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Originally Posted by BlueSky  Isophane is an intermediate acting insulin and acts over 22 hours. |
I've seen the charts... but... for whatever reason, NPH acts faster in me. Maybe it's [at least partly] because I use so little; I think that my record was something like 6U, when I had a gigantic 15U meal including lots of black beans. (My I:C ratio = 1U:15g)
The insulin
menage a troi also means that some of the isophane interacts with the rapid... i.e., I end up with rapid, rapid+isophane, regular, regular+isophane.
I've done NPH at various times of day, various times relative to Lantus and Levemir. The activity does not change. I get the full effect within 5.5 hr. R = 2 hr. Rapid = 1.5 hr.
If I eat dates and inject Novolog at the same time, I'll go hypo 50-55 minutes post. Dates aren't exactly low-glycemic, either. (Well-chewed raisins, however, work faster than Novolog.)
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Originally Posted by BlueSky Your stomach empties in 4 hours max. |
Yes, the stomach empties.. but how long do things take in the small intestines? Chyme is not instantly absorbed.
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Originally Posted by BlueSky Wouldn't it be simpler to increase the levemir and drop the N from your boluses? |
Presently, I only use N for foods that require it. I recently went several days without, as I was eating foods that digested in 1-2 hours.
When I used Lantus, that was another story. I'd have notable drops a couple hours after injection... then begin creeping up 18 hours later. Lantus @ 1730, 1U extra NPH with breakfast, 2U extra NPH with lunch. The inflexible lunchtime (or need for a separate teeny supplemental basal) was annoying.
the Lantus variability.
I set my evening basal to give me a 5-10 mg/dL drop overnight. Ideally, I go to bed in the low 90s, and awaken in the high 80s. BG declines linearly during the night.
I currently set my morning basal to match my evening basal's 1-ish mg/dL hourly decline. Once I catch up on work, I want to start doing some serious exercise... at which point I'll _decrease_ morning basal, and use shorter-acting insulins (primarily N) to cover "spots" when I'm not exercising.
I know it sounds wacky. When I first started shooting NPH, I was worried about hypos significantly later in the day. I was surprised when I consistently went hypo 4-5 hr postprandial. The activity is consistent, though.
The reason people choose Lantus/Levemir over NPH is for greater predictability, and for a longer, smoother, less-peaky insulin curve.
I mix my boluses for the same reason. My choices are:
- brutal hypos (40s or 30s) at one-hour post;
- wait to shoot a bolus (BG rises, then falls rapidly);
- split the bolus (multiple "peaky" shots, a la NPH basal on a shorter timescale);
- pump (see some of my other recent threads);
- mix.
If I live on processed food (readily-available CHO numbers) and fruit, and run my BG high, rapid works great. I was doing just that for the month after DX.
When I quit the junk food and cut back on the fruit, the 2x/3x-day hypos were just too much. I started mixing R with my boluses.
Then I found a few foods where even straight R gave a 2-hr hypo, followed by a rise during hours 3-4. I started mixing in N for those few foods.
I'm well aware that all this flies in the face of published charts. I'm just going on what I've determined empirically.
