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August 31, 2003

Daily Care, Insulin

Question from San Jose, California, USA:

My blood sugars are running 140-180 mg/dl [7.8-10 mmol/L] before eating breakfast (7:00 am), and I take NPH between 10-11 pm to help reduce increasing blood sugar while asleep. At what time would you expect the NPH to be in full swing? Can you recommend an injection time for NPH to help deal with night time increases in blood sugar?


The typical onset of NPH is approximately two to four hours, and it has a duration of six to eight hours. The rise in glucoses in the morning could be because the NPH is not lasting the entire night or could be due to the dawn phenomenon which is caused by an increase in counterregulatory hormones. These are glucagon, somatostatin, and growth hormone, which are secreted by the human body naturally, generally in the early morning hours (3:00-5:00 am).

You could move your NPH closer to midnight, but later than that could lead to hypoglycemia. You might want to discuss the use of Lantus which that does not have the “peaks and valleys” so to speak as NPH does. This insulin has been developed to provide background or basal insulin coverage and is formulated for night use. Another alternative is an insulin pump, but I would definitely discuss this with your specialist before making any changes.

Also, I would check a glucose in the middle of the night (2:00-3:00 am) to make sure that it is not low, and the highs you are seeing are a response to nocturnal hypoglycemia which is a common problem with patients using NPH or Lente.