[Oradev]

Hello All!

I am wondering if anyone takes NPH before bed to counter their DP? For the last week or so, my morning sugars have been high (around 170). I know this isn't too high or too bad, but I also know it is not too good. Also, has any Type I tried metformin before bed?

Adam

[Penny]

Hi Adam. I have high fasting (150 to 175) if I sleep 6 hours or more. If I get up between 5 and 6 hours, I am either very low or heading up. I have tried eating before I go to bed, doing some Novolog (this made a scary low), but have not tried taking Metformin before I go to bed. I was told to take one with each meal. I will try taking it before bed for a few nights and see if that helps any. Every time I increase my Lantus at night, my fasting numbers are low for a few weeks, but then start going up again. So I need an answer to this problem too!

[pdxdennisj]

I take NPH about 6am and 6pm - then hit the sack around 9pm. My readings all appear good to me. About 3am I frequently get warm which is sometimes a sign of going low for me. It seems to pass within an hour or so. I have never gotten up and checked the BG.

[Oradev]

Originally Posted by pdxdennisj

I take NPH about 6am and 6pm - then hit the sack around 9pm. My readings all appear good to me. About 3am I frequently get warm which is sometimes a sign of going low for me. It seems to pass within an hour or so. I have never gotten up and checked the BG.

Do you take Lantus as well? I take Lantus in the am and pm. I get great results from Lantus during the day, but the mornings tend to sometimes give me a problem. I've tried wine at dinner, but that does not seem to work.

Adam

[kiwi]

NPH is a cloudy insulin. It is actually insoulable even though it is in a solution. It does not 'mix' evenly (you have to mix it till it is 'cloudy') so the dose is not always accurate.
I used to take it and had the same roller coaster rides.
N does have a peak which is why the lows in the middle of the night.
I did get up to test in the night, and frequently I was low. You want to test and beat the liver dump. Otherwise you will end up with really high numbers.
When your basal dose is out, it is extremely frustrating. It affects how the rapid insulin works or doesn't work!
The new basal insulins, Lantus and Levemir are already mixed, so the dose is always accurate. They don't have a peak, so sustain the basal rate incredibly evenly. Levemir is designed to be taken twics a day. I like this as I take different amounts in the am and pm.
Lantus is not designed to be split. I found it only lasted 20 hours for me which is why I changed to Levemir.
It makes a huge difference when you have a relable basal.
You may want to change to the newer basal insulins.
By the way, quite a few years ago, Lantus was dubbed 'the poor man's pump' as it was so effective compared to N.
Kiwi

[BlueSky]

Originally Posted by Oradev

... I take Lantus in the am and pm. I get great results from Lantus during the day, but the mornings tend to sometimes give me a problem. ...

It sounds like your morning Lantus doesn't always last the 24 hours. Which is why you sometimes have high morning blood glucose levels. Within-individual absorption variability is about 25% for Lantus. Which is why your morning BG is often OK but sometimes it isn't.

Lantus is marketed as a once-a-day insulin, and Aventis is sticking to their guns on this. The reality for many of us is that it doesn't always last that long. Also bear in mind that, the bigger the dose, the longer it lasts. If you are eating low-carb and on a smaller dose, you really need to split it over two shots.

I would suggest splitting the dose and seeing how that works. You may find that it sorts the problem out. If you are still having high morning BG, you can consider replacing the evening Lantus shot with NPH. It is more effective in dealing with the DP and bridges the gap in Lantus action, at the same time.

The only problem with NPH is that its absorption and action is even more variable (about 30%) than Lantus is. But if you are just using small amounts, you should be a lot better off.

[JJM335]

Originally Posted by Penny

Hi Adam. If I get up between 5 and 6 hours, I am either very low or heading up. I have tried eating before I go to bed, doing some Novolog (this made a scary low.... So I need an answer to this problem too!

If you are routinely going low overnight you are taking too much Lantus. It's SOOO.. easy to get hooked onto the Lantus treadmill. Take too much L... BG drops overnight then rebounds...high in morning...increase L dose to correct.

You need to set your basal dose. Walsh (Using Insulin) explains how to do this very clearly. Eat your evening meal relatively early (i.e. at least 4+ hours before you go to bed to allow your Novorapid/Humalog to clear). Do not have anything more to eat. Measure your BG last thing at night. If you take your L before going to bed, do so. Set an alarm clock to wake you up 3-4 h later. Test your BG again. Test again when you wake. If your 2 or 3 am reading is lower than your bedtime your basal is too high (you are taking too much L). If your 2 am BG is low, you will probably rebound giving you a high number when you wake up in the morning.

The correct amount of L should give you a 2 am reading that is more or less the same as your bedtime. If it is lower, start reducing your bedtime L. The recommendation is to do this 2U at a time and wait a few days for it to settle down although I found that I could get away with 2 U a night on successive nights.

Once you have got near to a correct basal, give it a few days to settle down and test again. You may need to adjust it a bit. If you find that your bedtime and 2/3 am readings are the same but you are higher in the morning, you have dawn phenomenonon. This is a PIA, but splitting the L dose sometimes helps.

After years of TMFL this worked like a treat for me - I reduced my L dose by >30% and knocked my A1C way down. You should remember that if your basal is set "flat" you are now in complete control of the ship (as it were). If you miscalculate your bolus and shoot up to say 180/10 you don't have a big dose of Lantus circulating to drag you down - you will just stay there until you make a correction, so you need to test OFTEN.

[xMenace]

Given what I've learned about my basal patterns after pumping, I tend to bottom out at both 2's and peak at both 9's. The flatness of Lantus never lets me get my highs down at 9 without sending me low at 2. I don't think I'd ever go back to Lantus or Levemir. The humps in an NPH regimine suit me much better. I think I'd go for two of those a day.

[owlyn]

Originally Posted by JJM335

You need to set your basal dose. Walsh (Using Insulin) explains how to do this very clearly. Eat your evening meal relatively early (i.e. at least 4+ hours before you go to bed to allow your Novorapid/Humalog to clear). Do not have anything more to eat. Measure your BG last thing at night. If you take your L before going to bed, do so. Set an alarm clock to wake you up 3-4 h later. Test your BG again. Test again when you wake. If your 2 or 3 am reading is lower than your bedtime your basal is too high (you are taking too much L). If your 2 am BG is low, you will probably rebound giving you a high number when you wake up in the morning.

The correct amount of L should give you a 2 am reading that is more or less the same as your bedtime. If it is lower, start reducing your bedtime L. The recommendation is to do this 2U at a time and wait a few days for it to settle down although I found that I could get away with 2 U a night on successive nights.

What if you take your Lantus in the morning? I have problems when waking up- BG is usually too high. Endo had me increase the dosage by 4 units, but now it seems I get low a few hours later (almost like NPH), then the rest of the day is fine, until the morning, when it still seems I've run out of Lantus. I'm thinking I should split it, but I have no idea how. It seems to me that the overlap would cause a problem.