NPH or Lantus???

[iluvmhp]

We are currently on NHP and Humalog. Dx 2/21/08. Just turned 9. Numbers are all over the place, but mostly high. Dr. mentioned he would move us to Lantus "eventually". We were started on NPH in the hospital and then sent to the pediatric edno.

Based on what I have seen on this board, I asked them today if we could move to Lantus sooner than later and they said sure. They said it made sense, but it would take more training on carb counting.

Now that I have started the ball rolling . . .was it a good idea? Are there any reasons, besides fewer injections with NPH, to stay on NPH? For those of you who started on NPH and switched to Lantus are you happy?

Thanks for the feedback

[Boo]

We used NPH for almost 3 years. IMHO, the main advantage of NPH is fewer injections. Another slight advantage is that it allows for a small bit of "uncovered" grazing.

To me those benefits are outweighed by the big negative of an irregular peak. I think you made the right choice.

[Pauji5]

we've used NPH for the first 2 months (it's been almost 4 months since she was diagnosed). She had SOOOOO many lows. We switched to Levimir and what an improvement! For her, it was the best thing (for now........)

[liasmommy2000]

We found Lantus to be a big improvement over NPH in many ways.

That said I'm glad we started out on NPH as it made the first few weeks easier. Lia fought the injections tooth and nail so it took two of us to hold her down. Any more injections the first few week would have been the death of me I'm sure lol. Also since her school does not have a nurse it made getting things set up for school much easier in such a stressful time.

Lia was on NPH for six months. I tried after three months to convince the endo to switch her but he wanted us to try it longer. I wish we had convinced him sooner, but I am glad she was on it in the very beginning. Our problems with it we're the strict schedule and unpredictable peak time etc. Also our personal schedule as far as work and child care in the AM made it difficult. Lantus took those problems away. But it too is not perfect, at least when you have a very insulin sensitive child. Lia was still honeymooning on Lantus and her I:C ratio was 1:60 so we still had problems with accurate dosages that only the pump solved (though her honeymoon literally ended the week before pump start!).

I think it's so individual which insulin to use and for how long, what combination etc. Ideally for us, Lia would have only stayed on it for about two months and then switched.

[dbz2988]

Jr was on NPH & Humalog when he first started but was switched to Lantus and Novolog last July (4 months after diagnosis). We loved the switch because he wasn't on such a strick "this many carbs for breakfast, this many carbs for lunch, etc...." diet. There is more flexability, so if we want Pizza Hut and he wants 3 pieces, he can have it.

[AlisonKS]

Tony was switched from lantus to nph at one point, no matter what we tried it seemed to last too long, but he's a little guy. Now we're back on lantus and doing great, I like how it doesn't have a scary peak!

[twodoor2]

I think a picture is worth a thousand words. BTW, glargine is the medical name for Lantus.

http://upload.wikimedia.org/wikipedia/en/4/44/Glargine_02a.jpg

[Jeff]

The science supporting the use of Lantus vs. NPH is pretty compelling. See #2 at:

http://www.childrenwithdiabetes.com/clinic/care.htm

The dose response variability of NPH causes no end of trouble in kids.

[iluvmhp]

I am sure lantus will not be the answer to everything, but it sure sounds like my daughter will have more freedom. Believe it or not one of her biggest complaints in not being able to sleep in a little on the weekend. I think she would take an extra shot everyday of the week, if it meant she could sleep in an extra hour on Saturday am. (cant imagine what the teenage years are going to be like with her ;)_
thanks for all the information
susan

[twodoor2]

Elizabeth did really well with Lantus, but the extra injections were a downside, she had as many as 7 injections a day. Now we use the pump with Lantus, and we're really happy since it takes away the inconvenience and pain of all those injections. We still give the once a day injection of Lantus, but it's a small price to pay for the control we have. We did NPH in the beginning as well and I didn't care for it. A major contributor to this board, Wilf, gives his daughter NPH, and it works very well for her lifestyle. He'll probably chime in here later since he's an advocate of NPH.

You see that huge peak in the diagram I posted? If you give multiple small doses of NPH a day, like Wilf does, the peaks are smaller and overlap, and so the lows are not as pronounced. However, most endocrinologists in the U.S. prescribe only two large injections of NPH, and that can cause hypoglycemia. I'm not sure what country you live in, but depending where you are, they might prescribe NPH a bit differently.

[iluvmhp]

I live in sunny Florida and see a pediatric endo from Nemours children's hospital. Her dose is twice a day with Humalog as needed for lunch and at bedtime. Many days she has had just two injections, but we have only been doing this since 2/21 ;)

She hasnt experienced too many lows yet, only a few, but I think we would like the flexibility more. I just hope the number of injections doesnt drastically increase. do you have to take a dose for a snack? or is it based on bg level

[twodoor2]

I live in sunny Florida and see a pediatric endo from Nemours children's hospital. Her dose is twice a day with Humalog as needed for lunch and at bedtime. Many days she has had just two injections, but we have only been doing this since 2/21 ;)

She hasnt experienced too many lows yet, only a few, but I think we would like the flexibility more. I just hope the number of injections doesnt drastically increase. do you have to take a dose for a snack? or is it based on bg level

There are tradeoffs, NPH has less injections, but Lantus provides more control (not for everyone though), and more flexibility with eating. If you're a person that is used to grazing or eating a fixed amount of carbs everyday, and you don't get much hypoglycemia, then NPH is probably a good choice. If you want more meal flexibility, then Lantus or Levemir are probably a good options, unless you go on a pump. The real downside to Lantus and Levemir is that there are sometimes many more shots. Unless you are honeymooning to the tilt, then you will probably need a shot with every morsel of carb you put into your mouth.

There are ways to use Lantus to avoid a shot with each carb snack by using a very small carb ratio (a divisor used to calculate the bolus insulin) to cover one meal, so the dose will be so large that it will be able to cover a small snack two hours later. The smaller the carb ratio, the larger the dose of insulin. However, this can be dangerous if you're not careful, and it involves knowledge of something called "bolus on board" and "duration of insulin action." I do not advocate this, but some people on this board do this with success.

[Judy&Alli]

When they switched my daughter to Lantus it was the best! She was one of those kids that could not handle the peak of NPH. No matter what the dosage was she crashed at noon EVERY day! Some very scary hypoglycemic events. Since the switch we have not seen hypo's like that. Don't get me wrong we have had our share of hypo's but nothing like the NPH days.

As far as snacking does your child get any "free snacks"? Alli had free snacks just til a short while ago. Now that she doesn't get any free snacks we are switching her to the pump. This will give her more freedom and no shots for snacks.

I wish you the very best of luck with the Lantus. It is a really great drug and as long as you get the correct dosage you will love it too! Keep us posted how it goes for you.

If you have free snacks you should only have 4 injections a day. I know its a big jump from two. But the payoff for us was better control and many less hypo's.
Judy:)

[wilf]

NPH is not a bad insulin for people just after diagnosis, especially if they get some training in how to use it. Unfortunately that is all too often not the case - sounds like it for you too.

I am not sure why your daughter shouldn't sleep in - has she had high BG numbers when waking? If she hasn't why not let her sleep in, and eat lunch a bit later?

We have been using NPH during the day for more than 1 1/2 years, and it works well for us. But we know how to use it.

The switch to Lantus will for sure mean more injections. A minimum of 4 per day. Plus learning to count carbs - but this is something that you'll need to do sooner or later anyways.

You might want to consider using Lantus (or Levemir) for your basal so you don't need to worry about night-time lows, but keeping on with the NPH so you don't need to do a lunch-time injection on school days. This is our way of using NPH, and it has served us well for 1 1/2 years.

[Bsbllmom]

We used NPH for the first 8 months and I liked it. It helped me learn carb counting. We actually used choices then and we could go 5 carbs higher or lower. Then like a pp said you had uncovered snacks, but you had to have them because of the peaks in NPH.

We moved on to Lantus and I like it better but glad that we started on NPH. With Lantus you don't have to be on a rigid schedule so there is a little more freedom with it. You have to count every single carb to make sure it is covered with your fast acting. I am glad we made the switch though.