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Question:

From Toronto, Ontario, Canada:

I am 21 year olds, have type 1 diabetes diagnosed years ago, and I have pretty much been taking the same amount of insulin (56 units of NPH with 4 units of Regular) in the morning and (16 NPH with 4 units of Regular) at dinner, but I have recently changed over to a regimen of 2-6 units of Humalog in the morning, before lunch, before dinner, and at bedtime. Since my readings have been pretty much all over the place, I was wondering if taking some NPH in the morning would help my blood readings come down in the evening. I was also wondering if Humalog is supposed to be taken alone all together?

Answer:

Your questions are insightful. First, when we started gaining more experience with Humalog insulin, it was evident that in switching over to this insulin from Regular, more NPH had to be given to counteract the shorter duration of action of the lispro (Humalog). It may be helpful to add more NPH insulin.

Second, several clinical studies have shown that the activity of the Humalog is not changed a great deal if it is given with NPH, although that is not the case if you mix it with other long-acting insulins.

As always, I request that you speak with your physician before making any changes in your treatment regimen.

JTL

[Editor's comment: You are on the right track, but I do see several problems that need to be addressed with your diabetes team:

  1. Previously, you were on a total of 80 units of insulin per day, and now it appears that your maximum dose is 24 units which is only about 30% of what you were taking before. Clearly, this is probably not enough insulin.
  2. It is unclear as to whether you are only taking four injections of Humalog or if you are also taking some NPH (or other long-acting insulin). If you are not currently using any long-acting insulin, I would suggest that you speak with your diabetes team about using a basal insulin such as Lantus (insulin glargine) at night. Using four injections of Humalog alone will not provide adequate coverage, as Dr Lane has already suggested.
  3. You do not say how you determine your pre-meal Humalog dose. On a basal/bolus insulin regimen, the premeal bolus should be determined by using a system of carbohydrate counting and a correction factor for a premeal blood sugar which is too high or too low.
  4. It is essential to do frequent blood glucose monitoring (pre-meal and two-hour post-meal) to establish appropriate insulin/carb ratios for food intake.
It is evident that you have a lot of questions about your new regimen and about how to use it appropriately. As Dr Lane has said, I also suggest that you discuss this in great detail with your diabetes team. You might even want to consider use of an insulin pump (See Is pumping for you?.)

You might also find the book Stop the Rollercoaster by John Walsh and Pat Roberts to be a very useful tool. SS]

DTQ-20020110005915
Original posting 16 Jan 2002
Posted to Insulin

  
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Last Updated: Tuesday April 06, 2010 15:09:30
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