October 11, 2000
Daily Care
Question from Oshkosh, Nebraska, USA:
I’m 54 and have had diabetes for 15 years. I currently take 25 units of NPH each morning, R before meals, and 5 units of NPH at dinner. I’ve experienced three serious insulin reactions this summer and want to avoid them in the future. I have what my doctor describes as “brittle” diabetes, and, despite constant monitoring and adherence to diet, I can’t control the huge variations in blood glucose. Would Ultralente be better than the NPH I’m taking now?
Answer:
Insulin therapy nowadays places more emphasis on the use of short-acting insulins such as Regular and lispro compared to reliance upon longer-lasting preparations such as NPH, Lente, or Ultralente. This is mainly because the absorption of all the slow acting insulin has been found to be highly un-reproducible (Ultralente was the worst one), thus leading to wide fluctuations of insulin acting in the blood and unpredictable low blood sugar levels, often without symptoms (hypoglycemia unawareness).
In my experience, I’d advise you to change to a more intensified insulin regimen with multiple injections. Ask your diabetes team or your doctor for more help.
MS
Additional comments from Dr. Donough O’Brien:
The term, “brittle diabetes” is not used very much anymore. In the past, it was used to describe diabetes in which there were unpredictable and inexplicable fluctuations of blood sugar levels. It was not a specific type diabetes.
DOB
[Editor’s comment: Your situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. (See The Continuous Glucose Monitoring System).
If you are not currently being followed by a diabetes team, I would suggest that you find one. The diabetes team will have all of the tools available to help you sort out what is going on and then to provide you with options for optimizing your control. This might well include an intensive insulin regimen, as Dr. Songini suggests, or insulin pump therapy. For more information about insulin pump therapy, please see: Is pumping for you?.
SS]
