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Is NPH something to look into?

Discussion in 'Parents of Children with Type 1' started by Hudson_Rocks, Sep 28, 2011.

  1. Hudson_Rocks

    Hudson_Rocks Approved members

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    I am not very versed in types of insulin outside of Humalog and Lantus, so please bear with me if I make mistakes in this post ;)

    Hudson eats lunch at school but doesn't make the best choices - ie a chicken sandwich and jo-jo potatoes. Those flippin' potatoes stay with him a long time, and result in highs at the end of the day (over 200; one day last week he was 409 or something like that, his highest EVER).

    We're also not having a lot of luck with Lantus taking care of morning fastings. It's usually in the 140s-150s and I think we'd all like to see it under 120. We just last night upped the Lantus to 12 units to see if that helps. He's unable to do PE right now because of a knee thing, so maybe once that is resolved we'll see better responses to the insulin and be able to scale back, I don't know.

    Anyway, I was reading "Using Insulin" last night and looking at the section about NPH and whatnot, and got to wondering about that. In what situations do you use that? Benefits/drawbacks? Is it something he could take in the morning and then not have to inject for lunch at school? I'm interested to hear how it works from those who use it. Any info is valuable!

    Thanks :)
     
  2. Amy C.

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    My son was on NPH from diagnosis in 1997 until Lantus came on the market in 2006. Taking NPH meant no lunch shot, but lunch had to be consumed within a half hour period about 4 hours after the shot. He had to eat a prescribed number of carbs at lunch or he would be out of range.

    I found it to be a horrible regime -- very inflexible.

    I would find other ways to match the insulin and the food.
     
    Last edited: Sep 28, 2011
  3. cdninct

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    We did NPH for 5 months, and while the no-shot-at-lunch deal was good, the lack of flexibility was not. He had to eat within a 45-minute window and consume only a certain amount of carb. Presumably at school, they eat at predictable times, but if he makes his own meal choices (at a cafeteria or something), he is likely not to eat the same quantity of carb every day. In short, NPH will probably not work for lunch times for him.
     
  4. Sarah Maddie's Mom

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    Many folks really dislike NPH due to it's delayed peak time and the scheduled snack/meal that that peak necessitates. We used NPH with great success when Maddie was in pre-school and they were willing and able to check and treat but being a private co-op with no nurse, unable to do injections.

    That said I don't think NPH would help much in your situation. Regular, which we've never used, might help with high carb high fat lunch choices, but could be a problem were he to select a different sort of meal on a dose of regular.

    We avoid lunch "choice" issues by packing lunch. It works because there is no stigma at DD's school around bringing a bagged lunch and she prefers it that way.

    Maybe you can just let your son know that he gets one high carb. high fat option at lunch, but not two. Imho, there's nothing wrong with giving kids limits on the junky food options regardless of any health issues.:cwds:

    Good luck!
     
  5. sarahspins

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    Adding NPH can help if you have a problem with lows during the day as a result of increasing the lantus to bring the fasting #'s down. For many people, including myself, basal needs are either not steady throughout the day, and lantus isn't really able to accomodate that very easily. It can also help with delayed meal bolusing, but if you have humalog to use it might be easier (and safer) to just rely on that for meal coverage.

    As an adult, when I am on MDI my lantus dose is about 16-18u/day (split into equal doses morning and night) with 3-4u of NPH added in at night. With my pump, I am able to fine tune my insulin delivery and I still require more at night.
     
  6. bflohockeymom

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    My daughter used NPH when she was first diagnosed and it worked well for her. But her meals and snacks had to be at very strict times and very strict carb counts, whether she wanted to eat or not. After 6 months she was on a pump and realized how much better it could be! I would say the problem with your son's lunch wouldn't be helped by NPH or Lantus. They are basal insulins that should only be used to control diabetes when not eating. Is it possible for the nurse to give him half the lunch Humalog bolus before eating the potatoes and then the other half an hour later? This would help with the delay in digestion you're seeing. Maybe people use this feature on the pumps and see great results from it. I've also read that some people break up their lantus dose into 2 per day instead of one because it doesn't always last the full 24 hours in every person.
     
  7. danismom79

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    I loved NPH for very slow-digesting foods, but I would not use it in this situation. How often is he checked at school? Since you don't know what he's going to eat on a day-to-day basis, I would just check and correct as necessary after lunch.
     
  8. lisamustac

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    I agree! We did nph for a few months after dx. It was to regimented for a toddler. I also think you can find a better way to match the insulin to food.
     
  9. slpmom2

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    I noticed in your signature that he is taking "Humalog as needed". It may just be that school lunches are one of those "needed" situations. Is there a school nurse who could help him estimate carbs and do a lunch shot? Or could he text you to consult and dose himself?
     
  10. badshoe

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    We used NPH with both kids and came to view it as Not Particularly Helpful that said there are folks who have had great success with it as part of their care program. Your Diabetes May Vary.

    I did do a spoof of "Who's on First" featuring NPH and lot of other stuff we all use. Not clinically useful but maybe therapeutic humor. It is here: http://www.ydmv.net/2008/07/not-that-abbott.html
     
  11. katerinas

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    I read that you can not trust the peak time of NPH thats why I never used it. Why don't you try regular insulin it has helped us alot!
     
  12. selketine

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    If you have the John Walsh books you can see he is not very positive about NPH - definitely pay attention to the amount of variability in the action - it is not a consistent insulin in how it acts or when.

    We used it for about 3-4 months and it was a nightmare. The peak would come at random times and heaven forbid we weren't ready to sit down to eat immediately. I was practically homebound with him when he was on it. I still don't know how anyone figures out when it will peak.

    At night I think it is downright dangerous to use NPH because it still peaks - in the middle of the night - when you aren't generally eating.

    Proceed with caution on that one.
     
  13. emm142

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    These are pretty much my feelings exactly on NPH. I found it challenging to cover lunch with, but definitely dangerous overnight. I had a 30-40g snack every night and my BGs were just so unpredictable.
     
  14. MommaKat

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    We've never used NPH for my daughter

    but right around the time I hurt my back and had to leave nursing as a bedside nurse (late 2006), all our docs (both inpatient and out) were switching patients off of NPH - both type I and type II. When my daughter was diagnosed last Feb. the type I endo center we go to made it clear they would only put kids on NPH if insurance refused to cover a fast acting insulin (some of the state plans). I completely remember the variability of action and how much it messed up my home care patients with control. Even adults felt it was too restrictive a regimen. Nursing friends of mine say they're not even allowed to order NPH for inpatient care anymore. That usually says a lot about a medication. KWIM?
     
  15. amilaine

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    My daughter began on NPH the date of diganosis 2010 and we swichted soon after it seemed like a good idea since there was less injections but it was too rigid and it seemed like diabetes was taking control of our life and not the other way around. The schedules are very strick since you must eat everyday at the same exact time no room for flexibility or even sleep a lil beyond the time of injection. Also, the carb count must be exact I know it seems simple but its not if you have to run around or eat at a later time. Your life will become a lil more stressed.
     
  16. emilyblake

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    Our experience with nph was the time frame immediately after diagnosis until about a year after. Our daughter was 3 at the time and the nph forced her to 'feed the insulin' and eat at times when she wasn't always ready. She had several dangerous lows on nph as a preschooler and i don't feel safe with it overnight. Personally, i couldn't possibly consider having her go back on it, but again our experience is limited to post diagnosis. We didn't know a lot in the beginning and weren't aware of how different our situation could be initially. She is now on a pump which works best for us.

    Good luck to you.
     
  17. kiwikid

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    Kids here seem to have no choice. They are started on NPH (protophane) and regular usually.
     
  18. Hudson_Rocks

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    Oops, I need to correct that sig. He is on Humalog every day/meal now.
     
  19. Ellie'sMama

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    We used NPH for our 3 year old for seven months before starting on the pump. We found it to be "Not Particularly Helpful" to say the least. The schedule for timed meals and predetermined carbs was difficult and there is a 25% variability in the absorption of this insulin so it's very unreliable, too. We would NEVER go back to NPH no matter what!
     
  20. deafmack

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    I think the one big negative about NPH besides being on a strict carb allowance and a strict eating schedule which I could never do is the fact that one is constantly feeding the insulin. Just the thought of that turns me off.
     

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