NPH insulin question

[lisa68]

Hi,

I recently started taking NPH insulin. I already take 2000mgs Glucophage. My daytime bg is pretty good, but my fbg was about 160-170. We are planning to do an IVF cycle in another month and the perinatologist suggested we wait until my fbg is about 100 and he recommended NPH insulin for that.

My dr started me at 10 units and she said to step it up by 5 units until my fbg was where I need it to be. The first night I injected 7 units (I was scared my bg would drop too low during the night :o ) and my fbg dropped to the 130s, which seemed pretty good. I figured 10-15units would do the trick. Well now I'm up to 20 units and the lowest fbg I've gotten is 129.

Seems kind of strange that there would be a big drop off and then almost nothing...no progression at all.

Anyone have any insights or suggestions?

Thanks,
Lisa

[JediSkipdogg]

There is a point where you could be giving more insulin than you need and it could be dropping you low. Then your body is responding to correct and making your run back high again. How many days do you go between each increase?

[lisa68]

I didn't wait at all, just upped the dose the next day. This was the progression...7, 10, 12.5, 15, 20. The dr talked like I would see an immediate drop.

Also, I did try having a few cashews at bedtime one night, but it didn't seem to help. Does that usually take a few days to kick in?


Thanks,
Lisa

[Scratch]

We're lacking some potentially critical data to know what's going on.

One difficulty for anyone taking insulin through a syringe or a pump is the overnight period. One huge potential problem is the possibility of having too much insulin in the system, the blood sugar dropping low with eventually the liver kicking in to raise the blood sugar. This was the idea that Jedi was trying to bring up, it is entirely possible that you're injecting so much insulin that your blood sugar is dropping way down, and then your liver is kicking in to give you a rebound. It could be that it looks like increasing the dose has had no effect, but that it has had effect and your lack of data can't see the effect.

You should very likely set some alarms. Set one for 1 AM. Get up and check your blood sugar. Set another for 2 AM. See what's happening.

The overnight tests are the biggest pains in the butt. I hate them. I've had to do them to figure out what was going on.

[Richard157]

Lisa, I agree with Scratch. Frequent testing and keeping records during the night will give you a better idea of what is happening. I used to have morning highs (Dawn Phenomenon) and i started testing during the night. I found that I started going high at 3am. I then started giving myself a small dose of humalog at 1am. It kicked in by 3am and I no longer had that high. My fasting bllod sugar had dropped from 150+ to 100+. Now I am pumping and I program my pump to do what my injection were doing. I still do not have morning highs.

Here is a website that might help:

Dawn Phenomenon (http://www.diabetic-talk.org/dp.htm)

Good luck to you!

Richard

[lisa68]

Thanks for all the great info...it never occurred to me that I might be using too much insulin. It makes sense, though, since I'm not seeing any kind of progression.

I will definitely do some overnight checking tonight. :)

Thanks,
Lisa

[lisa68]

Okay, so I checked my bg last night. Here are my results...

1030pm (bedtime) -- 158 (not usually this high), injected 10 units, had protein snack (cheese and nuts)

2am - 123

5am - 137

8am - 142

Usually my bedtime bg is about 110-120, so maybe in those cases, my overnight bg is going too low. I'm wondering if it would help to split my Glucophage dose and take 1000 in the morning and 1000 at night? Any thoughts?

Thanks,
Lisa

[xMenace]

I suspect many, doctors included, conclude it's this Somogyi effect at work when in fact it the dawn phenomenon. We do not have flat line basals. No matter how much basal insulin I take I cannot get my fbg's normal without bottoming out in the night. Pumping is the only sane way I can control it.

I'm curious why they have you on NPH and not Lantus or Levemir. Insurance reasons?

[lisa68]

I don't think there's any particular reason I'm using NPH. Do the others work better?

I need to get my fbg 100-110 and that seems impossible right now. :(

Lisa

[Alice]

I don't know much about NPH, but just pulled a "Lilly" graph of insulin actions...It appears it rises fast and peaks between 3-6 hours, then poops out after 12 hours.

Looking at the graph, I'm glad I'm on Lantus...even with it's quirks, it's a much "flatter" even action...once it gets past the 4-hour warmup.

My endo's have never like NPH. Many, many years ago, I used to ask various doctors why "everyone I knew was on NPH"? They said they didn't know...I think NPH is an older insulin.

[JediSkipdogg]

My endo's have never like NPH. Many, many years ago, I used to ask various doctors why "everyone I knew was on NPH"? They said they didn't know...I think NPH is an older insulin.

Before Lantus it was the #1 long acting insulin for a very long time. I don't recall being on any other type of long acting insulin before I got my pump, and that would be 20 years of NPH.

[Alice]

I was always on Lente...another (similar?) long-acting insulin. It evolved to brand name of Humalin L. It's shown just under the NPH graph. They are almost idential, The downward curve is more "concave" on NPH, but only slightly.

Lilly has both NPH (N) and Lente (L) listed as intermediate-acting insulins.

This is an older chart, but it only lists Ultralente (U) as a long-acting insulin. This is what I took before switching to Lantus a few years later.

On this brochure I'm looking at, the pre-mixed insulins have the strangest graphs...I'm sure there is a reason they are around, but I'm glad I don't have to deal with those action times and declines.

[owlyn]

Due ti its action curve, NPH is not the best choice these days. You would likely be better off with Lantus or Levemir.

[Alice]

Years ago, I think NPH & Lente were considered "long-acting" since that's all that was available. I'm sure at the time, they were a huge improvement over the original insulins. Now, they are considered just intermediate-acting. I was diagnosed back in the 60's...had to wait a long time for Lantus. I do recommend it...

[Alice]

Strange question I'm asking...but is your doctor an older doctor? I'm wondering if some doctors just aren't prescribing the newer insulins...for one reason or another.

Of course, my "older" and most favorite doctor in Philly is the one who placed my on Lantus...so hard to say, right?

[lisa68]

We are preparing for an IVF (in vitro fertilization) cycle and Lantus and Levimir are not ok to take while pg, so I'm assuming that's why everyone is pushing NPH.

Lisa

[Alice]

Well, good luck! That makes more sense!

[Chris Graham]

Lantus is ok to take while pregnant. I had a beautiful, healthy baby girl 9 weeks ago...I was on Lantus for the whole pregnancy. I saw a peri and they told me that they might want me to switch to NPH later...I never went back because I thought it was terrible advice. They also told me I only needed to test 4 times per day...I am type 1!!

My endo managed my BG and my OB mangaged my pregnancy. This meant seeing 2 doctors, but it worked better for me.

[lilituc]

How about this?
LifeScan Diabetes News -- Insulin glargine safe for pregnant diabetics (http://www.lifescan.com/diabetes/news/20070420elin024/)

I don't know, but I don't think I'd ever go on NPH by choice. It might be easier if you're Type 2.

[Alice]

When I was younger, my endo at the time (one of my good ones) said if I decided to start a family he would insist on a pump during my pregnancy...which was ok with me. (I never started a family)...he said all his pregnant moms were on pumps and they had to fax their glucose results to him each day (or email).

I wish he was still my endo...he was very personable and real.

[RobiJo]

Before Lantus it was the #1 long acting insulin for a very long time. I don't recall being on any other type of long acting insulin before I got my pump, and that would be 20 years of NPH.


Ditto I went from NPH to pump. As a type 1, NPH pretty much ment I had to eat a specific meal plan at specific times of the day including snacks. I was often not hungry...but had to eat them anyways. I believe other than a flatter basal Lantus and Levemir offer that many stick with it b/c of the flexability you can have with mealtimes. Though perhaps more of a T1 issue. You couldn't pay me to go back to NPH. (or Regular for that matter.)