forgot to take NPH

dodo · #1 (**permalink**) 04-16-2008, 05:39 AM

Well, I don't know what I was thinking last night but I completely forgot to take my NPH last night.

So I woke up this morning with a BG of 20.1. Does someone know how I should deal with it so that my BGs won't be high all day? Thank you in advance!

shiftzor · #2 (**permalink**) 04-16-2008, 05:49 AM

My normal time for lantus is 7:00pm, however i did take it at 5:00am once, i guess you could take your shot now and stay up later tonight to test, maybe even leave yourself a bit high to ensure you don’t go low from the basal overlap. Or you could give yourself super boluses at each meal (i.e. more insulin than required) and keep correcting the highs.

I have never used NPH, I understand it behaves differently to lantus, I am sure someone with more experience could give you a better answer.

Emm · #3 (**permalink**) 04-16-2008, 06:22 AM

NPH is a 12 hour insulin, so if you're a full night past dosing time, it's too late - don't double up. You need to correct with your fast-acting insulin and keep a close eye on things.

Avoid carbs until you're back down to normal range again (easier said than done eh? If you're anything like me you crave carbs when high!).

Test LOTS!

Don't exercise until you're under 13mmol or so - you actually cause damage by exercising when you're high.

Do drink lots of water and get some rest though.

dodo · #4 (**permalink**) 04-16-2008, 06:03 PM

To be honest, I realized I forgot to take NPH when I saw my BG was 20 this morning. I took 10 units of Novorapid at breakfast for 38g of carbs (instead of 5) but my BG was at 11 at lunch so I took 12 units for 55g of carbs but my BG was 14.6 at dinner. But maybe it was the stress...

Thanks for your answers!

JediSkipdogg · #5 (**permalink**) 04-16-2008, 06:20 PM

Do you just take NPH once a day? In all my experiences I thought NPH was a 12 hour insulin (it lasts longer but dosing should overlap) and was meant to be taken twice a day.

RobiJo · #6 (**permalink**) 04-16-2008, 07:07 PM

NPH can be challenging to understand. It can last around 12 hours, but peaks (works hardest) sometime after hour 5-6. If you forget to take it, test often and correct with fast acting insulin until it's time to take your next NPH. Overlapping NPH with fast acting to correct a high bg could result in a drastic hypo when you least expect it.

Some folks use NPH for (and sometimes even in addition to their Lantus and Novolog) to help compat dawn phenomenon. Which is what I suspect if you are only taking it 1x day and your dose it at night.

nicole · #7 (**permalink**) 04-17-2008, 04:23 AM

Dominique,
I do that often with my Lantus.
What I do to help with that is first thing in the morning I test to see how high, then depending on my numbers I usually take my normal dose and add about 3-5 units on top of that. It helps me. But I don't know you may be different with how your body reacts. You may want to do that and drink lots of water to flush out any ketones if there are any. I know that NPH only lasts a little time, so you may have more issues with getting your numbers down. Lantus works 24 hours, so I don't wake up with extremely high numbers. The Lantus is amazing, it really does me wonders. Maybe try talking to your doc about changing then you wouldn't have to worry about your blood sugars being so high if you accidentally forgot to bolus.

dodo · #8 (**permalink**) 04-17-2008, 05:42 AM

I woke up this morning with a BG of 15 even though I took 17 units of NPH last night (I usually take 12). Yes I take it once a day but I'm thinking of spliting it today. Or maybe I should just take few units in the morning?

I have an appointment with a new endo April 28 and I'll ask about Lantus. I've been asking for it for months so hopefully this new doctor will prescribe it to me!

Thanks again for your help!

JediSkipdogg · #9 (**permalink**) 04-17-2008, 09:03 AM

Dodo, it's odd that you would go from NPH once a day to Lantus once a day. If you truely need Lantus, then you should be giving your NPH twice a day. Like I mentioned before, NPH lasts 12-16 hours and someone else mentioned the huge peak. It definitely does not last 24 hours and therefore to me it seems you are not getting all the insulin you need. I'd definitely bring up a new course of action at your next doctor appointment.

birdyland · #10 (**permalink**) 04-17-2008, 11:38 AM

If you took your NPH and are still high, sounds like there's something else going on???

I've upped my NPH and am still getting higher than 100 FBG.... I have a blocked salivary gland that is hurting worse at night. So for me, it's injury/sickness lately and I hope it's fixed soon.

nicole · #11 (**permalink**) 04-17-2008, 12:02 PM

I see there all saying you need to up your NPH, thats what we tried to do and it didn't work.

My doctor put me on the Lantus and it was like a whole new world for me.
Lantus is the ONLY 24 hour acting insulin. It tallks about it in a website I was just reading. (url=http://www.Lantus.com)So you just may want to check there. It says its specially for the control of high BS. Trust me, change to that and you'll notice a huge difference. Take it from me I know, I use it now.

shiftzor · #12 (**permalink**) 04-17-2008, 12:18 PM

Quote:

Originally Posted by nicole

I see there all saying you need to up your NPH, thats what we tried to do and it didn't work.

My doctor put me on the Lantus and it was like a whole new world for me.
Lantus is the ONLY 24 hour acting insulin. It tallks about it in a website I was just reading. (url=http://www.Lantus.com)So you just may want to check there. It says its specially for the control of high BS. Trust me, change to that and you'll notice a huge difference. Take it from me I know, I use it now.

Don't forget Levemir, its also a 24hour insulin, but i agree that Lantus would be a good move.

nicole · #13 (**permalink**) 04-17-2008, 12:19 PM

Hmm, I have never heard of Levimir.
Is that a newer insulin?

Alice · #14 (**permalink**) 04-17-2008, 01:02 PM

Taking NPH once a day is what the old (in my case...1960's) medical community thought was right...and they were very wrong. NPH & Lente are only intermediate acting insulins...but in the old days, they were considered "long acting" since that's all that existed.

Lantus would be a more modern insulin for you to take. It also eliminates that horrible peak that NPH/Lente contains. (Lantus doesn't have a peak, but it varies slightly and some call it a peak...more of a ripple...)

Lantus does have a 4-hour start up...so when it plateaus at 4 hours, some people will feel that level if they are taking too much...but that's not considered a peak.

Just info on what took me years to figure out!

dodo · #15 (**permalink**) 04-17-2008, 02:00 PM

[quote=Alice;325719]Taking NPH once a day is what the old (in my case...1960's) medical community thought was right...and they were very wrong.

I agree with you Alice! For 2 years I was seeing a doctor who was from the "old school" and I used to listen to him because he was the only reference I had (I don't know anybody who has diabetes). I started asking myself a lot of question when I became a member of this forum.

Now I moved to a new place. I'm seeing a great family doctor who reffered me to a diabetes clinic the first time I saw him!

This morning I tried 2 units of NPH with my usual 6 units of Novorapid and BG at lunchtime was 4.9 which is great considering the last few days it was 9.9, 11.9 and 13.6! So I am very happy!