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Nph treatment schedule

O

Opossum

Member
Messages
19
Type of diabetes
Parent
Treatment type
Insulin
Could someone comment ours or share their schedule if you are on treatment with nph (isophane, humulin n).

My daughter gets humulin r and humulin n @7:00 am
7:30 first breakfast
9:30 second breakfast
11:00 fruit
13:00 lunch
16:00 fruit or snack
18:30 humulin r
19:00 dinner
21:30 humulin n and eventual snack

Issues I am having with this schedule are:
- breakfast normally peaks @9:00am at around 13mmol/l - is this too much considering 1.5 hrs are past first breakfast. She is not below 9 when starting second breakfast
- @11:00 glucose level is steeply going down. That is 4 hrs after insulins. Nph should not be as effective yet
- after lunch she often can not get her levels down (e.g stuck at 13 mmol/l) as if nph is depleted. For that reason she often skips her fruit/snack and does not eat until dinner.
Diabetitian considers these things as normal, but that does not fit our plan to have <9 2 hrs after eating. And there are too many high afternoons where average is around 10mmol/l.
Also she advises we should reduce nph to avoid low levels before lunch as it creates rebound after lunch.

Her last hba1c was 6.9

Advices will be appreciated.
 
13 is a bit high. Are you carb counting for her meals?
 
Yes. We are carb counting from day one. Using freestyle libre, therefore i see those highs just after eating. I asked doc, but she seems to not care about any readings inside 2 hours after lunch.

It has been two years after her diagnosis and I don't think there were more than few days that my daughter was whole day below 10. There are always some peaks. Is there anyone that manages to be on nph therapy and avoid those peaks?
 
If she's always too high two hours after eating, you may need to reduce the carbs for the meals she goes high after. You could also increase the insulin but you should ask for help from her doctor before you do that.

If you're finding it hard to get good control, ask about swapping to a basal/bolus regime.
 
In the morning, she's having quite a few meals/snacks in a short time. If she's high before 2nd breakfast, she could reduce the carbs for that meal so she doesn't go higher.

When I was on a similar insulin regime, I had breakfast, mid morning snack, lunch, mid afternoon snack, evening meal, bedtime snack. I timed my snacks for when my blood sugar started to drop.
 
Is there a reason a young T1 diabetic is on NPH and not Lantus or something longer acting for basal? I tried NPH when I first got diabetes and it didn't work for me. My impression is you have to eat about the same things at the same times every day to make it work. And most people on this forum use Novorapid or Humulog for short acting. Humulin R lasts a couple hours longer and takes longer to start working as I recall.
 
She is going to kindergarten and having lunch there. This treatment was presented to us as best to avoid need for insulin shot before lunch, as we should not expect kindergarten employees to administer shots.
And yes, this treatment is intended to have constant schedule and food amounts, but we are unable to hit sweet spot, especially after last time she was ill.
 

If the schedule suits her then that's all that's important

Not everyone likes or,wants a basal/bolus regime. The important thing is good control.
 

Different insulins suit different people. We all have our preferences

The analogue insulins don't suit everybody and some people have particular ones they like or dislike.
 
OK that makes sense. When ill insulin needs and BS readings increase. You didn't let on how long she's been diabetic. I imagine this insulin regimen will take some fine tuning to make it even out. What times to take insulin, what time(2) to eat etc. I mean between 7:30 and 1pm she eats 4 different times/meals. That's a lot of moving parts for a 5 year old. In schools here a nurse or aide can give kids insulin shots. I realize that grade schools there probably don't have nurses (we don't either now days) but someone should have some healthcare training. I remember one of my friends used to go by his kids' school and give him his shot.
 
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She was ill two weeks ago, therefore I expected to normalize, but it is still not back. Also, she has been diabetic two years now and I have never been completely satisfied.
I asked for treatment change and I was offered levemir+humulinR. I am unable to assess whether this is a way to go, but she ends her kindergarten in two months time
 
Levemir is much longer acting than N, but I hear many need to split it into 2 doses. HumulinR lasts roughly 6 hours, peaks roughly 2-3 hrs. When I took that I tried to take it maybe 1/2 hr before I ate. I like the shorter acting Humulog/Novorapid better because I take those right after I eat. Sometimes I'd take XX units before my food came and wouldn't eat it all or it would contain stuff I didn't plan on when I took it.
 

There are pros and cons of each regime @Opossum I have an insulin pump now and I'm very happy with it, but when I was on a basal/bolus injection regime, sometimes I did wish I could go back to two injections a day.

Would a pump be available to your daughter?
 
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