A MDI question ...

LiveNormal · #1 (**permalink**) 03-05-2007, 06:02 PM

I have been on Actrapid/NPH for the past 3 years, actrapid before every meal and NPH at Noon and bedtime.

I have been controling my big D okay by the measurement of A1c but quality of living has been compromised in terms of having to be really watchful of the frequent lows (I always eat very little even during the actual meals, afraid of the postprandial high).

I am thinking of switching Actrapid to Humalog, do you think that will help cut back the number of hypos I am encountering currently? Also, with Actrapid, I found that my after mid-night BS always drop tremendously and that forced me to always have a full 15g carb of long-acting carb at bedtime even though my BS is as high as 7mmol/L (Actrapid injection at dinner has always been between 7~8pm, and NPH at around 11:30pm ~ 12midnight). I am wondering if Humalog will be better in this case?

Thank you for reading my post and if you are just like me, pls share your experience and advice.

Funnygrl · #2 (**permalink**) 03-05-2007, 06:03 PM

I think trading the NPH for something like Lantus or Levemir will help prevent lows more than changing the actrapid, but that wouldn't hurt either.

LiveNormal · #3 (**permalink**) 03-05-2007, 06:39 PM

Thanks FunnyGirl for your reply. Reason for not doing other basal insulin is because I am also trying to conceive and NPH by far is the most recommended...

I am more weary of the reactions of Humalog. For Actrapid, I can predict when it will become low, when I need to snack, when I can make use of its reaction to eat some slow carb like hi-fat or hi-protein meal. But for Humalog, I have no idea. This is mostly my concern...

Funnygrl · #4 (**permalink**) 03-05-2007, 06:47 PM

NPH and Actrapid are category B for pregnancy. Humalog and Lantus are both category C. Pretty much, any insulin during pregnancy is thought to be safe. The only reason NPH and Actrapid are B is because they have been along longer. Switching to Humalog would also be putting you in another category.

IMO, it's more beneficial to have in range blood sugars when TTC.

LancetChick · #5 (**permalink**) 03-05-2007, 06:54 PM

Theoretically, your lows could be caused by all sorts of things, but since you really need to have an unusual basal metabolism to match the action curve of NPH, I'm guessing NPH is the primary culprit. I've never met anyone who preferred NPH to Lantus or Levemir. As far as switching your fast-acting insulin, it really would give you better control, and it's much easier to stay on top of an insulin that's out of your system in a shorter period of time.

LancetChick · #6 (**permalink**) 03-05-2007, 07:06 PM

Quote:

Originally Posted by LiveNormal

I am more weary of the reactions of Humalog. For Actrapid, I can predict when it will become low, when I need to snack, when I can make use of its reaction to eat some slow carb like hi-fat or hi-protein meal. But for Humalog, I have no idea. This is mostly my concern...

For meals that will prolong digestion, I still use Regular to good effect, but I find that most of the things I eat match up better with Humalog. Before I started on it, I worried about its quick action, and how that would contribute to scary lows, but I don't find Humalog a scary insulin at all. Like any insulin, there's a learning curve for discovering how it works in your system, but I was pleasantly surprised by how much easier it was to get used to than I expected.

LiveNormal · #7 (**permalink**) 03-06-2007, 02:41 AM

Quote:

Originally Posted by Funnygrl

NPH and Actrapid are category B for pregnancy. Humalog and Lantus are both category C. Pretty much, any insulin during pregnancy is thought to be safe. The only reason NPH and Actrapid are B is because they have been along longer. Switching to Humalog would also be putting you in another category.

IMO, it's more beneficial to have in range blood sugars when TTC.

Most pumps use fast insulin and almost wherever I logged into the web, all recommended pregnant women or those who are trying to conceive to be on pump. So should I just ignore insulin category and focus on BS control? Any ill effect by following this rule?

LancetChick, can I assume that you were on NPH and regular before and now have switched to regular/fast acting/Lantus? Do you inject Lantus at the same timing when you were on NPH ? Do you have DP problem? How do you cope with it with Lantus? I am currently leveraging the nice peak of NPH 4~8hrs after injection for a good coverage of my DP. Don't know if Lantus can offer what NPH does to cover for my DP.

Funnygrl · #8 (**permalink**) 03-06-2007, 07:55 AM

Quote:

Most pumps use fast insulin and almost wherever I logged into the web, all recommended pregnant women or those who are trying to conceive to be on pump. So should I just ignore insulin category and focus on BS control?

Well, I wasn't gonna come right out and say it, but yes, that's exactly what I recommend.

LancetChick · #9 (**permalink**) 03-06-2007, 08:55 AM

Quote:

Originally Posted by LiveNormal

LancetChick, can I assume that you were on NPH and regular before and now have switched to regular/fast acting/Lantus? Do you inject Lantus at the same timing when you were on NPH ? Do you have DP problem? How do you cope with it with Lantus? I am currently leveraging the nice peak of NPH 4~8hrs after injection for a good coverage of my DP. Don't know if Lantus can offer what NPH does to cover for my DP.

Wellllllll....... actually, I use Lantus, Humalog AND Regular and NPH. Lantus and Humalog are my primary insulins. I use Regular for any meal I expect to take a long time to digest (either alone or mixed with Humalog), and the DP that you so correctly pointed out is indeed best covered by NPH, but as a small(ish) squirt at bedtime during a DP wave to supplement the Lantus. If I had a pump, I could be calculating all sorts of different basals and dual wave boluses, but I'm too lazy for that, and prefer to use the services of 4 different insulins, which make a pretty good approximation.

(I hope you don't think that sounds ridiculously complicated, because it really isn't).

LiveNormal · #10 (**permalink**) 03-08-2007, 10:07 PM

Quote:

Originally Posted by LancetChick

Wellllllll....... actually, I use Lantus, Humalog AND Regular and NPH. Lantus and Humalog are my primary insulins. I use Regular for any meal I expect to take a long time to digest (either alone or mixed with Humalog), and the DP that you so correctly pointed out is indeed best covered by NPH, but as a small(ish) squirt at bedtime during a DP wave to supplement the Lantus. If I had a pump, I could be calculating all sorts of different basals and dual wave boluses, but I'm too lazy for that, and prefer to use the services of 4 different insulins, which make a pretty good approximation.

(I hope you don't think that sounds ridiculously complicated, because it really isn't).

I have been using Humalog and NPH and... actrapid for a while and was really upset by the number of shots I have to give myself (used to be just 3+2 shots and since adding in the Humalog, I have been like giving myself about ... 2 + 3 + n shots .. where n is definitely greater than zero when I abuse the advantage of rapid acting Humalog and squeezed in many more snacks inbetween meals). This is really bad diet for a diabetic . Therefore, since then, I have been restricting myself to just 3 humalog shots at meal times and that is it!

By the way, I have been in HongKong for 3 days (therefore the late responses (:P)! I have been using Humalog + NPH at dinner time. My morning fasting sugar has been real good so far(from 4.1mmol/L to 7.0mmol) without having to eat at all when my BS is between 4.5~5mmol/L at bedtime.

I think I will stick to Humalog + NPH for a while and try to get used to things.

Thanks for all of your replies and advices ... ciao!

Funnygrl · #11 (**permalink**) 03-08-2007, 10:21 PM

Actually, snacking isn't bad. Especially when you are pregnant. It's when calories become excessive due to snacking that it's a problem.

Keezheekoni · #12 (**permalink**) 03-09-2007, 12:46 AM

I've had five children and with each of them I was on a different regimen of either NPH only, NPH + R, NPH + (I can't remember, but I think it was an early Humalog-ish one), Lantus + Humalog (x2). By far, the best results I had were with the Lantus + Humalog together. I enjoyed the freedom as well as the ability I had to control my numbers so much more. On the plus side, none of my children were above 7 and a half pounds.

While TTC, none of my OBs ever had a problem with my insulin use, though I was misdiagnosed as a t2 for a long time, I was just on insulin the entire time anyhow... they never switched my insulins just because I was pregnant, and actually the switch to Lantus + Humalog was actually done when I became pregnant with my 4th child because I was having such a difficult time with NPH.

I would definitely say try getting on a pump. That's by far the easiest way to go through a pregnancy... At least, I envision it being. I have only had my pump for a few months now, and I know that I'd have much rather gone on a pump while pregnant!

cheryl · #13 (**permalink**) 03-09-2007, 07:19 AM

[quote=LiveNormal;200566]Thanks FunnyGirl for your reply. Reason for not doing other basal insulin is because I am also trying to conceive and NPH by far is the most recommended...

OH girl I have been on them all, actually my old doc's hated humalog nph combo when pregnant...........

In all honesty I did the best with humalog and lantus, everyone is different, but my baby was smaller and my sugars were very stable and easier to manage, I don't have a pump, and won't ever get to experience pregnancy with a pump, but I have heard they are pretty good too......with pregnancy

Cheryl

LiveNormal · #14 (**permalink**) 03-12-2007, 01:50 AM

Thank you for all of your replies …

My problem with Humalog and NPH currently is this, if I apply Humalog too late at dinner time (later than 1930hr), my pre-dinner BS will almost always be very high. BS can jump 6mmol/L within 1.5hr. If I apply it normally at 1830hr, my midnight BS will be high. So it seems that NPH has been a lousy basal and it could not tie me over the long interval between lunch and dinner.

My Humalog and NPH application is typically like this:
Breakfast (0720hr) : H
Lunch (1140hr) : H / NPH
Dinner (2000hr) : H
Bedtime (0000hr) : NPH

So I am interested to find out those who are using Humalog and NPH, the timing of NPH and Humalog application and how is their BS control. IMO, I may need to either raise my afternoon NPH or do a boosting Humalog injection at around 1730hrs if I am taking my dinner late. If I am taking it at normal hour, then I will have to snack less after dinner or increase my pre-dinner Humalog dose.

TIA!