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Question:

From Vermont, USA:

I am switching from a regimen of N and R (morning) plus N and R (dinner) to one of U and R (morning) plus R (lunch) plus U and R (dinner). I will be taking less U than N. Is there a difference in the strength of U compared to N? Could there be any other reason for the difference in dosage?

Answer:

Usually when patients take Ultralente twice daily with Regular and/or lispro insulin [Humalog® brand] before meals, the total amount of Ultralente is less than the total amount of NPH given with a twice daily plan of Regular plus NPH.

The goal of the Ultralente routine is to more closely mimic the way the body makes insulin. Normally approximately half the amount of insulin made by the body in a person without diabetes is used by the body to keep the blood sugar normal when the person is not eating. This is called "basal" insulin requirements. The pancreas is then supposed to make extra insulin whenever the person eats to keep the blood sugar normal. When Ultralente is given twice daily, it is supposed to provide the "basal" insulin requirements. The regular and/or Humalog is supposed to provide the insulin needed with breakfast, lunch, and supper.

When you give Regular and NPH twice daily, the morning NPH is supposed to provide both the insulin you need for lunch (and carries over and provides some of the insulin you need for supper)and is also supposed to provide the basal insulin requirement along with the evening NPH.

In any regimen, you first have to start with a dose that you think will work based on your previous insulin requirement and based on average requirements of others using this regimen. Then you must "fine tune" the insulin regimen based on your blood sugar response.

TGL

Original posting 2 Nov 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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