My 26 month old son, diagnosed at 13 months of age, takes 1 unit of NPH at 10 pm and sometimes he goes low at 4 am. I was told you can’t adjust the NPH unit amount based on the bedtime (8 pm) blood glucose level. (For example: if over 200 mg/dl [11.1 mmol/L] give 1 unit NPH, if under give 1/2 unit.) I understand that NPH peaks inconsistently, but why can’t it be adjusted?

There are different philosophical answers to your questions. Some people suggest the changes can be made just as you questioned while others think the NPH doses should be the same each evening. It sounds like the NPH is peaking, as it usually does, too soon and not lasting sufficiently long to get to breakfast. You may try giving ice cream at bedtime since the high fat content of ice cream may produce longer lasting food effect and therefore prevent the middle-of-the-night hypoglycemia. Uncooked corn starch in some of the products like NiteBite or mixed with bedtime snack may also provide same slower food effect to prevent nocturnal hypoglycemia.

Some physicians also suggest using Lente instead of NPH at bedtime since it may have a reduced peak or delayed peak compared to NPH at bedtime. We have switched such patients to Lantus (insulin glargine) with good results since the Lantus has significantly less peaking than NPH and much more consistency of effect. You should discuss with your son’s diabetes team.

SB