Humalog/NPH interaction

My grandson is a Type 1 diabetic.  He takes Lantus at night, NPH and Humalog at Breakfast, and Humalog at evening meal.  He measures his blood sugar six time a day: 7:30am (breakfast), 9:30 am, noon, 5:30 pm (dinner), 7:30 pm, and 9:30 pm.  My concern is the apparent difference in effectiveness of the Humalog which he takes at 7:30 am and 5:30 pm.  He measures his blood sugar two hours after taking the Humalog (@ 9:30 am and @ 7:30 pm).  Over a seven week period his 9:30 am reading has averaged 214 and his 7:30 reading has averaged 113).  His physical activity during the 2 hour periods after taking Humalog are about the same.  The dosage criteria for Humalog are about the same (He takes one unit of Humalog for each 10 carbohydrate grams in the morning and one unit of Humalog for each 12 carbohydrate grams at dinner).  The only other difference is that he takes NPH at the same time as Humalog in the am and does not take NPH at the dinner meal.  The other difference I have noted is that readings 70 and below occur more often at the noon reading than at any other time.

My suspicion is that the NPH taken in the morning delays the action of the morning Humalog thus causing a higher reading at 9:30 am. and an inordinately low reading at noon since both Humalog and NPH are active then.  Am curious to know if others have had similar experiences, and if so, what might be a solution to the problem.

[JDRF-Team-wak]

I am not a physician, but the mom of a type one diabetic, and a volunteer.
When our daughter was on NPH and Humolog we had the same problems at first, but we discussed the numbers with our daughter endocrinologist and adjusted her dosage at the time.  The reason for this is that each person reacts differently to the different types of insulin

[Markie]

The most likely reason for your grandson to be high 9:30 am is the dawn phenomenon. Raised levels of hormones cause glucose to be released into the blood stream and simultaneous insulin resistance. The results is that blood sugar levels increase, in spite of higher levels of circulating insulin. The effect starts at about 3am and continues until around 11am.

You can try increasing the pre-breakfast Humalog dosage. The drawback of this is that Humalog is very short-acting. And getting the timing right is hard. You could also try injecting NPH before going to be instead of in the morning. It's action would peak in the early hours of the morning and waer of before lunch. And a Humalog injection before lunch would be required.

Cheers,

Mark

[JDRF-Team-LRS]

As Markie says, the dawn phenomenon is a likely culprit.  I'm not a physician, but as a long time diabetic, that'd be the first thing I'd check, too.

Many of us need a different ratio in the morning than at other times of day and it's an easy thing to check.  In addition to considering how many carbos are in our meals, we need to consider our beginning blood sugar.

FOr example, if his meal has 60gm of carbos and his blood sugar is within his target, he would take XX amount of insulin.  If his blood sugar is, say 50 points higher than his target, he needs to know how to include a correction for that in his dosing.

A person whose ratio is 1:10 "all day long," might begin to adjust the morning Humalog by using a ratio like 1:8 for a few days (and make adjustments for too high/too low starting point).

Hope this helps.  Good luck.