NPH fluctuations and frustrations

I started nighttime NPH about a month ago starting with 10 units and every few days increasing it 2 units until I achieved a range of 100-120 morning BG. All went well, I increased to 16 units and was having good results. I had a couple lows below 70 and the Dr. told me to reduce to 12. Well my morning numbers increased back to well above the range. He told me to increase to 14 but it didn’t change much. I went ahead and increased to 15 but still am not getting in the range. I feel like I have taken backsteps and am getting frustrated. Have any of you had similar experiences? How much is the typical dosage? What type are you all using.

I am curious about why you are on NPH because it is an intermediate acting insulin. Most that are on nighttime insulin are on a longer acting insulin like Levemir or Lantus.

NPH has a shorter duration and will have an active time of about 16 hours more or less which might be good if the only purpose is to stop dawn phenomenon.

Levemir or Lantus as it was explained to me covers the body's need for basal insulin during a 20 to 24 hour period. It allows our less than perfect pancreas to concentrate on producing and storing insulin for use at mealtimes when a large insulin response is needed. Because it does not have a 24hour duration for some people many will split their dosage in two shot morning and evening. You can get about the same results with NPH if you split it 3 ways

I would be curious to know how your BG runs thru out the day with NPH.

My daytime numbers are pretty good. I have a spike after meals but then it comes down to around 100 before the next. My morning numbers hover between 170-250 so the NPH was specifically to deal with the dawn phenomenon. Lately though the NPH is not doing its job; may be due to my chaotic life at the time or something else. Sometimes I feel that my low-carb diet triggers the liver to dump more often that it should. I eat a salad with chicken for dinner and 4 hours later I am 270. Crazy.

Thanks for the comments, Gary.

How much does it spike after a meal. 270 four hours after a meal of salad and chicken is way to high. I'm wondering if your NPH is exhausting itself before your dinner meal.

My goal is to stay under 140 at all times even after meals. Most of the time I am successful. Of course I use a pump but before that I was taking multiple shots a day of short and long acting insulins and was just as successful. I'm not tooting my own horn I just want you to realize what is possible

Type 2 is progressive. We find ourselves at times needing more to control it. The best we can do is try to keep up.

NPH tends to degrade fairly rapidly for many folks. It could be due to handling, reusing syringes (contamination), temperature variables, or unknown factors. My endo reports that some of his patients experience significant loss of potency after just 15 days and had to discard the vial and use a fresh one. I use NPH very sparingly (never more than 3 units) as an alternative to Levimir and Lantus strictly for DP but I have successfully extended the life/potency of a 10 ml vial to more than 60 days by using aseptic technique, keeping it refrigerated at all times, and dividing the contents into thirds using two additional sterile vials (each costs less than $1). Jenny Ruhl (Blood Sugar 101) posted on her blog that the technique did NOT work for her ("The Great Vial Experiment"). However, I have been using the technique for nearly four years and have only had to toss out unused insulin on a single occasion due to loss of potency issues. You might want to try a fresh vial to see if that resolves your issues (if you do try a fresh vial, it may be wise to scale back the dose, just in case).