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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I have the same exact reaction to waking up in the morning to very high BG I must wait 2 hours before having breakfast and then my BG stays up high until the middle of the day

There is dawn phenomenon, DP that will cause your BG’s to go up before you wake up.

Some people deal with this with a fast acting shot of insulin to bring it down when you first wake up, . I am on a insulin pump so I have it set at a higher dose in the early morning hours.

But it will also make you insulin resistant from a hormone release for a few hours when you get up.

Jim_in_CalgaryType 1 or LADA


Jan 31

Carbs (or glycogen released by your liver at around 4am) are not the predominant cause of early morning rise in blood glucose.

Your body has an adrenal release (it secretes higher levels of growth hormone, cortisol, glucagon and adrenalin). These effectively increase your short-term insulin resistance, after which even normal low levels of glucose in bloodstream cannot be neutralized.