I was wondering if anyone here that is on NPH can give me some feedback as to how they are doing with it.  My three year old is currently on a combination of Humalog during the day and Lantus as night, but her numbers are not great and her endo wants to try NPH.  She thinks this may work better for her until we can get her on the pump.  She did tell me it is very regimented and Shelby will have to eat at certain times every day, which is a concern to me, as she is three and doesn't have the best eating habits as it is.  :-)  Any thoughts or suggestions would be appreciated. 

My daughter just got off NPH. Personally I do not like it her numbers werent any better on it really she had numerous lows on it and not a one on the NPH. I fear the lows tho so my opinion on it might not be the best.

Thanks for your response!  I will keep that in mind.  My daughter tends to run both high and low.  We can't seem to get her to her ideal range and keep her there which is just frustrating to say the least.  The other option was to keep her on the Humalog/Lantus combination and add an additional dose of Lantus in the morning but that means another shot...  Fun, fun!!

I've never used anything but NPH, and I'm just used to it, but I've often wondered if it would be better on Lantus.  But this is all I know.

You know what's weird?  If you go to a pharmacy and ask for NPH, they won't know what you're talking about.  They call it what it's called now on the Lilly bottles: Humalin N.

That is strange about the name too.  Her endo has only ever called it NPH, so that's totally what I would be asking for.  Thanks for the heads up!  :-) I don't know about the difference between the two insulins either.  Shelby has only ever been on Humalog and Lantus since she was diagnosed in 2008, so the NPH would be something new for us. 

I would rather do the extra shot of lantus. With the nph there are so many peaks with it we got lots of highs and lows. Also we use way less levemir than than NPH which she used twice a day anyhow. She was on about 40 units of nph a day and is on 25 of the levemir only once a day.

Personal opinion after years on MDI with NPH. Chasing the lows is a real pain in in the but. 

NPH is old school. I think getting he MD to loan you a CGM for a week or so should be a first step before going on NPH. It is unpredictable and really needs to be watched for hypos. 

Thank you all for your input. :-)  I think I am going to go with the extra shot of Lantus.  Shelby gets low on a pretty consistent basis now as it is and she doesn't eat well either, so if the NPH seems to contribute to more lows, I will stick with the Lantus.  She is supposed to be trying the pump the week of the 4th of July, so hopefully that will work out for her.  Diabetes is a tough disease to manage, that's for sure!!! 

I think you're on the right track -- I'd avoid NPH with a young child if you possibly can b/c it has bigger peaks than Lantus, which stays "flatter" throughout the day. Splitting my Lantus into 2 doses a day really helped me when I did it a few years ago. NPH only lasts 12 hours, so you'd be required to do 2 shots of that anyways.

I'm surprised to hear endos are still recommending NPH for T1's! I didn't realize people still used it...

Hi Amy,


For starters....when I was 3 I was on NPH and regular...very regimented eating schedule. i think it was tough at times, but it was all i can remember now and there were times here and there I could have "unscheduled" meals and it was not the end of the world. but, you do have to account for how Shelby eats...if she is a grazer, or fights you and absolutely will not eat at certain times that could be tough.

My diabetes educator suggested something similar that I did. I am now on the pump, but I did the Lantus/Humalog routine for a while. For a bit in there I would take my Lantus dose, and take the prescribed amount of NPH 30 minutes after, and it actually did help, but I was allowed to eat whenever I wanted still. I was 20 at the time, so I am not sure if that's a possibility with kids, but it's something to bring up maybe.


I agree with Jen and some of the other guys. NPH works fine, but it's hard to live with the schedule it requires. I often got waaaay to low when I was a kid because of that NPH/Regular regiment. I like my Lantus (in place of NPH) and Novalog (same as Humalog prettymuch - works a bit faster and may be a bit stronger) much better because I feel it allows for more flexibility. But, I only had to take care of myself, so it's hard to know what would work for you.

Hi Amy,

My son is 2yrs and 7 months and is on NPH(NOVALIN) and novalog & Lantus at bedtime!  Soooooo,  I give him NPH and Novalog at breakfast time @ 8am.  The NPH starts to work 1-2 hours after it has been injected...kicks in real good at 12:00 and peaks somewhere from 6-8 hours for dinnertime numbers.  My son seems to peak a little later about 9 hours.  So on the NPH they need a 10 am snack to cover the NPH kicking and a lunch at 12 consisting of 35 carbs for him and then a 2pm snack to cover right before the peak of the insulin.  The snacks are 15 carbs.  For example Sawyer has a yogurt or a bag of chips, biggie for a picky eater.  I did take my son off the evening NPH because I did not like the fact of him peaking while I was sleeping so therefore if he was not at a high enough number he would have a low.   He gets his lantus at dinner time (5pm) religiously and it works creates a nice basal for his other two insulins.   

The great advantage is my son only gets two to three needles a day!  Another pointer is that you'll have to learn what a good number is before he peaks so that your child does not go low.  For example, at dinner I like Sawyer around 260 because he peaks and is about 130.  Sawyer has great A1C numbers and I contribute the balance of all insulins to these great numbers.   

Please touch base with any questions; my son was diagnosed on May 2 so we are almost a year using NPH so I could be of help.

I am going to talk to Shelby's endo Tuesday about the changes, but my thought now is to just stick with the extra shot of Lantus. Since she's already on Lantus and will be going to the pump in July, I think it's easier to just stick with what we know for now.  July will be here before we know it!!  Thanks again for all the input!

Amy has the endos office taught you guys how to self adjust and look for patterns in her numbers?  Our office taught us how to do it at the 6 week mark, we can always call them if we have a question but it helps with how kids change so fast if you know how to do it.  What time of day is she getting her lantus? If at bed time what are her morning numbers like?  If she is waking up with good numbers and had no snacks or novolog during the night her lantus is more then likely at the right amount.  She might just need her insulin to carb ratio fixed better. Its just something to ask your doc about.  The other thing I have learned on in the 3 months we have been doing this is the way fat cause delayed release of the carbs.  When Cassidy has pizza it can really mess with her sometimes.  We dose right for it but cause the fat delays the carbs about 4 hours down the road we will be seeing spikes from it, that we have to correct.  Hopefully you guys can get her figured out.  Good luck.

Sounds like a good plan - I was on NPH when that was pretty much the only option, and it was horrible.  Control was difficult, and it's hard to eat the same number of carbs at the same time everyday.  There's no flexibility.  Lantus seems like a huge step up, although I was never on it.  I started my pump before they came out with Lantus.  I've heard Levimir can sometimes be a better insulin than Lantus though?

My daughter is on Levimir. We were told the only real difference is the PH levels in Levimir are lower than Lantus so it stings less and its closer to 18-20 hours than 24 like Lantus.

Just wanted to give everyone an update - I met with Shelby's endo and we are going to try waiting to check her BG at 3 hrs instead of 2 like we have been doing to see if that makes a difference.  If not, we're going with the extra shot of Lantus.  :-)

Sounds like a plan! (:

When I split my Lantus from 1 to 2 doses, it got my a1c's down from the 7's to the 6's, so I'm a true believer. (: (Not that you'd want a child's a1c that low of course)

I didn't know that NPH was still made, I thought it went the way of pork and beef insulin!

Like above, the Levimir may work better than the lantus, I had problems with site irritation after injecting it back when I was doing MDI.

I use lantus when I go off my pump for all day sport events and I used lantus humalog regm before going on the pump. When I lantus all the time, and now on the days I use it, I have to take 2 doses. The doc's and I had to play around with it a bit as just because it says it last for 24 hrs everybody is diff. I would take about 1/3 at night and 2/3 in the morning. I agree with the other post on adjusting the dose and looking for patterns. I was on NPH for the first 3 years as a T1 and the NPH was just way more work than others, such as, lantus. Good luck with this :)