Lantus vs Humulin N?


I did NPH 4xday + Regular with each meal for about a quarter century and got quite good at it. It is interesting that the citatations to late-90’s papers make it sound like 4xday NPH was an invention of the late 90’s when I had been doing it since the mid-80’s. I don’t think I invented it, but I read about it in a book (possibly one of Dr. B’s books from that era).

About 10 years ago I switched to Humalog and Lantus and to be honest I never felt that I had mastered that. Lantus 1x a day was not long-lasting enough and Lantus 2x a day was not obviously better than NPH 4x a day. Dawn phenomena was a common problem with either.

In the past year I switched from Lantus 2x a day to Tresiba 1x a day. Wow, I have begun to figure this out. I take the Tresiba in the evening and although it is not perfectly flat, by taking Tresiba in the evening I get a very broad peak in the morning that has absolutely eliminated dawn phenomenon. It’s not perfectly perfect: my breakfast Humalog dose is anomolously small because I still am in the Tresiba broad peak. And the Tresiba feels like it is “running out of gas” late next afternoon and I kind of make up for it with extra Humalog units then.

No matter whether I was taking 4xNPH a day, 2xLantus a day, or 1xTresiba a day, my basal total units has been 20 units (except when I’m sick or on steroids) a day. Amazing that it has held steady for 30+ years.

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