What the heck was NPH for, anyway?

I used ultra Lente before lantus and I really liked it better but they discontinued it.

I think basal-bolus thinking picked up speed of use with introduction of pumps, and then backfit to injection and pen usage.
My first pump was Regular, for many years, until humalog/novolog vame out.

For those without insurance/low income, nph+regular is often lowest cost and still used today.

I wrote this blogpost in 2015 as part of Diabetes Blog Week. Remember that? But I wrote that the biggest improvement in my diabetes care as a result of the switch from NPH to Lantus. I still consider that to be true although I would hate to give up my pump. Or my CGM. My Blue Ribbon First Place Change | Test Guess and Go

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I don’t know if I read that before but it is SO parallel to what I went through, right down to YDFLNCA. I’ve said many times that it was Lantus that was the life-changer for me. Pump was incrementally better but it didn’t have me crying in my office with the door shut the first time I realized I could delay lunch and nothing was going to happen!

Yes, Lantus was revolutionary. But it was not approved until 28 years after I first started using NPH.

For almost 30 years there were no other basal options for me to use except the zinc basal’s. And I learned how to make it work. That’s why I am not an NPH hater.

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It was the first long acting insulin, lasted roughly 12-18 hours. Regular was good for about 5 hours max.

I’m curious about details. I suspect that you were taking 2-3 NPH doses per day. Is that correct? What else did you do to make it work for you?

I only ask since NPH + R would likely be my fall-back disaster (physical or economic) contingency.

I was only on NPH + R for about three years back in the '80s and I wasn’t anywhere close to mastering it. I experienced many brutal hypos, sometimes in painfully awkward social situations. This was well before CGMs appeared. It wasn’t until the last several years that I became aware of people like you and Dr. Bernstein who used NPH well.

I used NPH for a long, long time. I think I changed insulin in the early 80’s. I took one shot a day for decades. I was probably using 2 insulins because I remember I could mix them.

Besides, having to eat on time, I don’t remember it being horribly difficult. I have never lost consciousness and have never been rushed to the hospital for hypoglycemia. Of course, my control was terrible, but I made it. I am just thankful there was an insulin I could use.

In the early 80’s I started taking several shots a day and my control improved drastically. At the same time at home blood glucose monitoring became available and I also had my first A1c drawn.

When I think of my first 23 yrs of diabetic care, I am amazed I had so few complications and did so well.

Type 1 dx 1959

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Back in '89, they had Humulin R, NPH, L, and U. R was said to be fast, NPH medium, L long and U ultra long. They still had pork and bovine insulins, since many had started on pork or bovine and preferred to stick with what they knew. My endocrinologist prescribed R and U. R as needed, with frequent finger sticks. If high, take more R. If low, eat something. Once a day take U for basal (I can’t remember if I could mix R with U, it’s been 30 years).
Then they came out with Humalog, which is only supposed to be mixed with NPH, and my endocrinologist said to take Humalog as needed and NPH three times a day (mixed with Humalog before meals). R had to be taken precisely 45 minutes before eating, which meant you had to take it and hope your meal arrived after exactly 45 minutes.
Humalog was to be taken just before a meal, mixed with NPH if necessary. L and U and pork and bovine insulins were discontinued.
Someone suggested Lantus, saying it has no peak according the the pharmaceutical company graph. The real graph shows a peak and that it lasts about 18 to 20 hours, so not that much better than NPH and 6 times more expensive. So after a couple of bottles of Lantus, I went back to NPH. Then I got a new Endocrinologist who suggested Tresiba, and that had a much smoother curve than NPH or Lantus and lasts more than 24 hours, so I switched.
I remember when most physicians used glass syringes and a steriliser, because disposable syringes were not available. I know almost all syringes were disposable by 1989, but I can’t remember exactly when everyone switched from glass to disposable.
I used disposable syringes until Tresiba, which is only available in pens (the pharmacies won’t get vials for people like me since most customers here prefer pens, and they don’t want to special order for just one customer).

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Originally I started off with one injection in the morning. It was a combo - both the slow regular animal insulin, and NPH.

The combination of NPH and the slower regular insulin would cover most of the day and night. The regular covered breakfast. The onset of NPH and the longer lasting regular covered lunch. And the peak of NPH coincided with dinner. We occasionally did insulin corrections when needed, so it was not always one injection a day.

A few years later, I moved to 2 injections. For that, I did regular alone in the morning, and both regular and NPH together in the evening. With corrections as needed.

My basal needs are higher in the middle of the night. The peak of NPH matches that 4am spike, so NPH at night worked really well for me.

When Lantus first came out, I tried it. I kept going high at night, because it did not have a peak like NPH. So I dropped it and went back to NPH.

A few years later, I tried Lantus again, but this time I kept some of the NPH at night to cover the spike. For this, I did Lantus in the morning, rapid insulin as needed for meals and corrections, and NPH at night. I was able to rock that really well, got into the 5’s fairly often.

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I think it was usually part of a insulin mix with regular. Its not as long acting as Lente. The goal was to achieve better control with fewer injections and less injection site reaction. Part of the bad old days.

I used Lente and Regular, and then later Ultralente and Regular before being switched to Humalog and Lantus.

I’m guessing this was based off urine testing or bg testing ? And I think your parents were key in going beyond what the doctors followed at the time, rather than this being the norm.
I (my parent’s) were still in the “doctor knows best camp”, and I had 4 younger siblings that kept my mom busy. Dosing changes only made by doctor, mainly based on my weight, at 2x per year appointments.
After college, had a non-endo who was first to suggest Regular, when urine test was high, in addition to single daily lente. NPH several years later, seeing first endo in larger medical facility.

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@MM1, yes all of the stuff we did was implemented by my parents, not from doctors. They were not going to wait months to have the next doctor’s appointment before making a change.

It wasn’t rocket science, if X units wasn’t enough, take a little more next time. If it was too much, reduce the dose.

Unfortunately, still too many people today that don’t get great care from doctors, and don’t know there are better options. Certainly forums like this are helping. I found this forum after struggling with early medtronic cgms, and Endo/CDE and Medtronics support were no help.

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This attitude is indicative of a fundamental stance that some of us take with regard to who is primarily responsible for our health. It appears that your parents subscribed to the basic belief taken by founding members of the #WeAreNotWaiting movement.

I wish I could say that I embraced that aesthetic early on. For me, as a person diagnosed as an adult, it would have benefitted me if I had taken responsibility for my diabetes health much sooner than I did. I didn’t take full responsibility for my diabetes until year 28! I could have and I should have, yet didn’t.

I grew up in a middles class well-educated household that honored and revered the long training and knowledge that doctors attained. Unfortunately, we gave them much more credit than they deserved.

How could anyone defend a medical care system for people with diabetes that often counseled patients to manage their minute to minute diabetes treatment while only consulting with the “experts” for 20 minutes, four times each year. That’s 1.3 hours out of the 8,760 of each year!

I am amazed to read about some diabetes doctors who want their patients to let them decide which insulin dose changes to make and when to make them. This ignorance sets up both them and their patients for failure. Plus it contributes to enabling their patients to off-load responsibility for diabetes health fully onto the doctor’s shoulders. No medical professional should have to solely carry that burden.

Sorry for the topic divergence. The concept of ultimate responsibility for our diabetes health, whether it lies with the doctor or us or somewhere in between is an important one that should be sorted out early after the diagnosis.

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Dawn Phenomenon is a pretty good use case for NPH. I was going to say I only started to have the problem after switching to Lantus, but it’s more accurate to say I only noticed it then, because before the switch I wasn’t carb counting so I wasn’t testing anything like as often. Like every few days, except when I had a dr appointment coming up and need to provide some data to avoid getting scolded. So my awareness of what my BG was doing around the clock was minimal. For me, the solution to DP was a pump, but if I went back MDI I could see maybe using it that way. I’d have to overcome a LOT of resistance, though. :wink:

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I didn’t have a problem with it until I switched to Lantus. Later, nearly 10 years ago, I asked the community how I could reimplement it. Let me tell you it was miserable when I started using it again. Returned to Levemir some time after.
It’s funny but now I frequently have some in my fridge these days and I don’t hate it anymore. I’m reluctant to admit, I’ve seen decent control with it although it will never be as predictable as Levemir for me. Also it paired wonderfully with Tresiba, and it costs $25 CAD for a vial.

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I was diagnosed at 15 in 1973 and my regimen was one shot of NPH each morning. I was also taught that the NPH would peak at lunchtime and dinner. I moved to two shots of N+R daily in 1984.

It was a different diabetes world in 1973. My NPH cost $2.54/vial. Blood glucose testing didn’t exist. There was no type 1 or type 2, only juvenile diabetes and adult-onset diabetes, and the cause of either condition wasn’t understood. I was told I could live to be 50 if I took good care. Now I’m 63. We’ve learned so much since.

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Here’s another reason for NPH over Lente–I became allergic to Lente after starting on it. Not the first person my endo had who started getting reactions at the injection site. So for me, it was the only long acting option I could safely take at the time (along with Regular). I took mine 3x a day (morning, dinner, right before bed I think? It’s been a long time) which is a much more plausible regimen than 2x a day, as far as getting it to give basal-ish coverage.

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