NPH vs LANTUS

[twodoor2]

What is the main difference between these two forms of long lasting insulin?

[nebby3]

NPH only lasts 4-6 hours. It has a strong peak and is usually used to cover lunch so that a shot is not needed then. You do have to have NPH twoce a day though plus short-acting insulin for some meals. Lantus is supposed to last 24 hours so you get it only once a day (some people find it works better to split it into 2 doses though) but you need a short-acting insulin to cover all meals and snacks. Lantus lasts longer and has a much milder peak than NPH.

[twodoor2]

Does Lantus come in a pen device for children? What short acting insulins are usually used with Lantus?

[Kaylee's Mommy]

yes, lantus comes in a pen for kids.. Kaylee was using novalog with her lantus, she now uses novalog in her insulin pump.. there is also huma-log (not sure if I've spelt that right) .. and I think there is one more rapid acting insulin.. but not sure what the difference is.. I believe novalog and humalog are the same thing, just different 'brands' and may react a little different in people..

[wilf]

What is the main difference between these two forms of long lasting insulin?

NPH has a definite peak in terms of effectiveness (typically 3-5 hours after injection for smaller doses), and can be used to cover lunch in schoolchildren. It does not stay in the system nearly as long as Lantus.

For the adventurous, NPH can also be used to cover longer periods of "grazing" for children who are so inclined. In Europe, one is taught how to "play with" the NPH, and in combination with Regular and NovoRapid one can have a multi-faceted insulin injection regimen that rivals a pump for effectiveness.

Unfortunately, the medical community in North America in my view often mismanages the application of NPH. It is far too common for almost all of the NPH to be given in one huge injection, which then has a profound, unpredictable and dramatic peak many hours later during which lots of carbs have to be consumed to prevent a low.

If the NPH is broken into smaller lots and given throughout the day then this can be prevented. We typically give 40% at the breakfast injection, 30% after school, 5% at supper, and 25% at bedtime to get a pretty smooth basal coverage through the day. Plus the NPH covers lunch. Bolus injections of either NovoRapid or Regular cover the other meals.

Lantus is a much "smoother" and longer lasting (24-hour) basal insulin, and while it seems to have a peak it is not nearly as pronounced as the peak you see with NPH. Lantus can not be used to cover meals, that has to be done with bolus injections.

Lantus can cause problems for children involved in very strenuous sports (they'll tend to go low cause the Lantus just keeps working..). With NPH, if its broken up the way we do it then you can skip an injection or scale it down if you know heavy sports are coming.

My sense is that most D families prefer Lantus, but as said I think that may be at least in part because the medical community in North America doesn't really understand how best to use it..

[ScottB]

To my knowledge novalog and humalog are the 2 most commonly used fast acting insulins used with lantus. I don't know what the diff is between the 2 nor do I know what is the determining factor in which one an endo will recommend. Our son is currently using lantus and humalog.

[Nelson]

Novolog is a Novo Nordisc rapid insulin anolog while Humolog is an almost identical product by Elli Lilly. Once company produces the insulin in genetically modified E. Coli and the other produces the insulin an genetically modified yeast. Both are normally thought to be pretty much interchangable, although I have heard rumor that Humolog may cause more clogging problems with pump infusion sets. Apidra is a newer rapid insulin produced by the same people that produce Lantus. It has not yet been approved for children and apparently lingers less long in the body than Humolog or Novolog for most people and is somewhat faster acting in some people, especially heavy people that struggle with insulin resistance.

[Heather(CA)]

NPH's effectiveness lasts 10 to 12, with a peak at about 4 to 5 hours so that you can avoid a lunch shot. On NPH you have to eat on a schedule...NOT fun, Also, on NPH a child with D will need to have snacks, for example, one at the morning break during school and another one after school. We had pretty good control on NPH, Seth was on it for 2 years until he learned how to give himself a shot, and was tired of having to eat snacks...He was never on NPH at night, always Lantus at night.

So he had NPH/Novolog in the morning and Lantus/Novolog at dinner.

Lantus is supposed to last about 24 hours, it doesn't for everyone. In about 20% of cases it has small peak. The goal is to have it work to keep them within 40 points when there is no fastacting working...IMHO it works best when given in the bootie as the bootie is a slow absorbtion site. With exercise, a snack w/o insulin is needed to keep them from going low. On Lantus you don't have to eat on a schedule, but you do need a shot for every meal. We love Lantus, for us there is no peak and it works at least 24 hours.:D I hope this helps..

[miss_behave]

The best thing about Lantus vs NPH is that you can eat whatever you want, whenever you want, and just dose for the carbs. No meal plans, no set carbs, no HAVING to eat because of the nasty peaks.

[Caynuns mom]

NPH has a definite peak in terms of effectiveness (typically 3-5 hours after injection for smaller doses), and can be used to cover lunch in schoolchildren. It does not stay in the system nearly as long as Lantus.

For the adventurous, NPH can also be used to cover longer periods of "grazing" for children who are so inclined. In Europe, one is taught how to "play with" the NPH, and in combination with Regular and NovoRapid one can have a multi-faceted insulin injection regimen that rivals a pump for effectiveness.

Unfortunately, the medical community in North America in my view often mismanages the application of NPH. It is far too common for almost all of the NPH to be given in one huge injection, which then has a profound, unpredictable and dramatic peak many hours later during which lots of carbs have to be consumed to prevent a low.

If the NPH is broken into smaller lots and given throughout the day then this can be prevented. We typically give 40% at the breakfast injection, 30% after school, 5% at supper, and 25% at bedtime to get a pretty smooth basal coverage through the day. Plus the NPH covers lunch. Bolus injections of either NovoRapid or Regular cover the other meals.

Lantus is a much "smoother" and longer lasting (24-hour) basal insulin, and while it seems to have a peak it is not nearly as pronounced as the peak you see with NPH. Lantus can not be used to cover meals, that has to be done with bolus injections.

Lantus can cause problems for children involved in very strenuous sports (they'll tend to go low cause the Lantus just keeps working..). With NPH, if its broken up the way we do it then you can skip an injection or scale it down if you know heavy sports are coming.

My sense is that most D families prefer Lantus, but as said I think that may be at least in part because the medical community in North America doesn't really understand how best to use it..

Yeah to my Endo then! he gets it! He told us that when Caynun starts eating more regular instead of grazing we will be splitting up his NPH throughout the day. He's currently on 22 units in the AM its a big dose for him. he was starting to feel it so I give 1/2 then give the other 1/2 in a different location so he dosent feel the weight of it all in one spot. Its better absorbtion.

[OneTwinWithJD]

I am pretty new to this and though I have read about the differences at this point of the morning the main thing I remember is that Lantus had NO PEAK.

Devin is 2 1/2 and diagnosed a little over a month ago. He is "Honeymooning" so he is on REALLY small doses of insulin at this time.
They started him on NPH (Novolin N) and Novolog. I felt like I was feeding the insulin. He would go low (Like 30-40ish) at least twice a day. His Endo would NOT change him to Lantus so we changed Dr's. The new DR sent us home with a bottle of Lantus and agreed he definatly needed to be on that in the first place. Two year olds are too unpredictible in when/how they eat.

They started him on 2 units of Lantus at bedtime but we quickly went down to 1 3/4 units. This is MUCH better.
He started him on 1 unit of Novolog for each of the 3 meals (he didn't need it for snacks right now) but today we are starting on 1/2 unit of Novolog for each meal.

I do notice that there is not the MAJOR drops if we are late getting a meal like there was with NPH.

HTH

[allisa]

Ty has been on NPH for almost five years...it works for us.

His school numbers (lunch time) are always perfect....yes, he is on an eating schedule.....but.....it isn't a big deal for us.....it works fine for us....and I know others who hate it......

At dinner I only give him Humalog and give his NPH around 10 or 11 PM to last through the mid night hours.

[twodoor2]

Since my daughter, recently diagnosed a few weeks ago, hates 99% of most foods out there (even most candy, juice, soda, etc. . . ), and doesn't eat snacks that much except maybe before she goes to bed, I think Lantus will work best for us. The doctor is switching us to Lantus next week. Right now she is honeymooning, and on NPH. I''m supposed to give her Novolog only if her BG is 200 or greater before breakfast or dinner, and it hasn't been.

Also, is NPH given in half units usually? Each time there is an adjustment made to her insulin amounts, the doctor keeps prescribing the NPH in whole units, and the novolog in half units.

[twodoor2]

What also doesn't make much sense is that if NPH has higher peaks, why not just give less, or is it because the lows and the peaks are far too much apart and a larger bell curve than lantus?

[wilf]

Since my daughter, recently diagnosed a few weeks ago, hates 99% of most foods out there (even most candy, juice, soda, etc. . . ), and doesn't eat snacks that much except maybe before she goes to bed, I think Lantus will work best for us. The doctor is switching us to Lantus next week. Right now she is honeymooning, and on NPH. I''m supposed to give her Novolog only if her BG is 200 or greater before breakfast or dinner, and it hasn't been.

Also, is NPH given in half units usually? Each time there is an adjustment made to her insulin amounts, the doctor keeps prescribing the NPH in whole units, and the novolog in half units.

If she's not a grazer or worse yet a picky eater, then she'll likely be better off on Lantus. NPH can be given in whole units or half units. Today my DD got 6.0 in the am, 6.0 in the mid-afternoon, 1.5 at supper, and 3.0 at bedtime..

[twodoor2]

She is a super picky eater. These are the things she will eat or drink. This is it!! I try to offer variety to no avail. Bananas, bread, cream cheese, kiwi fruit, apples, apple sauce, mangos, boca burgers, noodles (when she's in the mood), only certain types of chicken nuggets, some kinds of cheese pizza (when she's in the mood), yogurt, milk, cheerios, carrot sticks, one kind of granola bar, and that's it!! If it were up to her, she would have cream cheese sandwiches every day, all day. Today, all she wanted for lunch was applesauce!!

She won't drink juice, soda, or eat anything else beyond that list. It's pathetic when you can list all the foods someone eats in a small list. She won't even try most candy except for plain chocolate. Therefore, I'm hoping since Lantus isn't for the food crazed individual, that she will do better on it. She's also good if I tell her she can't have a snack. I just tell her, she'll get that food item later, and she's okay with that. We're not big eaters in our household.

Question: If you're on lantus, can you have a low carb snack (ie some protein, or low sugar veggie), without having a dose of fast acting insulin? She's quite happy to have a carrot for a snack.

And here I am the mother who eats eel, crab, shell fish, every fish imaginable, octopus, sushi, seeweed, fish eggs, and other exotic things (I'm sure many of you are barfing right about now:p). I think she inherited her pickiness from my husband who grew up eating the exact same meals for breakfast, lunch and dinner from his mom.

[Momof4gr8kids]

Here are a few links that might help you out. Everyone has their oppinion about this topic. Basically it either works for you or it doesn't. Julia isn't predictable enough to judge what she will eat in 6 hours. I'm happy to have the pump. I don't feel that there is a regimine that can touch it, but I do understand why some people are hesitant, or choose not to go the pump route.

http://www.drugdigest.org/DD/Comparison/NewComparison/0,10621,40-12,00.html

http://www.childrenwithdiabetes.com/d_0n_115.htm

http://care.diabetesjournals.org/cgi/content/full/24/11/2005

http://www.annals.org/cgi/content/full/140/8/667