We need delayed-onset insulin!

[mentat]

Problem: Some people on MDI have a huge liver dump at, say, 4am, and there's not much they can do about it.

Solution: A new type of insulin you inject at (say) 10pm which starts acting from about 4am to about 8am. In other words, an insulin with a delayed onset of about 6 hours and period of activity of around 4 hours.

People would still take their regular long-acting, but could additionally take the delayed-onset insulin specifically to target the liver dump (just like we take boluses specifically to target meals). The dosage could be changed based on the severity of the liver dump. For people with a predictable liver dump, this insulin could be pre-mixed with their basal so they don't need to do an extra injection.

If someone gets their liver dump earlier (or later) they can simply take the delayed-onset insulin earlier (or later).

Would this be useful to you? Maybe if we make some noise someone will do some research into this.

 

[GrantGam]

Problem: Some people on MDI have a huge liver dump at, say, 4am, and there's not much they can do about it.

Solution: A new type of insulin you inject at (say) 10pm which starts acting from about 4am to about 8am. In other words, an insulin with a delayed onset of about 6 hours and period of activity of around 4 hours.

People would still take their regular long-acting, but could additionally take the delayed-onset insulin specifically to target the liver dump (just like we take boluses specifically to target meals). The dosage could be changed based on the severity of the liver dump. For people with a predictable liver dump, this insulin could be pre-mixed with their basal so they don't need to do an extra injection.

If someone gets their liver dump earlier (or later) they can simply take the delayed-onset insulin earlier (or later).

Would this be useful to you? Maybe if we make some noise someone will do some research into this.

I think NPH insulin taken in the evening matches almost all of the prerequisites that you've mentioned.

The best approach to gain the cover you desire, as outlined in Think Like A Pancreas, incorporates the typical basal/bolus regime but with the addition of NPH in the evening instead of a basal insulin. So it would look something like this:

Morning: basal insulin
Breakfast: bolus insulin
Lunch: bolus insulin
Dinner: bolus insulin
Evening: NPH insulin

The evening dose of NPH insulin can also be adjusted based on changes in your typical routine that may change your overnight BG levels - such as periods of illness, heavy bouts of exercise, stress, etc.

Hope that makes some sense? I'd love to show you the explanation in the book but I'd imagine that it's copyright protected.

 

[mentat]

Interesting! I'm rather unfamiliar with NPH for some reason.

Still, I think there's scope for research in this area as DP is such a common problem...

 

[NinaB73]

I am currently on MDI and have been reading Think like a Pancreas' I used to take Humalin (NPH) at split doses but have actually just switched to Lantus again as Humalin does help with DP but for me I had to get past the peak at 2-3am first!! I have spent years hypo'ing at night hence trying Lantus again which has helped with daytime control and night hypos but not particularly DP. One of the options in Think Like a pancreas is to take Lantus during the day, rapid action as a bolus and an NPH at night, obviously this is a very individual treatment but having a fridge full of insulin I thought I'd give it a go! So took my usual Lantus am and daily routine as usual and just for a trial took Humalin 3units at bedtime, my levels were in fact lower in the morning but this is still in trial mode for me!!! I did however find I was lower all morning so a tweek of rapid on my part would be required. I am not suggesting anyone experiment without help from their healthcare team if they are having trouble but personally I felt confident enough to try. So in answer to @mentat proposition, sounds great!! On Humalin I almost needed to take it at midnight to get the benefits on the DP and most of the time couldn't stay up that late!