Stacking?

I’ve started to notice a pattern, in that my daughter’s BG will start trending high, so we increase the insulin. It stabilizes, usually giving us great numbers for about 4 days, and then starts to trend lower. We cut the dosage, it takes a day to get caught up back to good numbers, stays good for a few days, then trends high again. Rinse and repeat.

I was attributing the swings to isolated events like illnesses sending her higher, then her getting better sending her lower, and it could be that, but:

It’s happened enough now that I’m wondering if this is the result of insulin building up in her system. Is there a residual amount that lingers past the 12-16 hrs mark (we’re on Novolin N), so that shot 1 was still a bit active when she got shot 2, and that left even more residual, active insulin when she got shot 3, and so on, until she has enough “extra” in her system to send her low?

So when we cut her back, we have to give less than she needs, to compensate for the residual, but since now we’re giving less than she needs, eventually the residual gets used up and she trends high again?

Did that make any sense at all? I will call the CDE, but until I can talk to her, what do you guys think?

Yes, I think you have it right, or at least on the right track. You are also correct in your thoughts about an illness causing her to go high - or more correctly that she needs more insulin to help her body cope with its extra work of fighting the illness / infection.

It has been many years since I have used “N”, but I recall that the overlap of shots was causing me some problems - some overlap is necessary for full 24 hour coverage because a dose of N does not begin immediate action. I’m assuming that your daughter’s body is small and that she is new to insulin so even a slight increase in dosage would have a big effect - so use caution and only change one of her daily doses at a time, watch BG tests closely.

If she is severely ill, you may need to use a “sick day” protocol - her nurse or doctor will provide direction.

hi @srozelle,

the little information slip with the micro print will tell you that N is good for about 17 hours. There are “pharamcokinetics” reports that suggest it hangs out longer in some people, even longer than 24 hours. so my opinion is yes, I understand you and yes, it could stack. Honestly, I never liked the way N peaked unless I was eating Pizza, but it was something I needed to put up with until they made a better basal insulin.

The CDE may not be allowed to offer opinions (the way we will) so good luck I hope they can offer something that works for you and your daughter. in retrospect I feel better off the NPH and with either a pump or MDI (lispro analog at meals and glargine). the answer may mean more injections.