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Issues with NPH peaking too fast

Discussion in 'Parents of Children with Type 1' started by jimarmol, Mar 30, 2019.

  1. jimarmol

    jimarmol New Member

    Joined:
    Mar 30, 2019
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    Hi

    I have a 4 years old boy who was diagnosed with diabetes type 1 8 months ago and we are having issues using NPH. We would like to use Levemir instead but fortunately, the daycare does not administer insulin.

    The NPH is supposed to peak between 4-5 hours, but in my son's case, it is peaking 2 to 3 hours. I am applying the NPN at about 9:00am before I go to work, but at around 11:45 is doing full peak which is too early because they have lunch at about 12:15pm, so they daycare ends up giving juice because the blood sugar goes too low before lunch and of course after that it goes too high.

    The dose we are using in average is 4.5, we've been trying different needle sizes (4mm, 6mm), different part of body, but nothing seems to work.

    I was wondering if any of you have had this problem? would it be acting to fast because of the age or the dose?

    Thanks
     
  2. liasmommy2000

    liasmommy2000 Approved members

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    Wow, it's been a long time since my dd was on NPH so my memory is foggy. She's 19 now and was on NPH for only a few months after her diagnosis at age 6.

    I think I would try having them give him a glass of milk (not skim but maybe 2%) a half hour or so BEFORE the time he usually goes low. Milk has a good combo of sugar and fat and that can help keep them steady. A few peanut butter crackers might work also if they are allowed peanuts.

    I'd also see if you can get him on a pump if they won't give shots.
     
  3. MomofSweetOne

    MomofSweetOne Approved members

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    A small dose would peak faster than a larger dose because of the absorption rate/surface area of the insulin. Activity would also affect how fast it kicks in. Do you know what his schedule is like?

    Why are they giving him juice rather than adjusting and feeding him lunch when he needs it rather than on their schedule? That's the first battle I would fight....while I also call the endo for a script for a pump and pump training.

    Even if they won't dose insulin, on a pump, you could program high rates of basal to cover lunch carb intake at the lunch hour, as opposed to giving a basal dose. A mom here did that for her jr. high aged school with ADHD. He had to eat the same amount of carbs every day and at the same time, but it solved the problem of him forgetting to dose in the forgetful jr. high years. You'll find T1D parents get very creative in making life work around challenges.

    If he were on the Tandem, it would shut basal off for lows....or DIY Loop for Omnipod is supposed to be out quite soon. I'd choose one of those if I were choosing for a little one.

    Does he have a CGM or is he dealing with wicked lows each day with the NPH?
     
    rgcainmd likes this.
  4. liasmommy2000

    liasmommy2000 Approved members

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    Yes, we did that one year for snacks. They had a snack every morning at the same time in elementary school and I think her first year on the pump we did that instead of going to the office to have the secretaries bolus for her. We later got an aide (shared with another child) so that was the only year we did that. But it worked.
     

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