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NPH - hypoglycemic reaction

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#1
jdezenzio

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I would like to get some input on a rare reaction that I receive once to twice per year while taking NPH. After it occurred numerous times and doctors were not able to figure out why it was occurring, I started doing my own research.

Diagnosis and Reaction:

The reaction occurs typically 10 to 15 minutes after taking NPH. Your sugars can be any reading from 90 to 140 and the reaction still takes place. Inflammation and welts appear around all of your injection spots and when you take a second reading, you will find your sugars to be reading around 70 to 90. At this point, I would take at least 4 to 6 sugar tablets and start the clock and take sugar readings every minute. The sugars will drop slowly to under 50 and halt around 45. At this point (the lowest reaction point that has occurred to me) it will start to slowly rise. My sugars will rebound up to 180 after the reaction and then they will stabilize.

Possible Reasons:

This is the most realistic reason as to why this is occurring. The reaction only seems to occur with NPH and from what I can guess, is that the reaction is occurring from a protein reaction that is processed in the NPH. From what I understand, proteins are not the same for every bottle which would explain why the randomness seems to occur over a long period of time. If I do not mix the proteins well enough, the reaction is more likely to occur. So, what I've been doing is mixing the NPH/proteins up triple the amount of time I normally would take and then watching my body for signs like a hawk for at least 15 to 20 minutes.

With every reaction, the same results applied. The fact that I actually get a sign makes me feel a little bit less scared but I want others to know what to look for and what to be aware of in case you have a similar event occur.

Make sure to mix your proteins up very good in your NPH bottle before giving yourself your dose. If you ever receive welts or strange redness around "all" of your injection points (could be the last 6 to 8 injection points), immediately check your sugars and if they dropped drastically lower, start eating some sugar pills.

I'm almost certain that people are not overly aware of this protein reaction that is occurring with some diabetics but I've enlightened my doctor and am keeping her abreast of what transpires with my testing this theory of mine. I found the initial theory after reading about strange protein reactions with diabetics in the early to mid-70s. I think that these reactions still occur today.

This is an awareness thread.
Joel Dezenzio

#2
DeusXM

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Actually it's surprisingly common for NPH/Isophane to cause hypoglycaemic reactions. Since it does actually have a peak action, you can certainly be at risk from a hypo, especially if you've taken a bolus does at the same time.

But certainly, it's good advice to ensure that you've properly resuspended isophane, since otherwise it's effectively the same as injecting something like actrapid.
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#3
HeatherP

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The local swelling and welts indicates an allergic reaction to the shot. I get them once in a while w/ some itching.

You shouldn't be getting a hypo so quickly, so I wonder if you're just one of those people the synthetic insulins doesn't work for. Have you been on beef/pork insulins before?

You may want to consider changing to Lantus.

Welcome, by the way
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#4
DeusXM

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You may want to consider changing to Lantus.



On the other hand, you may not. Lantus is statistically FAR more likely than NPH to cause irritation at the injection site (swelling, burning pains, welts) etc. because it's a completely different pH to the body. Unofficially it is also associated with other side-effects which are far more unpleasant.

However, you may want to try Levemir. It works like Lantus, and has an irritation rate of around 2% (for comparison, NPH is about 2% and Lantus is 4-5%).
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#5
HeatherP

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Okay, Deus has me there. Although, I have to say I don't seem to have much site reaction w/ the Lantus. I also take relatively small amounts compared to others. I still say NPH is nasty stuff.

Is Levemir out on the market yet? I haven't seen much about it other than here.

I have an appt @ the endo in a few weeks - I'm definitely interested in trying it.
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#6
jdezenzio

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Originally posted by HeatherP
The local swelling and welts indicates an allergic reaction to the shot. I get them once in a while w/ some itching.

You shouldn't be getting a hypo so quickly, so I wonder if you're just one of those people the synthetic insulins doesn't work for. Have you been on beef/pork insulins before?

You may want to consider changing to Lantus.

Welcome, by the way
HeatherP



I am clueless as to what the different "types" of insulin are. I know what regular and NPH is. I didn't realize there were name brand insulins out there and/or what they could do for me. Are they more expensive?

How do you tell what is in your NPH bottle? I'm not sure how to go about finding out whether or not I have beef or pork proteins etc. if that is what you are referring to.

Again, it makes me feel better to know that I'm not alone in these strange reactions. That they occur so fast though, makes me a bit nervous. All have taken effect in under 15 minutes. What is strange is that it only appears to occur once or twice per bottle. Strange..
Joel Dezenzio

#7
HeatherP

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Well, Joel, there's many many insulins out there and new ones being invented more often.

What are you currently taking? Obviously Nph, but any short acting like Regular or Novolog or Humalog?

As for synthetic vs. "animal" insulins, I'm not completely up on the subject, but synthetic insulins are somewhat new and some people that have been on beef or pork insulins for years don't respond well to the newer brews. The insulin manufacturers were actually going to discontinue making the animal insulins until there was a pretty large outcry from those on the older stuff because they couldn't use the newer. That's it in a nutshell, like I said, I'm not sure of all the intracacies.

Happy to provide more info if I can,
HeatherP
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#8
jdezenzio

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Grabbed my insulin box. Here's what it says.

Red label (Lilly)

Humulin N
NPH
human insulin
(rDNA origin)
isophane suspension

u-100 (bottle)

Side label says it contains Metacresol 0.16% and Phenol 0.065% added during manufacture as preservatives.
Joel Dezenzio

#9
HeatherP

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You're on synthetic. I think it's the rDNA and "humulin" that gives it away. The beef/pork insulins were harvested from animals and all that was available until relatively recently, say the 80's or so. Since then, I think they just give you the synthetic automatically. I've never been on animal insulin, but my mom was.

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#10
jdezenzio

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Heather you are so very helpful. I like you a lot and I've only just seen your kitty cat picture!

So, what do you suggest I do in the case of "type of insulin"? Should I swap to something else and what is the major difference between synthetic and real?

I'm surprised with all the problems I've stated to my doc about the reactions that she hasn't told me to try another type of insulin.

::Boggle::
Joel Dezenzio

#11
DeusXM

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Quick insulin primer:

Typically, Insulin comes from 3 different sources - pigs (porcine), cows (bovine) and then there's GM bacteria that can produce human insulin (synthetic).

Human insulin:

Made from GM bacteria (typically yeast), unrefined human insulin is pretty fast acting, and therefore is pretty much unsuitable for general diabetes treatment. It's ok for bolus doses, but it's rubbish for basal injections unless you do something to it. I'm not sure of the exact way isophane/NPH works, but it's known as an insulin suspension - when you shake it up to make sure it's cloudy, you're resuspending it which delays its action.

Most human insulins are now genetically modified to give them different action profiles - these are known as analogue insulins. Very fast acting ones include Humalog and Novarapid (Novalog in the US), which are the two most common ones for bolus doses. Recently they've also developed basal analogues - Lantus, made by Aventis, and Levemir, made by Novo Nordisk. Lantus has been modified so it has a different pH to the body, so it slows down its rate of absorbtion and gives it a fairly flat action profile. Levemir works by setting up the insulin molecules so they bond dynamically with albumen in your blood, which also slows down the rate of absorbtion and and gives a very flat action profile.

Typically most people with diabetes are on a combination of either Humalog or Novarapid, with either Lantus, Humalin I or NPH - Humalin I and NPH are what's known as isophane insulins (the onese you need to shake)

Animal-derived insulins also come in similar varieties, such as long-acting suspensions like NPH, although to the best of my knowledge there's no animal analogue insulins available.

One major problem you'll fine with analogue insulins is that they have a scientific name and also a brand name. Here's a not very exhaustive list, based purely on my own personal experience:

Insulin lispro - Humalog (made by Eli Lilly)
Insulin aspart - Novarapid (or Novalog, made by Novo Nordisk)
Insulin glargine - Lantus (made by Aventis)
Insulin detemir - (Novo Nordisk again)

There are really three main companies in the business of human insulin, Eli Lilly, Novo Nordisk and Aventis. At the moment, NN is the only one with a complete range of both long and short acting analogue, Eli has short-acting analogues but use insulin suspensions for long acting, and Aventis have long-acting analogues but no short acting ones (although I think they have one due out by the end of the year). I think NN still produce animal insulins too, and there are a few other small companies who also produce animal ones too, but really the market is dominated by human insulin. That's a shame because some people do have problems with human insulin (since it has a very aggressive profile) and they do much better on animal insulin. For the record I do fine on human insulins (except for Lantus) but obviously everyone's different.

Talk to your doctor about the range of different insulins. Last I checked there were about a dozen different types.

This chart is a little old and therefore misses out Lantus and Levemir but it's still useful - http://www.diabetes-...nsulin_2001.htm

And here's a thread we had earlier on types of insulin which you may find interesting - http://www.diabetesf...15&pagenumber=1
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#12
HeatherP

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Great info, Deus!

This is some great info Joel. I think most of us (in the states) are on Humalog and Lantus, although some people are on different insulins.

:topic:
Sorry I cut out on you yesterday, but we had a plumbing emergency that needed my attention.

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#13
lgvincent

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I've been using NPH for 36 years and I've never gone into insulin shock so soon after using it. I have had it happen with the fast acting insulin though. I used to use the beef & pork insulins but I was told they were going to be discontinued so I stopped using them. I can't say that I liked human better or worse than the animal insulins. They seemed pretty similar to me.
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#14
HeatherP

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Something I should have asked, Are you sure you're not injecting into muscle tissue? If you are, then the absorption of insulin can be very fast.

HeatherP
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#15
jdezenzio

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Hi Heather (and thanks Deux for the info),

No I'm injecting a lot lately in my stomach. I wish I could say there was a lot of muscle there but I'm what you would call the huggable type with a little bit of extra meat on his bones.

I usually inject within a 1 inch diameter of my belly button and if I get tired of stomach injections I inject into the meaty part of my upper thighs (on the inside where I pinch a non-muscle section).

The reactions occur the most when I inject my stomach. I don't think I've ever had a thigh reaction to be honest. That has me thinking anyways.

I hope that helps.
Joel Dezenzio

#16
Harold

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Thought you were supposed to stay more than an inch away from the navel, or at least an inch away from it.

#17
HeatherP

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Ooohh yeah - keep away from your bellybutton!

I'm stumped...
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