My boy has been going through a mild cold over the past week, which would probably not have kept him from going to school before diagnosis. But the nights have been brutal. The first few nights he had a couple of peaks we had to deal with, but the last 3 nights have been crazy - it’s not peaks but one giant unrelenting glucose tsunami. Last night he needed to inject every hour to hour and a half, and we weren’t even able to do a good job at keeping him in range - he was high pretty much all night, using more just for the night than his normal TDD for a regular day, not even counting 60% higher basal rate (on MDI).
The last three nights, I had to stay up all night through 6:30am non stop because he is injecting so often and so much every time that I don’t really know if his BG won’t drop like a stone. I am starting to run out of juice:-).
Please look at one of the mid-range basals like Humulin N or Novolin N (brand name for NPH). Just take a look at the release curve of them. They are perfect for things like this.
If they’d let me, I’d go to Wisconsin right now and give you some.
Thanks so much for the very kind thoughts! Funny, I thought exactly about
the same thing. I talked to the endocrinologist on call this morning and
asked for an NPH prescription. But he was worried we would stack Novolog on
top of the long tail of NPH and turned me down:(
I also suggested he prescribe some Afrezza to blunt the peaks we let
through but he turned me down too.
So I am thinking for the next night we will have to gamble on dosing the
peaks earlier and higher to give the boy a chance to sleep longer between
injections.
I hate having my heart between my lips when he injects because I am worried
of gambling too high. It is easier during the day… But I will stay up
anyway, so I guess there is not too much of a difference. Still, the boy
reads his body well during the day, so when his intuition and calculations
match I feel safer.
Sick days are terrible, and sorry to hear of your son’s troubles. If you are determined to obtain NPH, go to your local Walmart and purchase the Relion Novolin N. It sells for 24.88/10ml vial with no prescription required in the US. Many of us use the Regular and NPH variants to get through financial dry spells.
Oh that is maddening! There is no stacking because you give it at night before he sleeps, when there is no novolog on board. That’s like saying you can’t have Lantus because you might stack it on top of novolog. It’s the same basic idea of a basal insulin, it just has a different peak…
You can use the analogy of Lantus lasting from 9pm-9 Pm, 24 hours. And NPH lasting from 9pm-9 **A**m, 12 hours (maybe a little longer than 12 in reality). Simply a different basal.
I hate when Endo’s treat knowledgeable people like we are clueless. I have spoken with you, and I know you would know exactly what to do. Your son is in much better care with you than with anyone in the world. It’s crazy that someone would think you wouldn’t do exactly what needed to be done to make sure your son was ok. Have they seen your son’s Dexcom graphs?! That makes me so mad.
If I was on my deathbed, I’d rather you be in charge of my insulin than that endo…
Maybe there is another endo on call later? Can you try again?
I wasn’t aware you could get it without a prescription. I always thought you needed the prescription, but you could just get it cheap at Walmart without insurance. But let me know if you are able!
He did trigger a bit of an “I can’t believe this” reaction with me. Although he was a kind man.
You know, I recently sent the clinic a 14-day graph. They got back to me, telling me that he was
probably the lowest A1C in the pediatric clinic, which meant to them that we should loosen the controls and get his A1C up. They were worried good control might result in too many lows - but his dexcom shows him low 1.2% of the time, never below 60, and in range about 95% of the time. Although after these sick days it will worsen significantly I am sure:-)
Eric, I am so flattered, although the reference to your deathbead makes me shudder! But you would be way wrong: if I were you I would recommend @Terry4 or @Dragan1 or some others of the Bad Flatliners Gang.
Yes, there are many smart people on this forum. I will ask them if they would be willing to be on my deathbed watch. One of the requirements though, is that you have to want to keep me alive…
From the rest of this thread, it looks like you’re on the right track. Sending out prayers for your son’s recovery. May this be a quiet night so you can both rest
I would not advise NPH for a child. It can be highly variable and while it has an intermediate action curve it is better to have confidence in the insulin action and stick with the modern insulin. And the concern from your endo is reasonable, if an NPH injection didn’t properly control your son’s overnight blood sugar you would then be correcting with Novolog on top of the NPH.
When you are sick you should do a few things. Here is a good credible writeup on this situation. First, make sure you are not being treated with any medications which make your blood sugar worse (there are a few classic antibiotics that do this). Second, change your goals. Your mindset should be keeping your child safe from DKA and safe from hypos. You goals is not to battle the high blood sugar down below 100. Third, make sure your child is well hydrated (with electrolytes) and if they are up to it that they eat. If they cannot keep things down or have severe diarrhea, treat it aggressively (even asking your doctor for help). And correct high blood sugars, but do it safely as a way of preventing DKA. Accept some highs and give your child a chance to get some sleep. It is safer to check and correct every 3-4 hours to avoid insulin stacking even if it means some higher numbers.
ps. Again, I would not advise NPH but if you insist, make sure you understand and follow the directions. It must be properly prepared to make sure it is an even and consistent suspension. If you don’t roll it and move it to mix it you will get highly variable results.
pps. It takes some time to figure out the onset of action and duration of action for a new insulin like NPH, so expect that it will be several days or a week before you can figure it out.
I didn’t see anything in that link write-up that advised against NPH.
High blood sugar slows the recovery. It makes the kid feel lousy and it dehydrates them. And waking a child up every 2 hours to inject insulin also would slow recovery, because they are not able to get rest!
Have you ever taken NPH? I first used it when I was 5 years old. Like all insulins, it works differently for different people, so maybe it is better for some than for others. But I speak from a personal trial of over 15,000 NPH injections, and have never had a problem with it.
Without a pump, and with no other way to increase nighttime basals and leave daytime at the same level - (other than waking and injecting) NPH can be a great tool.
As you may have noticed this discussion was temporarily closed. The admin team is concerned that medical advice was being given. In this instance we are concerned that a new treatment option is being suggested and discussed that has been rejected by a doctor.
As this discussion is re-opened we ask that all participants remember that the giving of medical advice is not allowed, our TOS prohibits it. It is OK to relate your personal experience but it is not OK to suggest a specific course of action or to recommend a course of action that is contrary to a doctors wishes. A good practice is to always suggest that before any actions discussed are acted upon a person should first discuss it with their doctor.
But it’s ok when admin continuously encourages members to discontinue statin therapy against medical advice? I’m confused. We can’t make recommendations that non prescription medications be used as per labeled instructions? Can we recommend exercising? Or managing blood sugars to safe levels? Or not smoking? Can we recommend insisting on certain labs being done even though a doctor says they’re pointless? Those are all examples of medical advice…
I thought I would give an update on our first NPH night For the sake of allowing others to learn from the experience as we have, I am giving some specific details (my son is 12 and about 115 lbs).
We injected lantus and 8 units of NPH (on different sites of course) at 9:00pm. This what we found:
NPH activity was highest between 11:30 and 3:00am, then progressively tailed off gracefully, and appeared to have become small to insignificant for my son by late morning. At 11:20am we applied normal carb ratios for a meal, and they proved to be a bit shy of the job, so it is a good bet that whatever NPH tail there was was fairly insignificant by then (i.e. 14 hours after injection).
the boy needed to take some glucose (in two steps) around 11:30pm (2.5 hours after injection) to keep from going low (from the NPH). It was a predictable down drift that was easy to plan for.
The sick wave hit at midnight (a bit later than the previous night). We immediately added a small Novolog injection (1.5) to blunt the peak, then let the NPH handle the rest.
the peak topped off at 169. The boy came back in range 75 minutes after going out of range, then dipped towards the middle point of his range, then slowly drifted up the rest of the night. In other words, past the inception of the night sick wave (roughly the first 200 minutes), the NPH took care of the whole night. We were super relieved.
To be fair, I feel that the night’s sick wave was not as bad the as the night before since we only needed 9.5 units that night (8 units of NPH + 1.5 units of Novolog) when we had injected 17 units the night before. The previous nights had required 7-8 additional units through the night.
Nonetheless, I thought this was the best night we had in several nights (including for myself - I went to bed at 4:00am, vs 6:30am for the last few), and attribute most of the success to the use of NPH. From here on, I will look at NPH as an additional weapon when dealing with sick nights. Of course, YDMV:-)
For the record - as the OP, I did not feel that I was getting medical advice. I am an informed parent. The answers I got were truly helpful.
@Brian_BSC, your reply did not reach me before this morning. i.e. after the night had passed. It would have made me think further, as I have great respect for your experience.
That’s correct. We did, but we took it into account.
I really appreciate the write-up! We are familiar with standard sick day rules, but your interpretation of the BG management rules was very valuable - see below.
I found this really useful, and cut/pasted it in my sick day notes, as a valuable emphasis on changed goals. Clear and well written.
I understand where you are coming from. Retrospectively, I agree that it probably would have been better to let some of the highs from our previous nights go in order to give the boy more sleep. But I don’t agree with the stacking part: we are accustomed to tracking IOB whenever there is a risk of stacking. If you track IOB, imho it totally takes care of stacking issues.
If you don’t track IOB, of course stacking is a danger.
We carefully researched NPH yesterday afternoon, and looked up published data on activation curves etc. I understand your concern - in my case, I tend to be a bit research-obsessed before getting into unknown territory:-)
In the end, after our first try, I am finding NPH really useful tool for our purposes. What limits its application, of course, is that you have to guess how serious the night will be before it happens. I liked the fact that, even at a high dose for us (8 units for us), the down trend it gives is predictable and easy to deal with. As usual, YDMV.
