Ultralente Questions

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Question:

Thanks Marilyn, <snip I test at least four times daily – that’s how I knew that I was having hypos early in the morning. That and the rebound later in the morning.

Robin, Unless you actually wake up when you are low, it is difficult to tell the difference between a low during the night and the dawn phenomena or the failure of the NPH to cover your basal needs. The best way to document what is happening is to set an alarm so that you can test at 3am (or whatever time you think your NPH is peaking). On those nights, be sure to test before you go to bed and then when you wake up as well. This may be just enough proof to show the doctor that the NPH is not doign what it is supposed to. Thanks for the link. Dr. Hirsch is outstanding! I know people that are lucky enough to actually have him as a doctor. It looks like the best UL regimen is to split the dosage in two – I tried it years ago with just one dose and it didn’t last a full 24 hours for me. I’ll go back to the doctor soon armed with this information and see if we can work out a solution.

If you don’t mind being the first to try new things, you may want to ask about Lantus, the new insulin that is supposed to provide 24 hour coverage. Marilyn

Response:

If you don’t mind being the first to try new things, you may want to ask about Lantus, the new insulin that is supposed to provide 24 hour coverage.

any of the UL insulins provides 36+ hours of action. problem with "human"-UL is that it’s "peaky" and needs to be used 2x/day. say 2:3 "morning":bedtime with rigid 12 hour spacing. fwiw, i’m *still* waiting to see a decent detailed study that does a head to head comparison of Lantus vs. "human"-UL. then too, let’s not forget the Lantus guinea pig issue! bill t1 since ‘57, beef-L 1x, simple MDI; squeak! squEEK!! p.s. | in thread: "Activity Curves (Was: Changing from NPH to Ultralente)" <big snip || (See Human, Porcine and Bovine Ultralente Insulin, by D.R. || Owens, et al, Diabetic Medicine, July/Aug, 1986, p. 326-329). || || time Pork-UL beef-UL "human"-UL || 0 hrs || 2 .01 inch .00 inch .15 inch || 3 xx xx .30 || 4 .46 .00 .80 || 5 .55 .23 .98 || 6 .62 .25 .98 || 7 .68 xx 1.23 || 8 .68 .30 1.30 || 10 1.01 .42 1.54 || 12 1.17 .52 1.56 || 14 1.33 .55 1.72 (corresponds 0.05 nmol/L) || 16 1.41 .55 1.66 || 18 1.23 .60 1.66 || 20 1.14 .57 1.41 || 22 .86 .49 1.11 || 24 .73 .50 .98 || 26 .65 .49 .92 || 28 .54 .47 .86 || 30 .48 .39 .80 || 32 .48 .39 .74 || 34 xx xx .68 || 36 xx xx .62

Response:

Thanks Marilyn, The information you sent has been helpful. I found another source that you may find interesting because it has info on several insulin dosage strategies: http://www.aafp.org/afp/991115ap/2343.html I test at least four times daily – that’s how I knew that I was having hypos early in the morning. That and the rebound later in the morning. It looks like the best UL regimen is to split the dosage in two – I tried it years ago with just one dose and it didn’t last a full 24 hours for me. I’ll go back to the doctor soon armed with this information and see if we can work out a solution. Thanks, Robin Ferebee

– Hide quoted text — Show quoted text – Hello everyone, I’m a 43 year old Type I (since 1982) and I’ve been having problems lately with hypo episodes around 2-3 am. I take Humalog 3x/day and NPH in the morning and at dinner. It seems like UL is a better solution for me because of the smoother action; however, my GP refused to prescribe it because of an increased danger of hypos. Please share your experiences in switching from NPH to UL, particularly regarding the relative dosage. I would like to take this information back to the doctor and possibly educate both of us. Robin, People usually have the most problems with the insulin peaks. U, when taken two times a day, produces very minor peaks, some may not even notice these. With N, the amount you take may be just right for all times other than the peaks. You have to feed the peaks or you end up being high during the ramping up and ramping down period. This sounds like what is now happening to you. I would think that U would work well for you. Many many people find the U/H routine to be much less problematic since the U provides a more true background (basal) than the N taken twice daily. Has your doctor mentioned Lantus? I did an Internet search to see what I could come up with for you, hoping to find an article that would support the U/H routing. Amazingly, I did find an article that supports what your doc says: http://www.med.umich.edu/lrc/coursepages/M2/endocrine/insulin.html "There are several concerns about using ultralente as the basal dose of insulin. Even if it is administered once daily, the actions of successive doses overlap excessively and unpredictably. The incidence of hypoglycemia is higher with ultralente than with NPH insulin. The long duration of action results in unpredictable hypoglycemic effects, and decreases the flexibility of the regimen relative to meal timing and exercise. The relatively "peakless" profile of action of ultralente insulin, and its persistent presence in the background may lower blood glucose insidiously, such that the counter-regulatory processes may not be activated properly; in a way, it may induce a state of hypoglycemia unawareness. " The key to an intense insulin routine is testing. If you are willing to test and to work at setting the proper amount of insulin, the U/H routine is wonderful. It allows you to skip meals and change meal timing. The U should be taken at the same time each day but the meals, covered by H, can vary not only in timing but in content. With the N, you had to eat to feed the insulin. With the U/H routine you take H to cover the food you eat. The advice to see an Endocrinologist was very good however, I would start with your doctor and ask why s/he is so much against U. Sometimes they will make decisions based upon one article they have read. Maybe s/he has a patient that went on the routine and failed to test and merely wanted to shoot and eat. It would be worthwhile to see what you are dealing with. Marilyn Type 1 for 34 years

Response:

: Hello everyone, : I’m a 43 year old Type I (since 1982) and I’ve been having problems lately : with hypo episodes around 2-3 am. I take Humalog 3x/day and NPH in the : morning and at dinner. It seems like UL is a better solution for me because : of the smoother action; however, my GP refused to prescribe it because of an : increased danger of hypos. Please share your experiences in switching from : NPH to UL, particularly regarding the relative dosage. I would like to take : this information back to the doctor and possibly educate both of us. : Thanks, : Robin Ferebee Robin, It depends, among other things, on the dose you take. I am a type 1 since 1980, 67 years old, moderately active and I take 11 or 12 units of U twice a day, at approximately 6 am and 6 pm. If my bg is good at bedtime and it has been a couple of hours since dinner I notice whether my bg is roughly the same in the morning. If not, in several such experiments, I change the dose of U. H covers meals and snacks. I have found that my U dose goes up a unit or two in the winter and back down in summer, with some variation due to excercise-induced sensitivity. I do not change the U dose based on a single one of my "experiments". My A1c last was about 7.3% as I recall (not too sure, but it was below the "action" level from the ADA and above the goal level.) I occasionally have night time hypos just as I have them occasionally during the rest of the 24 hours. Life is tough. Now let me tell you about my other medical problems…… John Lilley — PLEASE USE IT FOR ALL NON-UNM-RELATED E-MAIL. THANKS. IN FACT, SINCE WE WILL PROBABLY CHECK IT MORE OFTEN THAN THIS ACCOUNT(JOHN IS NOT TEACHING FOR SPRING 2000), IF YOU WANT A QUICK RESPONSE SEND YOUR MAIL THERE OR TELEPHONE (505)672-9539.

Response:

Ultralente has a flat absorption curve, at least in theory, so night time lows shouldn’t be a big problem. (I’ve used Humalog/Ultra for the past couple of years with almost no nighttime lows.) However, many people find that Ultra doesn’t absorb very consistently, which can cause significant BG swings. A better choice at this time might be a new basal insulin called Lantus (see http://www.lantus.com). You only need to take it once a day, and it’s supposed to have a more consistent absorption than Ultralente. Lantus just started showing up in US pharmacies last week. – Rick

Response:

Hello everyone, I’m a 43 year old Type I (since 1982) and I’ve been having problems lately with hypo episodes around 2-3 am. I take Humalog 3x/day and NPH in the morning and at dinner. It seems like UL is a better solution for me because of the smoother action; however, my GP refused to prescribe it because of an increased danger of hypos. Please share your experiences in switching from NPH to UL, particularly regarding the relative dosage. I would like to take this information back to the doctor and possibly educate both of us.

Robin, People usually have the most problems with the insulin peaks. U, when taken two times a day, produces very minor peaks, some may not even notice these. With N, the amount you take may be just right for all times other than the peaks. You have to feed the peaks or you end up being high during the ramping up and ramping down period. This sounds like what is now happening to you. I would think that U would work well for you. Many many people find the U/H routine to be much less problematic since the U provides a more true background (basal) than the N taken twice daily. Has your doctor mentioned Lantus? I did an Internet search to see what I could come up with for you, hoping to find an article that would support the U/H routing. Amazingly, I did find an article that supports what your doc says: http://www.med.umich.edu/lrc/coursepages/M2/endocrine/insulin.html "There are several concerns about using ultralente as the basal dose of insulin. Even if it is administered once daily, the actions of successive doses overlap excessively and unpredictably. The incidence of hypoglycemia is higher with ultralente than with NPH insulin. The long duration of action results in unpredictable hypoglycemic effects, and decreases the flexibility of the regimen relative to meal timing and exercise. The relatively "peakless" profile of action of ultralente insulin, and its persistent presence in the background may lower blood glucose insidiously, such that the counter-regulatory processes may not be activated properly; in a way, it may induce a state of hypoglycemia unawareness. " The key to an intense insulin routine is testing. If you are willing to test and to work at setting the proper amount of insulin, the U/H routine is wonderful. It allows you to skip meals and change meal timing. The U should be taken at the same time each day but the meals, covered by H, can vary not only in timing but in content. With the N, you had to eat to feed the insulin. With the U/H routine you take H to cover the food you eat. The advice to see an Endocrinologist was very good however, I would start with your doctor and ask why s/he is so much against U. Sometimes they will make decisions based upon one article they have read. Maybe s/he has a patient that went on the routine and failed to test and merely wanted to shoot and eat. It would be worthwhile to see what you are dealing with. Marilyn Type 1 for 34 years

Response:

Do, There is not much relearning when you go from U/H to the pump. You already have the basic concepts of basal/bolus insulin down pat with her covering meals/snacks with H. You will just need to work with her on getting the basal set correctly *and* learn the equipment. Good luck to your daughter. I have been on a pump for over 13 years. == Marilyn

– Hide quoted text — Show quoted text – Hi, First of all get a good endo.Your GP doesn’t have a clue.Ultealente does not have the peeks that the others do and is much longer acting than NPH.Talk yo your pharmasist or check back issues of diabetes forcast for specifics.Given what little info I have about your problem U would be a good way to address the problems of late night/early morning lows.The hardest part of switching is realizing that you don;t need snacks inbetween meals since U doesn’t peek out.My 11yr. old daughter is still having probs with that mind-set.She is so used to eating mid-afternoon and before bed she doesn”t want to cover with humalog if she wants a snack.Anyway she will be starting on the pump in a few months and we’ll have to learn everything all over again anyway.The science of diabetes care is changing so fast these days you really need a specialist.Good luck to you.Let me know what happens. Do T2 for 15yrs Hello everyone, I’m a 43 year old Type I (since 1982) and I’ve been having problems lately with hypo episodes around 2-3 am. I take Humalog 3x/day and NPH in the morning and at dinner. It seems like UL is a better solution for me because of the smoother action; however, my GP refused to prescribe it because of an increased danger of hypos. Please share your experiences in switching from NPH to UL, particularly regarding the relative dosage. I would like to take this information back to the doctor and possibly educate both of us. Thanks, Robin Ferebee

Response:

Hi, First of all get a good endo.Your GP doesn’t have a clue.Ultealente does not have the peeks that the others do and is much longer acting than NPH.Talk yo your pharmasist or check back issues of diabetes forcast for specifics.Given what little info I have about your problem U would be a good way to address the problems of late night/early morning lows.The hardest part of switching is realizing that you don;t need snacks inbetween meals since U doesn’t peek out.My 11yr. old daughter is still having probs with that mind-set.She is so used to eating mid-afternoon and before bed she doesn”t want to cover with humalog if she wants a snack.Anyway she will be starting on the pump in a few months and we’ll have to learn everything all over again anyway.The science of diabetes care is changing so fast these days you really need a specialist.Good luck to you.Let me know what happens. Do T2 for 15yrs

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