Ran a 3 month NPH trial to see how it would perform as basal versus my normal Tresiba regimen.
NPH dosing
7:45 AM 3 units
1:15 PM 3 units
6:15 PM 3.5 units
11:45 PM 6.5 units
Tresiba dosing
7:45 AM 6 units
11:45 PM 6.5 units
Tresiba A1C - 5.0% May 2024
NPH A1C - 4.8% October 2024
5 units Regular bolus with meals
.25 to .5 units Novolog pre bolus with meal
No change in diet ( low carb high protein ). No major changes otherwise besides a broken hand with a metal plate surgically installed. And 2.5 months later a broken ankle. Thought these would effect blood sugars but didn’t seem to effect besides post surgery for a few days.
It’s not a bad basal when spaced out and in smaller doses. Id probably use it again in a pinch if something happened where I couldn’t get an Rx quickly or my Tresiba got nuked due to heat on a trip etc etc.
Though back on Tresiba again.
Based it off roughly off this dosing image from a med journal:
I remember the old days of NPH and it scares me, I had a lot of super lows on that and my meal timing was never very predicable.
Also you take a lot of injections per day, not even counting corrections. When I got up to 6 injections a day, I changed to a pump. Even when I was young I could not remember if I had take a dose or not. Everything ran together in my mind. And I would have little red dots in all my shirts.
I think I was at 10 injections a day with corrections. But still many people prefer that.
Didn’t happen often, but I HATED when that happened. Filled me with dread and fear.
I think people use smart pens now which eliminates that problem. Switched to a pump long ago and never used pens.
I ended up in an ambulance twice when I was on NPH due to lows, and hypo unawareness. Then I went on a pump - fewer lows and good awareness of lows before they get lower than high 50s.
On the other hand, I think if you were just using it as a substitute for Tresiba when or if you can’t use Tresiba, it sounds like an okay solution.
I think there’s a fair amount of a wiggle room. I forgot or delayed my evening dose at 6:15PM a couple of times forgetting to give it. I’d remember and give the dose ( maybe cut the dose down a little ) at 7:30 or 8:30 and didn’t experience high sugars.
I think the key in NPH is that it’s an intermediate insulin not a long insulin like lente ( when it was available ) used to be or like lantus, levemir, or tresiba.
Most dosing regimens in journals or medical associations ( or similar ) always mentioned giving NPH twice a day morning or before bed. This requires higher NPH doses to get a longer action time. With that higher dose NPH to get the longer action time you get the hypoglycemias due to higher and prolonged peaks.
Going lower on the NPH doses and spreading out really never had the high insulin peaks and subsequent low blood sugars…
If you look at the action profile of the NPH in that image above it lines up similarly to the basal analogs…
BUT giving 4 doses of NPH would be a nuisance for most people. Which is understandable with pumps and longer basals on the market which are more convenient.
And organizing your life around your insulin rather than the other way around. The END regimen: Eat Now or DIE! I still have a visceral reaction at the mere mention—I’ll never forget being threatened with it during a 4-day hospital stay, only a couple years after finally getting my first endo specialist who switched me to basal-bolus MDI. Brought my own Lantus and Novolog to the hospital but they weren’t gonna let me administer my own medication. Against hospital policy! First time I’d run up against that. Totally unexpected. “So how are you going to do it?” And the camera darkened, their voices took on a strange echo, and they cackled cruelly as they showed me the vial with the big “N”…
The thing is, that was in the pre-CGM era, so unless you were popping your sticker-clicker every hour or less you really had no idea what was going on, and the stuff could just creep up on you out of nowhere. With a CGM, that aspect of it is hugely alleviated. And if, for whatever reason, you lost all your benefits as a retired person utterly reliant on Medicare (can’t think why that might happen!) the old R/N thing is cheap. So I’ve tried to get past my prejudicial feelings about it, and much appreciation and kudos to @gallagher.neal for performing his self-inflicted human experiments and sharing the results. All kidding aside, this is is bookmark-worthy information.
Thanks for this! I did the same, NPH and R instead of my pump with Humalog though. My basal pattern is too weird to easily cover with the NPH, But I was able to approximate it, lived to tell, and feel better having the records of the 3 months I worked on this experiment. Who knows what our supply chain/insurance coverage will look like in the future, right?
