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RE: [IPk] Re: MDI

Hi Jackie,

I honestly don't know what 'most' people do, as doctors and patients should 
work out what seems best on a case-by-case basis (though, as we all know, 
these are not always or even often the truly optimal soultions!). Perhaps a 
DSN or GP could comment on the consensus among professionals re the 'best' 
schedules for MDI?

When I was last on MDI in 1996, before the advent of Humalog, my regimen 

Before breakfast (c.7:30 a.m.)
Regular + NPH (isophane; intermediate acting)

Before lunch (c.12 p.m.)
Regular (because the NPH was not peaking sufficiently to 'cover' my lunch)

Before dinner (c.6 p.m.)
Regular + NPH

Before bed (c. 10 p.m.)
Some regular if necessary to correct post-dinner BG.

I was never prescribed a longer-acting insulin than NPH (isophane), only 
Regular and NPH. My diabetes educator (i.e., DSN) was rather suspicious of 
the supposedly 24-hour insulins. In some people they actually work for 
closer to 18 hours (or even less time) and in others they might have effects 
for up to 40 hours. She thought the potential margin of error too great: at 
least with NPH one could sort of assume 8-12 hours duration (i.e., +/- 4 
hours), rather than something like 18-40 hours (i.e., +/- 22 hours!).

One could take an extra shot of regular to close a 4-hour gap or reduce the 
amount of a pre-meal regular shot according to the apparent duration of NPH, 
but the chances of something going funny with something like Lente or 
Ultralente seemed too great to my diabetes management team (great euphemism 
for 'doctor, nurse, and dietician' eh?) for them to recommend either to me. 
Also, I was not allowed to mention 70/30 split-mix insulins in my diabetes 
educator's presence--like Pat, she thought them the 'work of the devil'. I 
was taught to combine NPH and regular in the same syringe to spare myself 
the extra tissue damage of a second injection while getting closer to 
getting the right amount of insulin.

As for other insulins I _have_ tried: I used Buffered Regular in my pump for 
the first couple of years I had one (1996-1998) as Humalog was still being 
invented and tested.



Do most people take an intermediate in the morning AND at night, or do they 
have three shots of short acting (Humalog or Novorapid) and then use an 
intermediate or long acting at night.


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