Blog Entries With Tag: NPH


Posted: Oct 5, 2012

circa 70's - can you figure out where I am?

I am not sure if my memories of being a diabetic in grade school are wiped clean due to DKA that I had in my teens - but all I know is - my memories of growing up with diabetes under the age of 12 - sadly are pretty vague - only pictures and the few journals I keep jog my memory abit more.  I remember things from time to time, like summer time at the park across my street, where we had activities that kept us kids out of trouble (e.g. a ride from the west end of Ottawa to the Parliament Hills).  Did I have problems with hypos on that ride?  I have no idea.  I'm sure my Mum packed extra goodies for that day trip, but all I know is, that I had fun (or at least the little snippets I remember - were fun - except for cycling up hills ).

This blog has come to light after reading Steve's blog about being a father of not just one, but two Type 1 diabetic children.  Reading how their lives have been affected has made me wonder ... how it was for my own parents.  They've never really talked much to me about it, I just know that in those days (I was diagnosed in the 60's) - most of the child rearing went to the Mum who generally stayed at home while the Dad worked.  I'm not sure what age I was when my Mum started working again, but I just remember going to hospital visits for my diabetes by myself (being dropped off by my Dad as it was abit of a bus ride and very early in the morning - then I'd bus back later in the afternoon).  I guess my parents made me very independent at a younger age then most kids are these days (e.g. Mum's taxi service). l I sometimes think that they had too much trust in me, which ultimately lead to my having DKA in the end. 

One thing that came to my noggin' the other day as I was driving back from the boat (mast is now down - sigh - sailing over for this year) - I don't recall going to many birthday parties.  Was it because of my Mum being worried about the foods or an overnight sleep over going out of control because of my diabetes?  I know sometimes I used to feel abit left out that friends around me would be going to parties - because I'd hear about them at school on the following Monday about their goody bags, etc.  I'm not even sure if I felt abit envious - that I - the diabetic child wasn't invited.  We're those parents holding the parties scared of having a diabetic child at a birthday party or sleep over?


I know one of the best parties that I still have vague memories of, perhaps when I was 8 or 9 - was going to an Italian restaurant ... that served all of us "ladies”.... Shirley Temples (made from ginger ale / grenadine / garnished with SWEET marishino cherries).  Ehgads, these are sugar loaded - and I remembered sucking back on a few of those, along with munching on those cherries.  I felt like such an adult - drinking something from the bar!!    There was no going back at that point - as I was introduced to foods that I'd never had before at home - though again - no recollection of what I chomped down on - but for myself - it is something that stays in my mind as a good memory.

Remember, I was only on 1 shot of insulin a day of NPH  (an intermediate insulin that takes 3 to 4 hours to work - maximum effect is between 4 and 8 hours, and stops working after about 18 to 28 hours).  My one day a shot (in the morning before heading off to school) was based on an a diet set up by the dietician at my local hospital based on my needs and insulin dosage.

All I can say is, thinking back, my blood sugars if there was home testing available in those days would have probably been sky rocket with all the sugar / carbs consumed in that birthday meal - yum! yum!  I don't even recall if perhaps my Mum had at least had me do a urine test to see where I stood, but then, would a correciton dosage been done if a faster insulin was available then?  You just made do with that 1 shot of what I lovingly call "juice of life" a day and tested your urine for level of sugar and / or ketones (all of which are now done with convenient strips rather than my test tube days).

So, with today's parents - I'm not sure how it would be handled going to a party like this.  I'd like to think that if I had all the technology at hand like I do now, I would just do what I do with testing my blood sugar, adjust my insulin dosage, and LIVE! I mean having diabetes doesn't have to stop you from enjoying life to the fullest - or does it?


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Posted: Aug 23, 2010

I belong to a few D-OC (diabetic online communites) and one of my first ones I joined up to is Tudiabetes. I have made many friendships with other PWD's (people with diabetes) - and one of those is Danny, who has posted blog here occassionally at Diabetes1.org and recently posted a great discussion about Diabetes Timeline . I'm afraid my contribution is pretty lame, since I have never kept a diary of my years of having diabetes, but some of the other entries are very good and well worth reading.  Take a gander at what I had posted in the discussion - and maybe you'll want to saunter over to Tudiabetes to either join up or if you are a member there - perhaps place you own timeline story.

---------------------------------
This is tough – as I’ve never really kept a written record of my diabetes (have been reading some of yours - and they are so accurate - I feel like such a dumb dumb putting my contribution in here - as it's not very accurate). Anyway, I just had diabetes – and lived with it – and never started to “analyze” it until joining up to the D-OC believe it or not (and any diaries I’ve come across make no mention of diabetes – just usual girl stuff, my gerbils, where to stuff the mess in my bedroom to please my clean freak Mum, etc.).

Girl eating hood by witness4HIM at Photobucket1966-1967 – Age 6 – not well those years – chicken pox – losing weight – bed wetting (made parents VERY angry) – just remember being in the old farts section of hospital (diabetic children were under 1% of diabetic population in those days – much greater now). Spent 2 weeks while they figured out what to give to me. Don’t ask me what my insulin was – something made of oink, oink – I know I used NPH (cloudy insulin). No A1C’s in those days as well.
1968-1971 – Urine testing, being a kid, giving once a day shots. Being a kid.
1972-1974 – I went to Camp Banting – diabetic camp – that was so much fun – did this for 3 years. Wanted to be a camp counselor but that never happened due to my eventually getting 2 part time jobs.
1975 - DKA – coma for 3 days – had been ill for about a year with “flu” - I think that year I was maybe in denial of diabetes, hanging around the Pop Shop (great drinks - SUGAR) - and the Candy Shop (more SUGAR ). Was flubbing urine tests with water at home (duhhhh), doctors knew something was up with blood work when I went to hospital for check up every "x" amount of months ( A1C’s were available then - but due to going to check ups alone I never asked - and if you wonder where my Mum was - she was working - I was left to handle my diabetes daily control since age of 10). Anyway, Mum got into a lot of $#@! for allowing me to be this way – but wasn’t her fault really. She allowed me complete control of my diabetes – I knew I was doing things wrong – case closed. Oh, went back to ER a few weeks after getting out of hospital due to eating a roll of life savers. I really was silly wasn’t I?
1976 – 1979 – High school years – I think I was still on one injection a day – still urine testing. Again, I just did my diabetic thing like a good soldier, did the teenager thing, busy with school/work/partying – just like any other normal kid
1980-1989 – Work / quit job / went back to live in England / worked/drank beer – used glass syringe/needle meant for elephant behind / came back to Canada/ work / partying (got into drugs / alcohol / rock ‘n roll) / used Medi-Injector for awhile – but got fed up with that after awhile. No memory really of what insulin(s) I used, etc. Just did what I had to do to stay alive and kicking. Started to use a HUGE blood meter then (husband remembers this).

Adult woman on motorcycle by Macha5499 at Photobucket

1990 - 2010 – Moved to Montreal – worked / traveled / worked / bought house / settled down / started to take more notice of A1C’s at around 2000 – was usually 7% - which now that I know more about this – wasn’t bad for someone who doesn’t keep a log, etc. Again, don’t ask me which insulin’s I used, maybe HumilinR, I know for sure Lantus, NovoRapid later on. Went onto pump back in 2008 just for the heck of it, after using the poor man’s pump method (MDI). I now am back on MDI – since doing an “experiment” to see if control is as good as pump (lowest A1C I had on pump was 5.6%). Since being on MDI, my A1C has remained at 5.9% - and am happy with it (while doing MDI experiment – have used Levmir – but react in strange way to it which has been reported to NovoNordisk who claim they’ve never heard of this problem) – now back on Lantus / NovoRapid.

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Posted: Aug 4, 2008

Here's the thing.  You need long-acting insulin.  You are uninsured.  You have limited funds.  You can’t afford Lantus or Levemir.  What can you do?

 

Well, I’m happy to say, from experience, you can safely use NPH insulin which you can buy from Walmart for $22 without a prescription.  It wouldn’t be my first choice but it can be done and it can be done safely.  So your next question is, how?

 

  • Use small doses
  • Use three injections approximately eight hours apart
  • NPH has a peak so carefully work the peak into your eating schedule.   

What Doesn’t Work?

 NPH insulin used to be given in large doses once or twice a day which coincided with meals.  But then you had to eat the same amount of food at the same time every day without variance or you had some dramatic high or low blood sugar effects.  From years of experience, most of us NPH veterans can tell you the technique doesn’t work very well, isn’t very flexible and does not lead to good blood sugar control. 

What Can Work?

 Use NPH only as a background insulin as a substitute for Lantus or Levemir.  

 

What can safely work is to take the total amount of insulin you need (figuring that out I’ll save for another day) and divide it by three.  Determine when NPH peaks for you; in small doses that is likely to be four to six hours.  Position the peaks to coincide with your normal meal times or when you need a bit more insulin working, such as first thing in the morning to counter dawn phenomenon.  Subtract to figure out when you should inject to properly coincide with your needs. 

 

Example:        For you NPH peaks in six hours.  You eat at 5:00 p.m.  Take your insulin around 12 p.m. so the NPH will peak around 6 p.m. when your food is digesting.  You’ll offset the NPH with Regular and/or a rapid-acting insulin (again another story) but you won’t have a huge low when the NPH peaks because you’ve used a much smaller dose and it crosses a need for more insulin anyway. 

 

One note … many insulin products tend to last longer in larger doses.  Thus, the smaller the dose the sooner it tends to peak.  This can apply to any long, intermediate or rapid acting insulin product. 

What Do I Do? 

 I was using Lente (a bit longer acting than NPH) up until last year.  I switched to Levemir because they discontinued Lente.  Turns out for $116 per bottle, Levemir only gets me about 8 hours of solid working time and it still has a peak!  I get no more duration than Lente did for $30 a bottle but has a slightly delayed peak. 

 

So, using two shots a day, I either had to supplement the approximately four hour gaps or go to three doses a day.  I chose to experiment with three doses a day.  I didn’t want to take, nor did I think I needed, more total insulin; I just needed more coverage time.  So I took the 8 units I was taking and divided it by 3.  That got me 3, 2 ½ and 2 ½ units.  That works well.  I take 3 units at 7 a.m., 2 ½ units at 3 p.m. and 2 ½ units at 11 p.m.  I take the extra ½ unit in the morning to cover any insulin resistance from dawn phenomenon.   

Another Tip

Most practitioners tend to tell patients to inject in their stomachs.  For a variety of reasons, I have never used my stomach.  I use my arms and my behind.  I use my arms when I want a speedier absorption or when I'm in public and my behind when I want to slow it down, it doesn't matter or I'm at home.  So, normally, I use my behind for my long-acting insulin.  No reason to speed up long-acting insulin as I see it.  And after more than 31 years, I have no scar tissue on my behind to hinder absorption.  No lumps, no bumps, no scar tissue – seems like a win-win to me. 

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