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Not giving NPH

Discussion in 'Parents of Children with Type 1' started by mapoe4, Oct 28, 2008.

  1. mapoe4

    mapoe4 Approved members

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    I decided this morning I'm not going to give John the NPH this morning because he is going low right before lunch and still spiking afterwards. The NPH isn't keeping his lunch from spiking and they have to treat the low to close to lunch. I'm waiting for someone to contact me still about changing John's insulin again.
     
  2. Amy C.

    Amy C. Approved members

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    I can't see how this will be better. Now all he will do is go high. He needs the insulin, but the timing of the food and insulin is off.

    The problem you are having is very common with NPH. It sounds like the low could be overtreated and then he is having a normal lunch.

    The NPH is kicking in before John eats lunch. You could consider several options:

    Lunch needs to be moved back or the NPH shot moved later.
    Another idea is to have a larger snack about a half hour before he goes low and then less lunch. In essence, break his lunch food up into two parts. He gets part about a half hour before he typically gets low and the other part at lunch

    For a while, John was on Lantus and a fast acting before meals -- why was NPH added. Is there no one at his school to give the lunchtime shot?

    BTW, the timing of the NPH is precisely why my son went on Lantus/Humalog. School lunches were later and later. On NPH, he had to eat by 11:30 and that wasn't going to work with his schedule as he grew older.
     
  3. mapoe4

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    The school could give him the NPH but I have to wait for the endo to call me back first because they don't have a script to give him the NPH. He is already going high after lunch The school can't change his lunch schedule so that won't work. He has a morning snack usually before recess and recess is right before lunch so activity is some of what makes him go low with the NPH spike. When I wasn't giving the NPH he wasn't going low before lunch. They check him about 15-25 minutes before lunch depending on how many she has in the clinic and depending how soon she checks him depends on the snack amount she gives him. Sometimes it is only a few sips of juice just so he won't crash while he is in line at lunch. If it is really close to lunch they will make sure he is first in line. But they still have to treat his lows one way or another. I'm only not giving the NPH today til I here from his endo. I have a doc appt today and I just have this bad feeling if I was to give the NPH and won't be able to get there.
     
  4. Ellen

    Ellen Senior Member

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    I suggest you call the endo and tell the service it's urgent for a call back. It's not necessarily wise to send him to school without any long acting insulin on board. Have you discussed Levemir or Lantus with the endo if NPH isn't working well?
     
  5. ange_mom

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    I would try lantus and then use humulog to cover lunch. We rarely have a low before lunch. Npr is hard to predict and very restricting.
     
  6. mapoe4

    mapoe4 Approved members

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    He is on lantus and I did give him that just not the NPH. I will be back before he goes to lunch so if he is low or high I can be at the school in 10 minutes.
     
  7. danismom79

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    What are you planning to do when you get there? Give him Humalog? Chances are he'll need something, but you can't give the NPH then. It'll be too late.

    That small amount of NPH is peaking too soon. One fix would be to increase the NPH, but you'd have to increase his carbs leading up to lunch as well. Of course that's too late for today.

    I'm looking at that list of numbers from the other thread and I'm not seeing where he's going low before lunch and high after... What time is lunch?
     
    Last edited: Oct 28, 2008
  8. mapoe4

    mapoe4 Approved members

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    lunch at school is at 11:50. on the weekends I can keep his numbers up because I can allow him to eat more often. At school he is dropping into the 60's.and he doesn't level out til dinner then he goes up again.
     
  9. ecs1516

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    He takes Lantus, NPH and Humalog ?
     
  10. danismom79

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    Does he have a snack before lunch? What is he typically after lunch?
     
  11. wilf

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    Nope, just Lantus and NPH.

    Given that this is for today only and you're already committed to the decision, I wouldn't worry any more about it.

    But you really need to work with your medical team to come up with an insulin regimen that actually works. The current system is not working.

    My suggestion is dramatically reduce Lantus, and cover the meals with Regular. Your medical team may have another idea. But the bottom line is the cureent system is not working and should be changed.

    Good luck!
     

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