NPH insulin question

Hi all

My husband's friend is a type 2 on NPH twice a day (Kaiser, what else?). He only checks his blood sugar in the morning and he basically knows nothing else about diabetes, carbs, etc. I was at their house yesterday for Thanksgiving. Joe and I don't get along, but it has always been just a bit of bickering. Yesterday he was downright nasty to me. (Yeah, fun!). It wasn't till this morning that I thought...low blood sugar. He had eaten brunch and then we didn't eat till 7:00.

Does anyone know if NPH is known to cause lows or if it covers background insulin well enough to last from say 10 or 11AM to 7PM without food?

Short answer, yes . . . NPH can produce a low. This is due to it having a peak in the 6-8 range. Timing needs to be considered so the peak either coincides with a meal, or dawn phenomenon (a natural rise in Bg levels in the early morning hours) or eating a snack if needed. Depending when he took the NPH those 8-9 hours were a long time to go without “any” food.'

Either that or he was just having a particuraly surly day yesterday.

Sounds like he may have been having a low blood sugar. With NPH there is a need to “feed” the insulin, or time meals with the peaking of the NPH. If the NPH was peaking, and he hadn’t eaten yet, it is a good possibility that he may have been low. I know that nastiness is something I get when low. Did he get better after he ate dinner?

There were no more incidents after we ate; on the other hand I didn’t stay long after the meal!

Thanks for the info. I know nothing about NPH.

Btw I wrote “my husband’s friend” and some of you may wonder where I suddenly acquired a husband! I meant my friend’s husband!

0hnmy ,8iko950

Run that one by me again, Gerri! That’s the second inscrutable message I’ve seen here today, wonder if the program is scrambling things!

I think there’s an “oh my” in there, but I can’t find the lions, tigers and bears!

Zoe, you mean you don’t speak feline! English translation–send catnip.

Sorry, that was a message from Benny, my cat. What’s amazing is that it he managed to send it. Benny enjoys walking on the keyboard. He also chews on the keys. Thanks to his gnawing ability, with only his two remaining teeth, I have no cover on the “w”.


Benny is not a diabetic, though he may think he is from following many discussions while perched on my desk or lap. Kindly disregard any future coded posts from Benny. His advice to members: nap in the sun, eat more fish, catnip is low carb & yawning lowers BG.

Oh that is too funny, Gerri. Yeah, the typing part is one thing, but actually clicking Send is a sign of feline genius! If I’d known it was in feline, I would have brought Lula over to translate! I thought I was fluent, but I think they have different dialects - Lula speaks Siamese. But she CAN speak English AND use snail mail! I just received a birthday card in the mail from her! There is no connection, of course to the Philly postmark where my cat-lover friend Nick lives and that I get two cards from there every year, one from Nick and one from “Lula”!

Lula, too, spends a lot of time online/aka curled in the small space between laptop and mama.


I am a Type 2. Since you don’t get along with this fellow perhaps your husband is the best one to approach this. I always advocate family and friends to create a support system around a diabetic. Type 2 diabetics tend to more tight lipped about their diabetes than most. This may depend on the generation too. Some see it as a private matter and don’t want to burden the family or they may stay in denial for a long time. Both are non productive because you are still causing damage to your body. You will be a bigger burden to your family if you go blind or have a limb amputated. This would mean educating yourself about diabetes. All of this is on the internet for free. Yes your friend might think this is a bit intrusive so you be the best judge of the situation.

Definitely a diabetic should be testing more than once a day. Your friend sounds like he is in denial. I am only making a guess but your friend may not be “controlled” or needs to have their meds tweaked. This is why testing several times a day is so important. This the best way a doctor can see patterns and make changes. I would also suggest that he may see an Endocrinologist versus a general practitioner. Meds and insulin is not an exact science and may take several changes to get the right mix for the individual. NPH (humulin) is an immediate or fast acting insulin. So once administered it is suppose to help metabolism glucose faster than a long lasting insulin (levemier).

If a person hasn’t eaten enough food and takes medicine yes it can cause a low. Lows I describe as the feeling you get when you are super hungry but worse. You sweat and shake and become irritable because your body is starving for energy. You will need sugar to help get rid of the shakes. His nastiness may not have to do with having a low. Yes you can become irritable but if you are in a time of need a I figure a person would try to be nice to get some help. During the time of his “nastiness” did he test himself? Stress and emotions can cause your BS to rise too. Perfect time to test so he can have more knowledge about how his body reacts to emotions.

Does he know about his site? Have him sign in and we can offer support for him too.
I hope this helps.


You know all these things, Christalyn, and I know all these things, but my friend’s husband does not and does not really care to. (That was a typo, btw, I don’t have a husband). I e-mailed my friend my observations as I know she will listen and hopefully intervene with her husband. He is on an outdated regimen of insulin, and his doctor told him to only test his fasting, so that is all he does. (Kaiser HMO). He takes no more interest in treating his diabetes beyond that. His fastings are good, but he eats whatever he wants and has no idea what his post-prandials are. I’ve attempted a couple conversations with him on the subject and he listens politely, but bottom line is he thinks he’s doing what he’s supposed to according to his doctor and he thinks I’m obsessive on the subject (compared to him, I am!!).
He wasn’t aware that he needed help, Christalyn, or that he was low, and no, he didn’t test because he didn’t know there was a reason to. The sad thing is that my friend, his wife, is an RN and should know better. I’ve known her for 30 years and always respected her medical knowledge. It was an eye-opener to me how little she knew about diabetes which I think is emblematic of the medical field as a whole.

Cheryl actually thought Joe might sign on here on his own, but they don’t currently have a computer at home.

NPH I found to be horrid stuff with very poor control and was too high or low frequently. I finally divided the total daily dose in 6 equal parts injected every 4 hours or a close too as possible without loosing your sanity. Lantus with 2 shots per day in much better.

I’ve heard that from many people, Anthony, and gave my friend that feedback when I heard that’s what her husband was put on. As frustrating as I find it, that’s all I can do without crossing the line into intrusiveness which still might not help. I’m sure you’ve all been there with someone who hasn’t yet taken the step to be proactive in their own D management. In this case I think it hurts rather than helps that his wife is an RN. They both believe in the medical profession and think it’s Zoe being a know it all and a rebel when I talk about the need to self manage.

Hopefully the e-mail I sent my friend about her husband’s possible lows Thanksgiving Day (and what to look for) will help raise their awareness of one part of D management. One can hope.

Dear Zoe

The only good thing about NPH is that it is cheap. And possibly less fat making than lantus but of this I am far from sure.

Of course the only thing you can do is to relate our experiences.

Some people have explicit belief that there Doctors are omniscient, Good for them. With diabetes I found the un-educated peasant at my super market giving better advice on diabetes. with all fairness my GP said he did no know much about the disease and that I was on my own. He refered me to an Endo who may have given me life ruining advice.

NPH resulted in horrific lows for me, very consistently. The day I got to say goodbye to it and go on Lantus was among the best in my life. Seriously. I would never go back. It is hard for me to believe that anyone still takes it.

I think Anthony hit the nail on the head, Hope, when he said NPH is cheap, and that is why Kaiser, the huge California HMO uses it with their patients. I don’t know if they prescribe this for Type 1’s as well, as my friend is a type 2.

Zoe, this guy may have been low, or he may have just been crabby or maybe he’s just an a**. I think that we have to be careful of the “to a hammer everything looks like a nail” issue. Our lives are so about diabetes, that is easy to think that everything that happens in a diabetic life IS about diabetes but sometimes it isn’t. Sometimes it is the old, correlation does not equal causation thing. Because he takes insulin AND was crabby may or may not mean he was low. Maybe Thanksgiving itself made him cranky.

I think you have referenced being in mental health at one time, yes? Then you obviously know that you can’t save people from themselves, and you are right, if people do not want help or advice, offering it rarely helps and usually hurts the relationships and can exacerbate the situation. You are also likely familiar with the stages of change model and motivational techniques that are currently being used with anyone making lifestyle change, whether it be quitting smoking, improving diabetes management, weight loss, quitting drugs/alcohol. This mindset is also helpful in dealing with people in personal circumstances as well.

I am sorry to hear this. It seems your friend and her husband are both in denial. Anytime you feel highs, lows, mood swings, stress it will effect Bg levels. Great time to test to learn patterns. Well, your friends will have problems in the future and they will blame Diabetes for his problems when it was his fault for not taking care of yourself. You can bring a horse to water but you can not make them drink.

Good Luck!

That is definitely true, Christalyn. Sad.