So glad you wrote this, because I was hesitating about putting my own words on this thread. Like you, I was on NPH from the mid-60’s until I think whenever newer insulins came out, sometime in the 80’s. And being on one shot a day, where we ate like soldiers (even my 92 year old Dad still eats like he’s a diabetic and I left home at 16 to explore the world) . So off I went, with NPH and a glass syringe and 18 gauge (not sure if this is how thick it was, but it wasn’t 32 gauge like our pen needles we use today). Like you Marilyn, just glad we did okay. Today, I play with whatever comes across, in types of insulin, pumps (I have no insurance coverage in Canada for something, so I do what I have to do).
4 Likes
I think that I may be able to help. I am a retired Family Doc who developed Type 1 at the age of 37 (I am 73 now). Initially, I was placed on a twice / day combination of the old pork Regular insulin and NPH. I was told that the NPH was act as a basal between regular. The two were given before Breakfast on a crude sliding scale by estimated carbs. The regimen was awful for me, with wild swings in capillary sugars and frequent severe lows. After a couple of years (around 1985), I tossed that regimen and put myself on a new one, that was based more on frequent doses of the Regular and the old Lente at bedtime. I checked sugars 7-8 times / daily, adjusting regular premeals according to sliding scales for both carbs and sugars. That worked much better. I stayed on that regimen until I went on my first pump in 1995.
NPH was a disaster since it tended to peak 4-6 hours after being given, but not staying around long enough to be used as a single dose “basal.” Hence, its peak activity was late mornings to early afternoons and late evening or after bedtime. Any activity late mornings or early afternoons caused hypoglycemic episodes. Early bedtime lows were also fairly common. It is no wonder that it was quickly discarded as soon as longer acting insulins without peak release were developed, starting with Ultralente, then Lantus and Levamir.
5 Likes
That’s what I frequently administer to patients, yes.
I always thought 70/30 was for type 2.
How could you ever accurately dose that?
If my sugar is high right now. It’s seems like you are asking for it.
I think it’s only used in current times typically for people with T1D who don’t maintain tight control and don’t generally do corrections etc. I’ve seen it used with psychiatric pts with active severe mental illness for example–the diabetes control in those populations tends to be terrible, even when (especially when?) hospitalized, with 300-400 range blood sugars a common occurrence. It’s clearly typically no one’s priority to address with those populations… my guess is some seniors are treated similarly, with them running always high to be safe in the short term and simplest possible regimens.
1 Like
I used 70/30 up until 5 years ago when I started on a pump. I haven’t said anything until now because I most certainly wasn’t in good control with it. But I wasn’t ever in good control with separate vials, either. I never saw an A1c under 9 until I started on the T:slim. Had way less to do with the pump and type of insulin, and more so because I made some big life changes and finally really wanted to learn to do better so I could stick around and enjoy it. I was literally just trying to survive my diabetes every day before then. Never really learned how to thrive with it until recent years (mostly thanks to guidance I gathered from the online community!). The 70/30 was just an affordable option that meant only carrying one vial and kept me alive for another day.
The exact dosages didn’t matter so much, since the R/NPH routine has always been a matter of eating to your insulin, rather than dosing for the meal you want to eat. I always had food and glucose on hand. Whenever the crash came on, I ate. And I ate something before bed to make sure I didn’t crash in the night. The consequence of avoiding the lows was that I spent a lot of time high, though.
2 Likes
If a type 2 is still producing insulin, but not enough to battle insulin resistance, then the 70/30 can fill the gap, so dosing is different. Probably titrate up to get what works…
1 Like