Question about long acting insulins

[Darryl]

Last week Leah's pod cannula came out during school and her BG shot up to 415 so we convinced her to take a shot from her Apidra pen instead of applying her new pod without numbing cream. This was her first shot since she she started the omnipod in '07 and turns out it didn't hurt nearly as much as the needle shots she remembered, so now she's officially OK with shots from the pen if we need to. Tonight we were out and her pod was damaged, and again she preferred to take a shot from the Apidra pen instead of applying the new pod without numbing cream. It worked out OK but she needed several shots before we got home. I was just wondering, are there any long-acting insulins that are shorter than Lantus (or NPH as we don't want to deal with the "peak"). Something that would last for 4-8 hours to cover a temporary period without a pod, but not be a 24-hour commitment?

[RomeoEcho]

Regular might work better. Officially a short acting, but still lasts a good deal longer than today's rapid acting (usually 4-6 hours). Also, if you find yourself in a bind, it can be bought over the counter with no script and is reasonably priced.

[LantusFiend]

Levemir tends to be shorter acting than Lantus, but I think Regular would probably fit your needs better.

[Darryl]

Originally Posted by LantusFiend

Levemir tends to be shorter acting than Lantus, but I think Regular would probably fit your needs better.

That's interesting... any concerns with giving a bolus of regular to cover, say a 4-6 hour period, then giving a shot of Apidra during that time to cover a meal?

[wilf]

Originally Posted by Darryl

Last week Leah's pod cannula came out during school and her BG shot up to 415 so we convinced her to take a shot from her Apidra pen instead of applying her new pod without numbing cream. This was her first shot since she she started the omnipod in '07 and turns out it didn't hurt nearly as much as the needle shots she remembered, so now she's officially OK with shots from the pen if we need to. Tonight we were out and her pod was damaged, and again she preferred to take a shot from the Apidra pen instead of applying the new pod without numbing cream. It worked out OK but she needed several shots before we got home. I was just wondering, are there any long-acting insulins that are shorter than Lantus (or NPH as we don't want to deal with the "peak"). Something that would last for 4-8 hours to cover a temporary period without a pod, but not be a 24-hour commitment?

Believe it or not, NPH could be the closest to what you're looking for. Are you looking for something to cover basal needs, or something to bolus/correct with?

Levemir lasts about 16-20 hours.

NPH peaks at 4-7 hours (you need carbs to cover about half the injected amount of insulin) and lasts 10-14 hours. About half of the injection has a basal effect which is spread over that time.

Regular is a bolus insulin, which peaks at 2-3 hours and lasts 5 to 8 hours. So it has an even bigger "peak" than NPH - she would have to eat considerable carbs to cover an injection, with much less basal effect.

[virgo39]

Originally Posted by wilf

NPH peaks at 4-7 hours (you need carbs to cover about half the injected amount of insulin) and lasts 10-14 hours. About half of the injection has a basal effect which is spread over that time.

Regular is a bolus insulin, which peaks at 2-3 hours and lasts 5 to 8 hours. So it has an even bigger "peak" than NPH - she would have to eat considerable carbs to cover an injection, with much less basal effect.

I'm curious about this as just yesterday, DD was very excited to have a three hour "pod break" (current pod expired at 1:00 p.m., we didn't want to activate new one until later, her basal rate is low at that time, current pod was getting loose, and she was going to a friend's to play).

To determine the NPH dosage, would I simply add up her basal rate for the next 10-14 hours (2.3u - 2.7u) plus her meal carbs (50 g @ 1:50; so 1u) and make sure that she ate 4-7 hours later? Would the NPH dosage correlate 1:1 with her Novolog (so the NPH would be 3.5u -- halfway between the 3.3-3.7u in above example)?

[BrendaK]

Do they still make Ultralente? That's what Carson used as an infant at dx before Lantus was on the market. I believe it was 12 hours pretty steady acting not a big peak.

[LantusFiend]

Originally Posted by BrendaK

Do they still make Ultralente? That's what Carson used as an infant at dx before Lantus was on the market. I believe it was 12 hours pretty steady acting not a big peak.

No. http://healthcare.utah.edu/pharmacy/alerts/99.html

[wilf]

Originally Posted by virgo39

I'm curious about this as just yesterday, DD was very excited to have a three hour "pod break" (current pod expired at 1:00 p.m., we didn't want to activate new one until later, her basal rate is low at that time, current pod was getting loose, and she was going to a friend's to play).

To determine the NPH dosage, would I simply add up her basal rate for the next 10-14 hours (2.3u - 2.7u) plus her meal carbs (50 g @ 1:50; so 1u) and make sure that she ate 4-7 hours later? Would the NPH dosage correlate 1:1 with her Novolog (so the NPH would be 3.5u -- halfway between the 3.3-3.7u in above example)?

Easiest way to explain is by example. We use NPH to cover DD's lunch and part of her basal needs at school..

She gets 7 units at 7 am.

About half of the 7 units (3.5 units) have a bolus effect, and will cover 3.5 units worth of carbs over the 11 am to 2 pm timeframe. Note that these are lower GI carbs - fresh fruit and whole grain bread. NPH doesn't do well with high GI foods like white breads, soda pop or cereals.

The other half of the 5 units have a basal effect, with that effect kicking in within about 2 hours of injection and lasting until the late afternoon or early evening.

NPH more than any other insulin varies in its effect by individual, so you need to try it out and see.

In your case as described above, if it were my DD I'd be giving about 5 units NPH thinking that 2.5 units would be basal (which you want). The other 2.5 units would have a spread out bolus effect, which would cover a meal at about 4 hours out and some grazing a couple of hours later. A small snack might also be needed after 2 hours.

But anyways, my working assumption is that about half of any NPH injection I give DD has a basal effect and half a delayed and spread out bolus.

Hope this answers your question..

[Darryl]

Originally Posted by wilf

Easiest way to explain is by example. We use NPH to cover DD's lunch and part of her basal needs at school..

She gets 7 units at 7 am.

About half of the 7 units (3.5 units) have a bolus effect, and will cover 3.5 units worth of carbs over the 11 am to 2 pm timeframe. Note that these are lower GI carbs - fresh fruit and whole grain bread. NPH doesn't do well with high GI foods like white breads, soda pop or cereals.

The other half of the 5 units have a basal effect, with that effect kicking in within about 2 hours of injection and lasting until the late afternoon or early evening.

NPH more than any other insulin varies in its effect by individual, so you need to try it out and see.

In your case as described above, if it were my DD I'd be giving about 5 units NPH thinking that 2.5 units would be basal (which you want). The other 2.5 units would have a spread out bolus effect, which would cover a meal at about 4 hours out and some grazing a couple of hours later. A small snack might also be needed after 2 hours.

But anyways, my working assumption is that about half of any NPH injection I give DD has a basal effect and half a delayed and spread out bolus.

Hope this answers your question..

I need to think about this... we started with NPH so I remeber that pretty well, it seemed to last around 10 hours but with a significant peak that required 45 carbs to be eaten 3 hours after the shot. I was really hoping for something that would be shorter, like 4-6 hours. Of course back when we used NPH her insulin needs were very low. Maybe we just need to try it.