After years on Lantus I've decided to switch back to NPH. Years ago when I switched from NPH to Lantus I was impressed it's flatness and how long it lasted. I still like it, but there are many problems with it. Like it actually lasts too long, making exercise a challenge. I found it a pain to break it into multiple doses throughout the day, I guess because of the overlap. Another thing is the shelf life. I've read once opened it only lasts 1 month in the fridge and that it's more sensitive to temperatures. Even though I can't honestly correlate my fluctuating basal needs to that, the thought still makes me anxious. Doing terrible with Lantus anyway so I've made a very long overdue decision to switch back to cost effective NPH. Problem is that it's been so long, Does anyone have any guesses as to how to start this experiment? Anyone on NPH (or otherwise) care to share some insight as to how you spread out injections and to what extent? Currently my best guess would be 2 injections; 8 am and a slightly smaller one before bed. Has anyone had any experience splitting in more than just 2 injections?
Thanks
I took NPH until 2008, when I got my pump. The doctor and/ or Medtronic Sales/Nurse mentioned that NPH has only a 53% chance of peaking when it's supposed to, so it can be early or late but is not likely to be on time. This explained a lot of the "what the heck?" moments I had with NPH but, as I was moving on by the time I learned that, I never figured out a "workaround" I like the theory of more than the two injections but I suspect that the floating peaks might make it somewhat difficult to tell which insulin was working when as, for example, a low in the late afternoon could be due to a late AM peak or an early "lunchtime" peak or maybe a really slow hand from the night before. Or some combination thereof.
When I started insulin 2 years ago, I started with NPH. And I liked it. Sure, people say it is variable. But in my case, I have a wicked case of Darn Phenomenon(DP), and I could take a bigger injection in the evening and control the DP much better. Since I started Levemir, my morning numbers have been 20-30 mg/dl higher. So I've actually been debating the same thing. I still have nearly three boxes of NPH pens still in the fridge that are still good.
When I used NPH, I used 2 injections, one in the evening at 10pm and the second at 6am in the morning. And yes, I know that is not even, but I seem to need 3 times as much insulin overnight to combat DP. I tried 3 injections, but didn't see any difference. As to dosing, you might want to be conservative and reduce your dosing by 20% and work up. I had run across a guide for switching insulin's, but everyone is different.
If you split it into two you have a smaller peak three would give you a even smaller peak...in theory but at some point your also stacking the insulin.
It's U100 so it should lower your BG about the same as any other U100 insulin there will not be a huge difference in your TDD. My trouble was my night time injection, if I did it before 10 pm I would go low about 2 am when it peaked so I could never go to bead early, I hated long acting insulin...it ruined the best years of my life...;-)
For several decades I did MDI with NPH as the basal and regular as the bolus. NPH 4 times a day, 6 hours apart worked OK for me but not as good as my current regimen (Lantus twice a day).
I don't think 2 injections of NPH a day comes anywhere close to being flat. That was kind of state of the art in insulin therapy back in the 50's or 60's.
Personally... if you haven't tried splitting your Lantus dose, I think that Lantus split 2 times a day is way more stable than NPH will ever be.
I feel like I have a much better life on Lantus, such a broad statement but the long acting insulins bring me back to a time I'd rather forget. I can understand you saying that sometimes it last too long, sometimes I can't believe it. I take one dose at about 10.30pm each night. It seems to suit me fine. If you are fed up try switching and see how it goes. Bit worried now that the Lantus in fridge may be off, I haven't had any bother before, going to check now.
I agree with Tim and Josephine; it sounds like a step backwards! I would suggest either splitting your Lantus dose or better yet switch to Levemir and use two doses of that; many people find it a lot more effective. Or better yet, consider a pump.
I was going to suggest Levemir. I think it has a shorter action than Lantus, and definitely a smoother profile than NPH. If I were to ever go back to MDI I would probably use a small (like 1-2 unit) dose of NPH before bed, because I was never able to control my DP on Lantus (didn't even realize I had a problem with DP until I stopped using NPH in 2005!). But during the day I found Lantus superior, although if I ever went back I'd probably use Levemir (by the time it came out I'd already switched to the pump).
I know many people think NPH is a blast from the past, but after switching back and forth from Lantus several times, I'm back to NPH.
I did tons of basal testing and it works best for me.
Currently I take 12 units at 8 a.m. and 10 units at 10 p.m.
Thanks for the feedback everyone. This gave me a lot to chew on. I not excited about change but this makes me feel more comfortable. I guess there aren’t a lot of fans of NPH, though I hope it will be better for keep down dp. I think i’ll try the uneven dose of 2 injections. Sounds good. we’ll see how it goes. Thanks guys.