[bjacoby]

Hi, All. I have been unsuccessful at controlling the dawn phenomenon with lantus and humalog alone. Has anyone tried lantus, humalog, AND NPH? I am wondering about doing my lantus in the a.m., humalog at mealtimes, and NPH at bedtime to control for dawn phenomenon... NPH peaks in 4-6 hours... so if I go to bed at 11, would that help control the 3am-7am highs?? Thanks for any information anyone has. Barb

[jillrapp]

Hi Barb,

I take NPH 10 units at noon and 13 units at midnight. It takes my FBS from 170 where it used to be to less than 120 most days. Have you tried splitting your lantus dose? I've heard that others have tried that and have found success. Good Luck!

[xMenace]

Originally Posted by bjacoby

Hi, All. I have been unsuccessful at controlling the dawn phenomenon with lantus and humalog alone. Has anyone tried lantus, humalog, AND NPH? I am wondering about doing my lantus in the a.m., humalog at mealtimes, and NPH at bedtime to control for dawn phenomenon... NPH peaks in 4-6 hours... so if I go to bed at 11, would that help control the 3am-7am highs?? Thanks for any information anyone has. Barb

Adding NPH without cutting back on the Lantus is asking for trouble if you don't know your patterns. Be careful and test well.

Lantus tends not to last 24 hours, so taking it at breakfast is counter productive IMO. If you take it in the morning now, maybe switch to dinnertime so the slack time is when you don't need it, or even split it.

You have to know your middle of the night numbers. If you tend to bottom out like me, adding NPH could be dangerous. If you tend to rise while sleeping, and some do, then it may be just the ticket.

You could also consider waking at 6am or earlier every day and shooting some humalog.

[jillrapp]

Yes, I'm not sure I'd "add" nph - maybe try splitting the lantus first, if that doesn't do it, ask your dr. about switching to Levemir or NPH. (btw - I will be trying Levemir by the end of November instead of the nph. I find it too peaky.)

[maya0606]

I have done all of them NPH i hated it soo much i felt liek it was making gain weight a lot right now I am on Lantus at night 16units and Humolog by carbs counting ) I am liking it

[BlueSky]

I have done the Lantus/NPH combination very successfully. I don't do it anymore because I somehow stopped needing it. But the reason for starting it was that Lantus on its own didn't deal with the DP. So I injected about 8 units of NPH before bed, a similar amount of Lantus in the morning, and I did all bolusing with Novolog.

The advantage of NPH is that it peaks sooner than Lantus. When figuring out your dosage amounts and timing, refer to the graph below.



NPH is the solid line at the top, and Lantus (Glargine) is the dotted line at the bottom. The shortcoming of NPH is the large amount of variation in its action (see the CV%, which is Cumulative Variation, table). It means that taking large amounts of NPH can make blood glucose unpredictable. But if you are only using small amounts of it, you should be ok.

I found that I still had an insulin action gap later in the morning, and I cover breakfast with Actrapid (regular) to close it. I don't use the NPH at night anymore and have Lantus both in the morning and before bed. But I still use the Actrapid to cover breakfast.

[owlyn]

My endo had suggested that combination (NPH at bedtime, Lantus in the am, etc...) if splitting the Lantus didn't work (it did)