Just want to remind all of you reading this that I am not a doctor, this is not medical advice. Merely how we manage the day-to-day of Elise diabetes. It works for us. I'm not suggesting it will work for you. Talk to your doctor about making any changes.
***Also, this post was written pre-pump... I was just too lazy to go in and make changes***
Some time ago, I was reading a post on Nicole's blog, and she mentioned how she had learned about how many people hate the insulin NPH at the FFL conference. She mentioned being shocked.
You know what? I'm not.
Because I have had people (not doctors, not CDE's, but people who think they know best) tell me that NPH is "a horrible, awful insulin", and that "nobody in their right mind should have their child on it".
If you don't know, NPH (or Humilin) is an intermediate acting insulin. It's said to have a peak effect 4-12 hours after injection, and a duration of action of 18-26 hours. That can differ from person to person and even from one day to the next in the same person. No wonder most people refer to it as, "Not Particularly Helpful" (get it? NPH? HA!)
Elise gets her dose in the morning combined in the same syringe with her humalog. We see it start to work about 2 hours after injection, a peak at about 4 hours, a second peak around hour 6 or 7, then it is gone by about 5:00 pm (as always, your diabetes may vary).
The reason we were started on NPH at diagnosis is because Elise was so tiny, and so early on in the development of the disease, that she was on diluted insulin (and still is for her fast-acting). The only background insulin you could dilute was NPH. To give you an idea, Elise's (background) insulin needs at dx was 1 unit of diluted NPH (or .20 of a unit), given once in the morning. That is an itty-bitty amount, people.
These days she gets 3.5 units in the AM and 2 units at night. And we don't dilute anymore. So why do we still use it? And why don't I hate it like everyone else?
For one, it means less shots for Elise. She only gets 3 per day, and gets to eat 3 uncovered snacks (and no lunch shot since it peaks at noon). Actually, with the way we have her dosage set up, she can pretty much graze (within reason) for most of the afternoon and not have any adverse affect on her BG.
It also means that at school, she can eat her snack and we don't have to worry about someone else giving her a shot, or me needing to go up to school to cover her snack. She just eats with the rest of the kids.
Having used this insulin for over 3 years, I have a pretty good understanding on how it works (in Elise's body) and how to tweak it. When we're not dealing with illness, stress, growth spurts etc., I often see a pretty straight line on her CGM, and we don't get those crazy peaks and valleys. This past week, her BG was between 85 - 150 for three or four days. It was BG nirvana!
And last, Elise's past few A1Cs have been; 6.7, 7.0, 7.0, 7.0, and 6.6. Because of the CGM, we know it's not due to lows. For whatever reason, we get awesome control using NPH and diluted Humalog.
Having said all of that, we would not still be on NPH if it were not for the CGM, which has allowed me to study and gain a better idea of just how the insulin works in Elise's body. NPH is a very unforgiving insulin in that you need to be on the ball and watching the clock for an approximate peak-time. With the CGM, I can see the peak starting to happen and act accordingly.
These days, I cannot imagine managing NPH without the CGM. To me, it would be like flying blind. Plus, I was lucky to be able to become an "expert" at NPH without any other distractions (read: other kids) running around at the time.
We are not going to be using NPH much longer; a move to the pump is imminent. We've done everything we need to do. Elise has given her okay. The delay is due to not knowing which pump to go with. We thought we knew, but some recent issues have changed our minds (that's a different post for a different day).
I just wanted to put it out there that NPH is not all bad. It's not the "evil" insulin like I've been told. It's just happens to be what works for us.
2 days ago