what was happening to me. I called the doc's office and was told to eat something right away. Welcome to diabetes! It was very difficult with no meters or even strips.
Then in time I began using ChemstripBg strips, but without the meter. I would read them visually. I often guessed wrong at the colors...
I didn't count carbs between 1978 and 1996 so you can imagine how I roller coastered. I'd drop below 30 and climb to over 400. I once hit near zero thanks to an accidental injection into a vein. that was the only time I went to the ER for a diabetic issue.
I got my first meter, a Lifescan (it was before the old Profile meters) in 1992 after seeing a relative use their meter. Much more accurate than reading colors on chemstripBg!
Pumping helped a lot but we didn't have a fast acting insulin in early 1996 so it was a bit tricky pumping with Velosulin, a buffered Regular. I was one of the first people to obtain Humalog in late 1996 and that was a nice change!
Just the last 3 months I'm using the Enlite sensors which sometimes work super well and other times get bent and then they give useless readings. MM is great at replacing sensors for free due to any reason, as long as it is within the 6 day wearing period that they are approved for.
I doubt I'll live to see a safe "artificial pancreas" in my lifetime. Some of the younger ones here might. I sure hope that they do.
I think people are surprsied because anyone diagnosed within the last 10 years would have just been prescribed Humalog and Lantus from the start or maybe started directly on the pump. So there are lots of people on this site who have probably never used R or NPH! Makes me feel old. :) I think switching to MDI or a pump would be utterly life-changing for you. It certainly was for me (I took R and NPH or Humalog and NPH like you until 2005). The extra injections and carbohydrate counting seem like extra work at first, but it's far offset by the ability to literally eat whenever you want, sleep whenever you want, exercise whenever you want, and it makes travelling and eating out so much easier.
Haha I guess I am basically on sort of a MDI schedule. Just not "officially", maybe.
I'm just hesitant with change! I've been doing things this way for so long... the thought of changing my routine is both enticing and scary. But I have a feeling I'll be trying out a pump before too much longer. Would likely be a welcome weird to not be on such a set schedule!
I'm actually surprised that people are surprised I take this combo!
I am surprised mostly because my personal experience when I was using that combo back in the mid 90's was that it sucked.
Of course, I did not actually realize how much it sucked (for me) until I switched to a doctor who started me on a pump (Minimed 507). Suddenly, almost immediately after starting to use a pump I just felt "better" than I had in years. Hell, in decades.
I wish I could give a more useful or quantifiable description of what was different and why I became so completely sold on using a pump, but unfortunately I can't. I can't seem to describe that any better than I can describe the feeling(s) I get that make me check to see if my BG is low.
All I can say is that this was my experience, and it shaped my attitude towards NPH. If I was forced ... kicking & screaming ... to go back to MDI, I'd try Lantus or Levemir as the basal. I would only use NPH again if there was no other option available to me.
-iJohn
It is indeed interesting to see how many variations there are and how different things work for different people. I was kept on R/NPH for a long time even though I'd heard there were other ways to do things, and I did ask about it, but my doctor back then said "You're doing fine so why change it?" and I went along with that for years before a change of health plan allowed me to get a referral to Joslin. I think there is a strong "If it ain't broke don't fix it" mentality that physicians can have around this stuff, but just because it's "working" A1C-wise (and your remarks about that I totally agree with) doesn't say anything about whether it's imposing a lot of constraints and limitations on your life that another regimen could free you from without sacrificing anything in terms of BG control--quite the opposite in fact.
I'm obviously at risk of seeing your experience too much through my own, but I would strongly encourage you to investigate transitioning to a pump--it really sounds like you're getting bounced around a lot in ways a pump can help to even out and simplify.
Yes! That sounds a lot like my story--dx'd in the early 80's--only without the allergic part (I was on pig insulin from the start. I'm guessing there are a lot of people on this forum who are thinking pig? beef? huh?)
As for My First Insulin Reaction--I think we could have a whole thread on that. I remember having some inkling that there was such a thing before I was dx'd, and I recall thinking when I was first put on insulin "Oh come on, how bad could it be?" And then about two days in, missing lunch, taking a nap, waking up and Oh. My. God. Fortunately I was still able to talk and we had some OJ in the house.
I was on R/NPH until 2000. Met a friend's ex earlier in the 90s who was a T1 on MDI and he told me about it, but it took a couple of years before I was able to get a specialist who understood it and switched me to it. I didn't know from pumps back then but just changing to MDI was life changing.
But I totally hear you about kicking and screaming--I actually HAD that experience. Had major surgery a few years back and of course in the hospital they don't let you administer your own meds. Morning after surgery they come to my room with those vials with the R and the N on 'em and I'm like NO WAY ARE YOU putting that stuff in me! I had to kick up a serious fuss before they'd let me use my Lantus and Novolog pens under nurse supervision.
it's like you've bought your ticket for the roller coaster.
Yeah, that resonates. Too true.
The thing is that how insulin affects me can be changed a great deal by exercise. The difference between sitting all day versus walking for a 1/2 hour can result in my BGs becoming unexpectedly low.
I just never knew when NPH was going to sucker punch me. I was just always waiting for it to happen.
-iJohn
Haha yes, this does make me feel a bit "old", or at least old fashioned.. I had no idea my regimen was considered so archaic!
I like to think I'm pretty good at counting carbs and adjusting my insulin accordingly, so I think that part should be a relatively minor adjustment with MDI or a pump. It's that freedom to eat when I want, sleep when I want, exercise when I want, traveling and eating out etc., that would take the adjustment! Not that I CAN'T do those things now, it's just more complicated. For example I can't tell you how many times I've had the dilemma around 5:30pm where my sugar is beginning to rise and Idk if I want to take a shot for a mere 1 or 2 units to correct or wait it out until "Dinner Insulin". Or those nights where I just want to go to sleep but have to stay up until at least 3 hours post dinner to make sure my sugar doesn't drop (although now that I have my Dexcom I sometimes just go to sleep anyway and let that wake me if needed). Just a couple of MANY examples that come to mind that I suppose wouldn't be an issue with a pump for instance. It honestly just about makes me cry just thinking about not being required to maintain such a strictly scheduled lifestyle. Being in a position to not NEED to eat 3 hours after injection, not NEED to have breakfast at this time and dinner at that time.. The main reason I have not tried a pump yet is because I've feared going low in the night, not realizing and waking, and possibly not waking up at all. However, after much research and especially now that I have my Dexcom, that's no longer a fear. Though still a bit scary - just because it's so different than what I'm used to - the excitement and positive factors are outweighing the fear of change more and more every day.
"It honestly just about makes me cry just thinking about not being required to maintain such a strictly scheduled lifestyle."
That first week for me off of R/NPH felt just exactly like that--like being released from prison or having someone give you a pair of wings. Only hard part was not being able to explain to anyone else what the big deal was.
It's not just you. Though in my case it's more of a shudder.
@TiedyedSunshine
You don't need to switch to a pump to get increased flexibility. That's the whole point of the flatter profile basal insulins, Lantus & Levemir. When dosed properly you should have to worry a lot less about having to eat to match your insulin.
I'm personally very pro-pump. But for me it was a "fun" choice when my new (at the time) doctor suggested it. I like tech.
But I realize ... at least from the neck up ... that for other (most?) people it's a big decision. But there are also other options worth considering and/or trying that should be simpler to transition to than a pump.
The main reason I have not tried a pump yet is because I've feared going low in the night, not realizing and waking, and possibly not waking up at all.
I've never truly understood that perspective. You actually have the same risk now. Or to put it another way, you can set the pump so that you over night basal rate is as low as you currently make it with whatever you do for your NPH regimen.
-iJohn