NPH question

I started NPH last night.
30 units of NPH before bed.
Woke up, BG = 400.
10 u NPU this morning.

30 units of basal is typical for me when I run Lantus.

So far, so good. Think that extra 10 units in morning set things straight. Just gotta be cautious of lows, now.

Everything, now, is dependent on speed of USPS and their ability to deliver mail…and insulin pumps.

I only very briefly did the rapid acting and Lantus combination, trying to establish my pump settings coming from the R/NPH regiment. What I found is that it’s definitely not a 1:1 exchange. Mostly because NPH isn’t just basal insulin… You’ve got to treat the big peak as an extended bolus, best covered by food unless you want to ride the rollercoaster. You’re back the peanut butter before bed regime. It’s also not equivalent during the last few hours where it steeply tapers off.

I don’t remember the exact numbers anymore, but I took something around 40% more NPH than Lantus.

I switched off the regular and NPH roller coaster 20 years ago.
It was never manageable I would have crazy lows and crazy highs.
My first switch was ultralente and novolog. It really changed everything and I could relax a little.
When Lantus came out I went for a pump instead.

I really can not imagine taking NPH again except in an emergency, where I had nothing else.

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google dr richard Bernstein on NPH. His book is worth a read, he might have a youtube video on it among his many. For a flatter basal, some take NPH every 8 hours, instead of the twice a day. The bolus R regular, works better on a lower carb diet. It matches the action curve more. The mysugr basal test page, works for NPH too. You know the NPH has to be mixed well, it settles more than the others

The guy is 85 and still has his toes, so something was working back then.

Oh shoot, is NPH a 2x daily? OMG, I didn’t remember that. I did a (around) 9pm and 10am:

You could do the mysugr basal test to get the NPH right. It’s the same rules. See if you can get it ok on 2x a day. If not look at 3x
Are you using R for bolus?

Thanks for the suggestion. It actually looks pretty decent. Surprising, right?
I’m using humalog.

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Getting there, see what the miss a meal basal tests show. Set the alarm, because you may go low with the miss evening meal. there is a rise till 3 and then drops low. See what the more experienced guys think.

You might be able to get Bernstein’s diabetic solution from your local library. There may be better info on NPH, but I don’t know of any.

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I’m surprised its doing this good.
I took my morning basal too late (forgot until 11am) and it shot to the moon (350’s).
But, otherwise, I feel ok about this…maybe even good. Kinda makes me not want to go back on the pump right away.

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Can you set alarm/reminder on watch or phone? At least until you are in habit of doing this new routine. Notes on bathroom mirror or other common places you see can be helpful too.

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I used to reuse a syringe once and use it as dose tracker. Used new syringe the morning dose and put the syringe on the counter, then use that syringe again in the evening, then break it. If there was no syringe on the counter in the morning, still needed insulin. If there was still a syringe on the counter in the evening, then I still needed insulin.

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I haven’t used NPH in decades.

But I’m willing to bet that the NPH was just starting to kick in when you woke up this morning. So while your bg was 400 it was probably already falling because of the slow absorption of the large 30 unit NPH dose the night before.

Some sort of glitch is almost always to be expected when transitioning from pump basal to long-lasting insulin basal or back.

I used NPH for many decades as a basal. I took 20 units per day, split into 4 shots of 5 units each spread 6 hours apart. It worked pretty good like that.

In many ways NPH 4x a day was superior to 20 units of Lantus once a day. Lantus was only usable for me when I split it into two shots of 10 units 12 hours apart.

But Tresiba - Tresiba is perfect for me.

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