Is it safe to mix all sorts of insulins?

Type 1 and LADA
#1

Hi all,
I have a question about mixing insulins, and not in one and the same syringe of course.
I read in Scheiner t.ex. that sometimes NPH could be used better for covering high fat meals:

As for the long-term delayed rise caused by the fat itself, there are a couple of strategies that might work well. For those using injections, a small dose of NPH insulin given right after the meal usually provides just enough extra insulin to offset the delayed glucose rise for the next 4-10 hours. For those on a pump, an increase in the basal rate will accomplish the same thing. Try setting a temporary basal rate increase of approximately 50% for the next 6-10 hours, starting after the meal.

I know that Bernstein doesn't support NHP usage at all.
So I am curious, is it OK to use all sorts of insulin in order to maintain good control?

For example:
Levemir as basal,
Regular for bolus (if you low carb)
Novorapid (Apidra) for corrections
and NPH over the night if you munched on salmon and cheese i.e.fat meal :-)

Or it is totally crazy and mixing all sorts of insulins human not human insulins is not good at all?

#2

Note how the instructions for NPH note 4-10 hours. It is much peakier than Lantus/ Levemir and I don't think that it's very useful. The peaks are not very predictable so it might be 6 hours one day and 12 the next, really variable. When I learned that it had only a 53% chance of peaking when it was supposed to, it explained a lot of what I experienced using it for 20 some-odd years.

#3

Actually Bernstein does support the use of NPH, he just thinks that Levemir is a superior basal and cautions against NPH because it contains protamine which can cause potential allergic reaction problems. He actually mentions mixing NPH with regular insulin to slow it down for the treatment of gastroparesis and he has mentioned the use of NPH overnight for treatment of Darn Phenomenon. And long as you aren't mixing the insulins into the same syringe, using multiple insulin types is fine. Bernstein regularly has bit patients use Levemir for basal, Regular for meals and a rapid like Apidra for corrections.

#4

By mixing I assume you mean using at the same time and not mixing in a syringe.

My concern with using many insulins at the same time would be with allergic reactions developing and intolerance over time. I lean towards using the same 1-2 insulins, and then if my body becomes intolerant of them, other insulins would be new to me.

#5

Well, I suppose it depends heavily on what one means by "OK".

In theory, assuming your body tolerates all of them well, there shouldn't be any physiological issue.

However, managing all the math/data to know when things are peaking, what your IOB is, etc. would be a nightmare. And these parameters are crucial to avoiding hypo.

Really the only practical solution to this sort of problem is a pump.

#6
...use of NPH overnight for treatment of Darn Phenomenon
Okay, that's not a typo, is it Brian? I've seen you post it too many times...
#7

BTW, has this really been a problem for you?

Bernstein's book is the one to read if you are going low carb. I'm low carb on MDI, and the rise from fats/protein is so slow for me that it is easily covered by an additional shot of Apidra later. If you aren't going low carb then I think you'll end up having to do a correction even if you use 3-4 types of insulin,

I agree with Dave about the complexity. Keep things as simple and systematic as possible so there are less opportunities for mistakes to happen.

#8

. . . which is precisely what I do. (Brian's last sentence.)

#9

I think it could be very confusing using all of these different types especially if you tend to not have predictable results and fluctuate. As AR says, those earlier insulins have problems and are often not predictable themselves so they are often harder to manage. I would be very careful because you don't want to end up with too much insulin & suddenly go low. I'm often wondering about the whole timing of insulin and how it varies so much for me, why I can drop very, very rapidly at times and at other times stay high for a few hours. Clearly the insulin doesn't do what it is supposed to a lot of the time.

#10

Unfortunately it is a problem for me, protein and fat get me high :(

#11

It is more predictable on LowCarb, I've tried going higher carb around new years, but experienced the same thing you mention - sometimes 2 units could drop me very very low, sometimes 4 units didn't do anything at all.

#12

I do as well :) Just wanted to know if NPH could be added in some cases, like too much french cheese during Christmas dinner:-)