From America On-Line:
My daughter is presently doing three shots. We are thinking of changing to Ultralente because her 3rd shot is not until 11:30 at night. Any earlier and she drops too low around 3:00 and then is too high again in the morning. Getting NPH at 11:30 p.m. seems to help deal with that early morning rise in blood sugar. This does, however, restrict her and us. (No sleepovers for her and no real late nights out for us.) Plus it is emotionally difficult for me to give her the shot in her sleep. We do wake her up but she is not aware of it the next day. Anyone else with a similar experience?
If I interpret your question correctly, if you give NPH before supper (or whenever 'earlier' is) it peaks in the middle of the night and then its action has faded by morning so that you get high blood sugars. It is possible that the high morning blood sugars are a rebound and that lowering the dose might help. However I think this is unlikely because when you give what I presume is the same dose of NPH at 11:30 pm you get normal blood sugars in the morning. In that case though you have the inconvenience of the 11:30 pm shot. Ultralente at bedtime might work well, it peaks at 8-15 hours and so should cover the morning without causing low levels in the early morning. It would of course continue to have some effect for 18-24 hours. Be sure to talk the situation over with your Diabetes Team before revising her program.
There is hope for a new substituted insulin to be available (in the next year or so) that can be given once a day and is released very evenly over the whole 24 hour period.
Original posting 31 Oct 96
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