I won’t be mixing them…
2 Likes
Damn, doc… based on your sketch I’m starting to believe you maybe could have been a real doc;). Thanks for this I think it may be helpful…
2 Likes
FYI we will start a new thread when I actually start doing it, which I think will be a couple weeks
I just wanted to remark how interesting I find it how different the concepts that people are articulating are. I’m an MDI analog and afrezza guy… how to manage basal and bolus is deeply ingrained in my mind of how I learned and how I know to do it… then to hear some explanations of how guys who’ve done R and NPH had to conceptualize it, really makes one think… I remember poking at @Jen about how she was framing her entire tresiba experiment in the psyche of pumping strategies… interesting to me now in hindsight that maybe I’m doing something similar.
We will see. I’ll be starting the approach with an MDI mentality, which in my thinking just hadn’t quite been figured out when most people were doing R and NPH… maybe because those were just the times and tech, and maybe because that just wasn’t what actually worked. I intend to find out.
2 Likes
FWIW, for many years I was on Lente, which is quite similar to NPH, and ancient notes indicate a starting dosage is 0.3 U per kilogram body weight. For a long time I was on one dose a day, later two. I vaguely remember that getting good control around breakfast was nearly impossible. (Not that I tried very hard …)
ETA: And you may find you need to feed the insulin via the old-time mid-morning, mid-afternoon, and bedtime snacks.
2 Likes
Nice! I will be interested in seeing how it goes. I think the last time I used NPH it was in three shots a day—not sure I ever went to 4. It was a long time ago though so I’m not 100% sure. Definitely remember to roll your bottle first like Jen said.
Part of what sucked about it is you had to have a strict diet plan that was the same day to day, so that your peaks from R and NPH matched everything you ate, because you have no way to do any quick corrections or to supplement for meals as they happen. Even if you’re not implementing the exchange diet, you may want to consider implementing some sort of very specific daily diet plan that you expect to match your insulin, and then consider that as the additional variable you can tweak along with the insulin. It’s just not something you want to be tweaking day to day once it’s sorted out.
3 Likes
The main difference between R+NPH and MDI is that with the former you really had to structure your life around the peaks and valleys of the insulin. Insulin that you took hours earlier would peak at specific times, and if you didn’t eat the meal or snack outlined in your plan on schedule, you’d drop really low. Most people didn’t test after meals (or at least I didn’t), because the action of R was so slow that, even taking it an hour before eating, if you tested at two hours you’d be high, yet you’d drop down into range at the next meal without any additional insulin (and even eating a snack in between). There was no “adjusting your diet” because once you had a meal plan that worked, you stuck to it. There was some adjusting of insulin, but nothing like the dose-to-dose adjustment we have today.
The big breakthrough of MDI was that, for the first time ever, people could have a life that was actually somewhat spontaneous and could adjust their insulin doses to eat whatever they wanted and accommodate exercise and other events.
Pumps and the like did exist back in the '80s and '90s, and I’ve read of people using Ultralente to do a sort of MDI-type regimen. So I’m sure it “existed” back then, it just wasn’t what most people did. Maybe because to make it work well on R+NPH It would take 9 shots a day, which most would be unwilling to do (especially kids in school; not having to do shots at school was about the only advantage of the R+NPH regimen for me personally).
I’ll be really curious what you come up with that allows for the tightest control and most closely simulates today’s MDI regimens.
3 Likes
I could see how this would be really tough when it was all timing guesswork before people were checking their bg 10+ times / day and / or using a cgm…
I suspect the intensive bg monitorong that we do Now compared to even what most people did 10 years ago will make all the difference in the world
I hope that it does! But I think the order things went at the time was that better insulin led to more ability to fine-tune doses and hence more testing to facilitate fine-tuning of doses. I only started testing frequently when I switched to Humalog and Lantus and could suddenly aim to keep my two-hour postprandial readings in range. Before that, we actually asked and were told there was nothing that could be done to control two-hour spikes, since R is just not a fast-acting insulin. Hopefully you will find a combination that works between doses, timing, food, and meal/snack schedule.
3 Likes
@Sam, I’m following this experiment with keen interest and applaud your sense of scientific inquiry. Years ago I bookmarked the link below as a safety net. I’m fortunate enough to have my needs being met with insurance coverage. But that can go south quickly. So know, whatever your findings, I’ll be saving the bottom-line, because you never know what the future holds.
3 Likes
This is the issue (or one of many really, but why a CGM may not be as helpful as with modern insulins)—you don’t have any capability to correct things quickly, so having a better ability to track what’s happening may help you adjust your whole protocol for the future but doesn’t offer much in the way of being able to make any in the moment quick corrections, except perhaps via exercise like a T2.
1 Like
If the point is to prove that it’s “not that big of a deal” if you have to switch to R/NPH because you’ve lost insurance then using a cgm would hardly prove that since you wouldn’t have access to a cgm if you couldn’t even afford analog insulin.
I think the major benefit of a cgm with R/NPH would be that you could catch lows before they became a real problem. This technology would be lost without insurance though.
1 Like
@Sam When I started MDI with Novolog and Lantus my doctor told me the reason it was better than Regular and Lente.
He said with R & L you eat to cover your insulin, but with MDI and analogs you take insulin to cover what you eat.
That’s about as succinct and accurate as it gets.
1 Like
Really doesn’t sound that terrible…
Glad you’ll have a cgm to show you when you need to eat so you don’t drop low.
1 Like
Wait until you try it. You may well change your mind, especially if you do it for a few months not a couple weeks.
4 Likes
It means absolutely no flexibility in your eating schedule or portion sizes, doesn’t matter how hungry you actually are. Learning to disregard my internal hunger cues was one of the biggest disservices this approach to diabetes did to me and many others, especially as children/adolescents. It may be less of an imposition on an adult, but for a teen going through growth spurts/hormones that create major variability in hunger (or say, being a naturally cycling adult woman with that same kind of variability across each month), it sucks and can be really detrimental. It’s the exact opposite of what psychologists try to have people do to develop healthy eating habits.
2 Likes
I think few people who have never used this regimen understand how truly rigid the schedule was. Looking at my logbook from back then, I was like a robot. Breakfast at 8:30, snack at 10:30, lunch at 12:00, snack at 3:00, dinner at 5:30, snack at 8:30… Meals weighed and measured out. It was sort of okay until your friends decide they want to meet at a restaurant you’ve never been to for a 7:00 dinner…oh, and we’re going to walk 20 minutes to and from the restaurant. That sort of thing presented a major issue as far as figuring out how to handle it without ending up seriously high or low (not only during the evening itself, but also through the night and into the next morning).
4 Likes
We’ll see… I think that if I can get NpH to behave with multiple small doses I won’t have to be that rigid with eating plan
If only it would work that way.
1 Like
Because everyone here just didn’t know what they were doing while using this insulin…