overlaping?

[Batty]

Okay so it's 4am and I'm up getting ready for work(at my new job in the bakery)...and I just took my insulin..but I know that the 32N I take at 10:30(or 10 last night) hasn't warn off yet...but I had to eat breakfast and do my insulin. It's been a while since I did this kinda shift at McD's, so I don't remember what I did then..but it's okay that I took just the basic of my insulin right? Instead of going 10R and 38N, and adjusting it for my 15.5 blood sugar..I just took 10R and 36N because my N from last night is still in my body...that make sense? is that okay? :confused:

[gettingby]

Batty,
I would definitely ask your doctor/endo what to do in this situation. It's been so long since I was on NPH and Regular that I have forgotten what the duration is. :confused: Sorry I couldn't be of much help. Just try to check your levels as often as you can.

[duck]

Yeah, I *think* you were close, batty--There is a sliding scale somewhere, let's see if I can find it.

Seriously, we need to get you on a very-fast acting insulin (Regular is as old as yur grandparents) and Lantus (which I think has just become available in Canada). I think your control will improve and you'll feel better...

[Batty]

Yeah, I *think* you were close, batty--There is a sliding scale somewhere, let's see if I can find it.

Seriously, we need to get you on a very-fast acting insulin (Regular is as old as yur grandparents) and Lantus (which I think has just become available in Canada). I think your control will improve and you'll feel better...

I was put on that fast acting stuff..Humalog? and actually..my levels were a -lot- better with the insulin I've been taking since I was 6. So my doctor put me back on them. All he had me do, was replace my R with the Humalog..but kept it with my N at night..and yeah..i was always really high and my A1C was higher when they tested me.

[MarkMunday]

Batty,

So you reduced your NPH at 4am because it would be overlapping with the NPH you injected at 10pm the previous evening... Hmmm .... remember that NPH only peaks after 6 hours. So reducing the dose would have no effect until about 10am. If you were going to reduce anything, it would make more sense to reduce the Regular. It peaks after only 3 hours.

As you can see, aligning the action of these insulins can become a nightmare. Your requirement for insulin increases in the morning, from about 3am-10am. Which is why NPH is usually injected before bed. But injecting NPH again at 4am would mean that this shot would peak at about 10am. And there would still be strong action from the shot you had 12 hours earlier (before you went to bed).

You may find that this causes you to go low in the middle of the morning (10am-11am). And that you go high after lunch. So I would suggest that you have Regular before breakfast at 4am, as usual. But don't inject your NPH until, say, 7am. That way, it will peak around lunch time (1pm). Which is what you really want.

To help you make sense of all this, see the diagrams below. They show the action profiles of NPH and Regular insulin. I agree with Duck that switching to Lantus/Humalog would make things a lot easier for you. But you need appreciate when the Humalog action peaks and match this action with your meals.

I really don't think your doctor did you any favours by switching you back to the conventional therapy (NPH/Regular). Because of the overlapping of these slow insulins, it is not surprising that simply replacing regular with Humalog didn't improve your control. Your doctor really should have helped you make intensive therapy work better for you.

Hope this helps.

Cheers,

Mark

[Batty]

Batty,

So you reduced your NPH at 4am because it would be overlapping with the NPH you injected at 10pm the previous evening... Hmmm .... remember that NPH only peaks after 6 hours. So reducing the dose would have no effect until about 10am. If you were going to reduce anything, it would make more sense to reduce the Regular. It peaks after only 3 hours.

As you can see, aligning the action of these insulins can become a nightmare. Your requirement for insulin increases in the morning, from about 3am-10am. Which is why NPH is usually injected before bed. But injecting NPH again at 4am would mean that this shot would peak at about 10am. And there would still be strong action from the shot you had 12 hours earlier (before you went to bed).

You may find that this causes you to go low in the middle of the morning (10am-11am). And that you go high after lunch. So I would suggest that you have Regular before breakfast at 4am, as usual. But don't inject your NPH until, say, 7am. That way, it will peak around lunch time (1pm). Which is what you really want.

To help you make sense of all this, see the diagrams below. They show the action profiles of NPH and Regular insulin. I agree with Duck that switching to Lantus/Humalog would make things a lot easier for you. But you need appreciate when the Humalog action peaks and match this action with your meals.

I really don't think your doctor did you any favours by switching you back to the conventional therapy (NPH/Regular). Because of the overlapping of these slow insulins, it is not surprising that simply replacing regular with Humalog didn't improve your control. Your doctor really should have helped you make intensive therapy work better for you.

Hope this helps.

Cheers,

Mark

actually i didnt get low at all. I had a regular breakfast at 4am, and worked until 11:30 when I went home for lunch and I was no shaky at all. I had lunch and went back to work. I was a little high tonight..but that happened when I did morning shifts at mcd's as well.

I can't take my insulin and do it there because I am in the bakery, and it's really busy first thing in the morning, so it's hard to escape to the washroom, unlike at mcd's when doing a 5am shift i'd had a 30mins break around 7:30-8am.

and as for the other insulin, I perfere the way I have it now anyways. With Humalog I would be taking a shot every meal. This way, I have three shots a day and my last shot is more flexible(so its okay if i do it at midnight if i get home late), and I don't have to worry about going high because I didn't take excatly when the insulin from the shot before runs out.