Lantus plus NPH???

Long story short, I've been fighting for AGES to get ridiculously high
fasting BGs down (like 10-12s (180-230s)). NONE of the hints & tricks in
here work. And I'm not going low through the night. Periodic overnight
tests show a constant upwards progression every time.

I'm on 4mg Avandia morning & night, 60mg Diamicron MR at night, quit
Metformin (500mg AM, 1,000 mg PM) at the beginning of October 'cause I
couldn't handle the gastric distress any more. Humalog for meals.

I was experimenting with NPH, then Ultralente, then both. Ultralente is
discontinued, so I got a bottle of Lantus to experiment with.

I took the Lantus 100% at bedtime along with the NPH at bedtime through an
entire bottle (1,000 units, at 30, then 36 units per day means about a
month). And averaged fasting BGs around 7.5 (135)

When the Lantus ran out, I went back to my last bottle of UL. Split the
dose, though, 20u AM & PM, along with 35u NPH at night. Then upped the UL to
30u AM & PM. Mostly 8s (150ish) fastings.

UL is now gone, and no more available that I know of in my city. So I went
back to Lantus. Split that dose, too. 30u AM & PM, and continued the NPH
35u PM. Started that on Thursday evening (2 days ago).

Well, a diabetic nurse (not *mine*, but one that works with him) read me the
riot act. First off, said I should be splitting my AM & PM doses of Lantus
60/40 (or 40/60, I forget which), rather than the 50/50 I'm trying. But,
most importantly, she said that Lantus plus NPH was ABSOLUTELY
contraindicated. DO NOT take them at the same time. Period. (I don't
mean in the same shot, I mean in the same DAY)

However, so far, my numbers are INCREDIBLE! "Normal" eating yesterday, with
no Humalog with meals, and last night at bedtime I was 4.4 (79). Ate 2 mini
(Halloween size) chocolate bars. Fasting this morning was 4.0 (72). *NO*
Humalog with a large carb breakfast and lunch, and pre-dinner I was 5.2
(94). No lows yesterday OR today.

Point is, so far, I'm absolutely LOVING the combo of Lantus and NPH. Might
have to lower the NPH some, though, to be safe.

What do y'all think of this? SHOULD I quit one or the other of the NPH or
Lantus? Or should I ignore the nurse & keep doing what I'm doing, with
maybe some adjustments?

*ARE* there actual "contraindications" with using both of these insulins?
Or is she just scaremongering or overreacting, while not knowing *MY* actual
situation, & panicking at the possibility of hypos (that don't seem to be
manifesting?)

---
Kelly
T2, yada, yada

Opal wrote:

>
> What do y'all think of this? SHOULD I quit one or the other of the NPH or
> Lantus? Or should I ignore the nurse & keep doing what I'm doing, with
> maybe some adjustments?
>
> *ARE* there actual "contraindications" with using both of these insulins?
> Or is she just scaremongering or overreacting, while not knowing *MY* actual
> situation, & panicking at the possibility of hypos (that don't seem to be
> manifesting?)
>
> ---
> Kelly
> T2, yada, yada
>
>

Kellydear!

The "diabetic nurse" knows not. The whole 60/40 vs. 40/60 thing is
nonsense. There is nothing contraindicated in using NPH and Lantus
simultaneously, so long as they aren't in the same syringe.

Hypos *are* contraindicated though, and with the huge variability of
absorption in NPH, you may hereby consider yourself to be admonished to
be careful. :-)

Personally, I won't use NPH, but that's more about wanting the heparin
to work when I throw a clot. But that's just me.

Since you can't really control the NPH, I'd consider backing off on the
Lantus a bit and aim for 5.5 or 6.0 in the morning. If the NPH works too
well, you end up above 4.0 (hopefully). If it doesn't, you end up at
7.0, and that's OK, too.

My tuppence.

Your pal,

Jim

Opal wrote in message <76ecc$454419a5$cfd226c9$4420@QUICKCLIC.NET>...
>
>
>Long story short, I've been fighting for AGES to get ridiculously high
>fasting BGs down (like 10-12s (180-230s)). NONE of the hints & tricks in
>here work. And I'm not going low through the night. Periodic overnight
>tests show a constant upwards progression every time.
>
>I'm on 4mg Avandia morning & night, 60mg Diamicron MR at night, quit
>Metformin (500mg AM, 1,000 mg PM) at the beginning of October 'cause I
>couldn't handle the gastric distress any more. Humalog for meals.
>
>I was experimenting with NPH, then Ultralente, then both. Ultralente is
>discontinued, so I got a bottle of Lantus to experiment with.
>
>I took the Lantus 100% at bedtime along with the NPH at bedtime through an
>entire bottle (1,000 units, at 30, then 36 units per day means about a
>month). And averaged fasting BGs around 7.5 (135)
>
>When the Lantus ran out, I went back to my last bottle of UL. Split the
>dose, though, 20u AM & PM, along with 35u NPH at night. Then upped the UL
to
>30u AM & PM. Mostly 8s (150ish) fastings.
>
>UL is now gone, and no more available that I know of in my city. So I went
>back to Lantus. Split that dose, too. 30u AM & PM, and continued the NPH
>35u PM. Started that on Thursday evening (2 days ago).
>
>Well, a diabetic nurse (not *mine*, but one that works with him) read me
the
>riot act. First off, said I should be splitting my AM & PM doses of Lantus
>60/40 (or 40/60, I forget which), rather than the 50/50 I'm trying. But,
>most importantly, she said that Lantus plus NPH was ABSOLUTELY
>contraindicated. DO NOT take them at the same time. Period. (I don't
>mean in the same shot, I mean in the same DAY)
>
>However, so far, my numbers are INCREDIBLE! "Normal" eating yesterday,
with
>no Humalog with meals, and last night at bedtime I was 4.4 (79). Ate 2
mini
>(Halloween size) chocolate bars. Fasting this morning was 4.0 (72). *NO*
>Humalog with a large carb breakfast and lunch, and pre-dinner I was 5.2
>(94). No lows yesterday OR today.
>
>Point is, so far, I'm absolutely LOVING the combo of Lantus and NPH. Might
>have to lower the NPH some, though, to be safe.
>
>What do y'all think of this? SHOULD I quit one or the other of the NPH or
>Lantus? Or should I ignore the nurse & keep doing what I'm doing, with
>maybe some adjustments?
>
>*ARE* there actual "contraindications" with using both of these insulins?
>Or is she just scaremongering or overreacting, while not knowing *MY*
actual
>situation, & panicking at the possibility of hypos (that don't seem to be
>manifesting?)
>
>---
>Kelly
>T2, yada, yada
>
>

Very few medical persons would recommend using both NPH and Lantus at
the same time because we diabetics are too dumb to handle the combo.

The problem is night time hypos which we diabetics are too dumb to deal
with.

You fight the night time hypos by checking your blood sugars at 3 a.m. or so
but we diabetics are too dumb to handle that, i.e. no diabetic would think
of doing that by herself or know what to do with the numbers.

That said, IMO, NPH is one of the most powerful night time control/ FbG
control insulins around. It has a fairly significant peak at 4-6 hours
after injection and is about gone by 12 hours. That means you can take it
late in the evening. expect it to reach full power during the most
difficult hours of the Dawn Effect, but then "go away and stop bothering
you" during the rest of the day when you don't need a big basal kick.

My technique was to take it late enough so that the peak came after 3 a.m.
Most folks' circadian rhythms call for minimum insulin needs around then so
we want to avoid a 3 a.m. NPH peak. My Morning Effect starts up around 4
a.m. and is in high gear until mid-morning. If I timed the NPH well enough
(best results for me: ~midnight), it peaked right in the middle of the 5-7
a.m. hot spot and would hold my bG down until my morning short acting
insulin could take over.

Ultralente was useful for tailoring my "after 3 a.m." insulin peaks. I
took a small shot at 5 p.m. to give me a 5 a.m. peak, then another at 9
p.m. to take over when the 5 a.m. peak died. That mostly gave me nice
control in the mornings. My 7 a.m. shot handled the rest of my basal-day.

Lantus is nice for providing a steady dribble throughout the day. No
really big peaks which is a nice way to avoid hypos but is not too useful
when you need a peak of something around 5 a.m. That, BTW, is why I
switched to Levemir when UL went off the market. Levemir has a sort of a
slower and more consistent NPH-type activity profile and I need an insulin
that can manipulated to give me a 5 a.m. kick.

As your only basal, NPH is not that good. Since it is quite variable,
you run the risk of surprise hypos unless you split your daily into several
small doses. That way, any variation is a variation in the activity of a
small dose and thus less likely to cause a hypo. That's about what you are
trying to do, BTW. You are just skipping your 6 a.m, 11 a.m., 3 p.m,
and 7 p.m. NPH doses and letting Lantus carry those parts of the day.

I suggest, however, that at 35 units P.M., the NPH variability is going to
give you a 3 a.m. hypo sooner or later. You want to counter that
variability by taking the smallest dose of NPH that produces an acceptable
effect.

FWIW, Levemir has a useful peak though slower than the NPH peak, has less
variability than NPH, but is just as expen$ive as Lantus.

I have never read anything about any interactions between Lantus and NPH in
the body. Note that your dual use would but both into the blood in minute
concentrations at any given time. I would expect no more problem than
having Lantus and Humalog in your blood at the same time.

Remember how injected basal insulins work. They get "hung up" in your fat
layer and take a long time to work their way through the nearest veins and
capillaries into the blood. Then, once in the blood, they have a ~5
minute half-life. IOW, when talking the Lantus+NPH combo, you're talking
about insulins that spend a lot of time in widely separated portions of your
subcutaneous fat layer, then a very short time at very low concentrations
in your blood.

I would expect big problems if you mixed them in the syringe but you know
that already.

Regards
Old Al

"Opal" <nobody@quickclic.net> wrote in message
news:76ecc$454419a5$cfd226c9$4420@QUICKCLIC.NET...
>
> Point is, so far, I'm absolutely LOVING the combo of Lantus and NPH.
> Might have to lower the NPH some, though, to be safe.
>
> What do y'all think of this? SHOULD I quit one or the other of the NPH or
> Lantus? Or should I ignore the nurse & keep doing what I'm doing, with
> maybe some adjustments?
>
> *ARE* there actual "contraindications" with using both of these insulins?
> Or is she just scaremongering or overreacting, while not knowing *MY*
> actual situation, & panicking at the possibility of hypos (that don't seem
> to be manifesting?)


Thanks for your input OldAl & Jim.

I cut the NPH back to 20u last night, with 30u of Lantus, and woke this
morning to a lovely 5.7 (103). I think I'll leave it at that for now and
see how it goes. And definitely ignore the scaremongerers. <GRIN>

Now to see if I can drop the Diamicron without any ill effects...

---
Kelly
T2, yada, yada

I can tell you from personal experience that 4 months before I started
pumping, my ENDO (a medical professional) PUT me on NPH to suppliment
my Lantus that we found was only lasting me 19hrs. So, YES, I took BOTH
insulins the same day within a few hours of each.

I also confirmed this with Aventis if it was "okay" and the research
department
stated it was very much OKAY.

I'm glad you're finally getting some good results. If it works, don't change
it.

--
Reisa, T1, Animas IR1250 Pumper
DX-5/00 ASD-7/00
A1C: 6.2% (8/24/06)
Daily CHO: 150-200gm
TDD: 34-38u
"Opal" <nobody@quickclic.net> wrote in message
news:76ecc$454419a5$cfd226c9$4420@QUICKCLIC.NET...
:
:
: Long story short, I've been fighting for AGES to get ridiculously high
: fasting BGs down (like 10-12s (180-230s)). NONE of the hints & tricks in
: here work. And I'm not going low through the night. Periodic overnight
: tests show a constant upwards progression every time.
:
: I'm on 4mg Avandia morning & night, 60mg Diamicron MR at night, quit
: Metformin (500mg AM, 1,000 mg PM) at the beginning of October 'cause I
: couldn't handle the gastric distress any more. Humalog for meals.
:
: I was experimenting with NPH, then Ultralente, then both. Ultralente is
: discontinued, so I got a bottle of Lantus to experiment with.
:
: I took the Lantus 100% at bedtime along with the NPH at bedtime through an
: entire bottle (1,000 units, at 30, then 36 units per day means about a
: month). And averaged fasting BGs around 7.5 (135)
:
: When the Lantus ran out, I went back to my last bottle of UL. Split the
: dose, though, 20u AM & PM, along with 35u NPH at night. Then upped the UL
to
: 30u AM & PM. Mostly 8s (150ish) fastings.
:
: UL is now gone, and no more available that I know of in my city. So I
went
: back to Lantus. Split that dose, too. 30u AM & PM, and continued the NPH
: 35u PM. Started that on Thursday evening (2 days ago).
:
: Well, a diabetic nurse (not *mine*, but one that works with him) read me
the
: riot act. First off, said I should be splitting my AM & PM doses of
Lantus
: 60/40 (or 40/60, I forget which), rather than the 50/50 I'm trying. But,
: most importantly, she said that Lantus plus NPH was ABSOLUTELY
: contraindicated. DO NOT take them at the same time. Period. (I don't
: mean in the same shot, I mean in the same DAY)
:
: However, so far, my numbers are INCREDIBLE! "Normal" eating yesterday,
with
: no Humalog with meals, and last night at bedtime I was 4.4 (79). Ate 2
mini
: (Halloween size) chocolate bars. Fasting this morning was 4.0 (72). *NO*
: Humalog with a large carb breakfast and lunch, and pre-dinner I was 5.2
: (94). No lows yesterday OR today.
:
: Point is, so far, I'm absolutely LOVING the combo of Lantus and NPH.
Might
: have to lower the NPH some, though, to be safe.
:
: What do y'all think of this? SHOULD I quit one or the other of the NPH or
: Lantus? Or should I ignore the nurse & keep doing what I'm doing, with
: maybe some adjustments?
:
: *ARE* there actual "contraindications" with using both of these insulins?
: Or is she just scaremongering or overreacting, while not knowing *MY*
actual
: situation, & panicking at the possibility of hypos (that don't seem to be
: manifesting?)
:
: ---
: Kelly
: T2, yada, yada
:
:

I used NPH for the past year to control FBG's with great success. The peak
worked just when I needed it, an hour or two before awaking. I would take
it just before going to bed.

I'm now using Lantus, two shots a day, and that's all the insulin I need
most days, with carb controlled meals.

As you and most everyone knows, the only prohibition is mixing other
insulins with Lantus in the syringe. I 've never heard of any prohibition on
mixing Lantus and NPH in the body, though such a concoction would likely be
avoided by most physicians because they may see it as a bit too complicated
for their patients..

On the other hand, you may have discovered a valuable strategy for persons
with your specific needs.

On the other hand, maybe not. Be careful. Chart and take counter measures
for night time lows.

Is your body sensitive to lows? You may want to set an alarm for critical
times during your sleep to check up on yourself.



"Opal" <nobody@quickclic.net> wrote in message
news:76ecc$454419a5$cfd226c9$4420@QUICKCLIC.NET...
>
>
> Long story short, I've been fighting for AGES to get ridiculously high
> fasting BGs down (like 10-12s (180-230s)). NONE of the hints & tricks in
> here work. And I'm not going low through the night. Periodic overnight
> tests show a constant upwards progression every time.
>
> I'm on 4mg Avandia morning & night, 60mg Diamicron MR at night, quit
> Metformin (500mg AM, 1,000 mg PM) at the beginning of October 'cause I
> couldn't handle the gastric distress any more. Humalog for meals.
>
> I was experimenting with NPH, then Ultralente, then both. Ultralente is
> discontinued, so I got a bottle of Lantus to experiment with.
>
> I took the Lantus 100% at bedtime along with the NPH at bedtime through an
> entire bottle (1,000 units, at 30, then 36 units per day means about a
> month). And averaged fasting BGs around 7.5 (135)
>
> When the Lantus ran out, I went back to my last bottle of UL. Split the
> dose, though, 20u AM & PM, along with 35u NPH at night. Then upped the UL
> to 30u AM & PM. Mostly 8s (150ish) fastings.
>
> UL is now gone, and no more available that I know of in my city. So I
> went back to Lantus. Split that dose, too. 30u AM & PM, and continued the
> NPH 35u PM. Started that on Thursday evening (2 days ago).
>
> Well, a diabetic nurse (not *mine*, but one that works with him) read me
> the riot act. First off, said I should be splitting my AM & PM doses of
> Lantus 60/40 (or 40/60, I forget which), rather than the 50/50 I'm trying.
> But, most importantly, she said that Lantus plus NPH was ABSOLUTELY
> contraindicated. DO NOT take them at the same time. Period. (I don't
> mean in the same shot, I mean in the same DAY)
>
> However, so far, my numbers are INCREDIBLE! "Normal" eating yesterday,
> with no Humalog with meals, and last night at bedtime I was 4.4 (79). Ate
> 2 mini (Halloween size) chocolate bars. Fasting this morning was 4.0
> (72). *NO* Humalog with a large carb breakfast and lunch, and pre-dinner
> I was 5.2 (94). No lows yesterday OR today.
>
> Point is, so far, I'm absolutely LOVING the combo of Lantus and NPH.
> Might have to lower the NPH some, though, to be safe.
>
> What do y'all think of this? SHOULD I quit one or the other of the NPH or
> Lantus? Or should I ignore the nurse & keep doing what I'm doing, with
> maybe some adjustments?
>
> *ARE* there actual "contraindications" with using both of these insulins?
> Or is she just scaremongering or overreacting, while not knowing *MY*
> actual situation, & panicking at the possibility of hypos (that don't seem
> to be manifesting?)
>
> ---
> Kelly
> T2, yada, yada
>
>

"Uncle Enrico" <Uncle@nospam.com> wrote in message
news:TK51h.132$m54.88@newssvr14.news.prodigy.com.. .
>
> Is your body sensitive to lows? You may want to set an alarm for critical
> times during your sleep to check up on yourself.


Actually, I would hazard to guess that my body handles most non-severe lows
all by itself.

No way to know for sure without a continuous BG monitor (or a MUCH better
memory lol), but the evidence certainly points that way.

Consider... 2 days of the exact same eating. One day, I shoot only the
basal insulins, and test a 5.x (90ish) before dinner. The next day, I shoot
my "usual" dose of Humalog with the same breakfast & lunch, and get a 5.x
before dinner.

Choices are:
a) I'm going high and coming back down by dinner time on the day I'm not
shooting Humalog, or
b) I'm going low & my body is correcting on the day I DO shoot Humalog.

Unfortunately, I'm usually so busy at work that I completely forget to test
PP to find out which. However, prior to starting to shoot these basals,
when I've forgotten to take my Humalog, I've stayed high(er) right through
until dinner, testing a 7 or 8 pre-dinner on those days.

---
Kelly
T2, yada, yada

Opal wrote:

> "Uncle Enrico" <Uncle@nospam.com> wrote in message
> news:TK51h.132$m54.88@newssvr14.news.prodigy.com.. .
>
>>Is your body sensitive to lows? You may want to set an alarm for critical
>>times during your sleep to check up on yourself.
>
>
>
> Actually, I would hazard to guess that my body handles most non-severe lows
> all by itself.
>
> No way to know for sure without a continuous BG monitor (or a MUCH better
> memory lol), but the evidence certainly points that way.
>
> Consider... 2 days of the exact same eating. One day, I shoot only the
> basal insulins, and test a 5.x (90ish) before dinner. The next day, I shoot
> my "usual" dose of Humalog with the same breakfast & lunch, and get a 5.x
> before dinner.
>
> Choices are:
> a) I'm going high and coming back down by dinner time on the day I'm not
> shooting Humalog, or
> b) I'm going low & my body is correcting on the day I DO shoot Humalog.
>
> Unfortunately, I'm usually so busy at work that I completely forget to test
> PP to find out which. However, prior to starting to shoot these basals,
> when I've forgotten to take my Humalog, I've stayed high(er) right through
> until dinner, testing a 7 or 8 pre-dinner on those days.
>
> ---
> Kelly
> T2, yada, yada
>
>

If you want to track your basals as best you can without a CBGM, use
this method. There's also other tricks and calculation strategies useful
for all insulin users regardless of type or insulin used.

http://www.insulin-pumpers.org/howto.shtml

Sounds to me like you're well on your way.

HTH,

Vicki

"percy" <vbeausoleil@nowhere.bum> wrote in message
news:454be3c9$1_2@x-privat.org...
>
> If you want to track your basals as best you can without a CBGM, use this
> method. There's also other tricks and calculation strategies useful for
> all insulin users regardless of type or insulin used.
>
> http://www.insulin-pumpers.org/howto.shtml
>

hehe Thanks, but the problem is that I always FORGET to test. As I said, I
get so busy at work, I long miss the 2hPP breakfast & lunch tests, and I'm
usually already OUT for lunch before I remember that I wanted to test
pre-lunch (I keep a meter in my desk so I don't have to carry it around all
day).

Kelly
T2, yada, yada

Opal <nobody@quickclic.net> wrote:

: "percy" <vbeausoleil@nowhere.bum> wrote in message
: news:454be3c9$1_2@x-privat.org...
: >
: > If you want to track your basals as best you can without a CBGM, use this
: > method. There's also other tricks and calculation strategies useful for
: > all insulin users regardless of type or insulin used.
: >
: > http://www.insulin-pumpers.org/howto.shtml
: >

: hehe Thanks, but the problem is that I always FORGET to test. As I said, I
: get so busy at work, I long miss the 2hPP breakfast & lunch tests, and I'm
: usually already OUT for lunch before I remember that I wanted to test
: pre-lunch (I keep a meter in my desk so I don't have to carry it around all
: day).

: Kelly
: T2, yada, yada

Could you get a wrist watch with an alarm to remind yourself?

Wendy-

"Opal" <nobody@quickclic.net> wrote in message
news:abb6b$454c0921$cfd226c9$16352@QUICKCLIC.NET.. .
>
> hehe Thanks, but the problem is that I always FORGET to test. As I said,
> I get so busy at work, I long miss the 2hPP breakfast & lunch tests, and
> I'm usually already OUT for lunch before I remember that I wanted to test
> pre-lunch (I keep a meter in my desk so I don't have to carry it around
> all day).
>

Did somebody already mention an alarm watch?
I have a runner's watch that has a chrono (to measure laps &/or splits as
well as overall time in a race, for example), a countdown timer, and *3*
alarms. Something like this might work for you.
bj