August 19, 2007

Musings on NPH and the meaning of life.

I sometimes think those of us who frequent the diabetes online world can scare people with heart felt and school of hard knocks experience.

I think at times we leave new people with the idea that they are doing something wrong by following their Doc's instructions and using NPH. That is a mistake (making people feel that way), I am sure nobody has that intent but I think I see it happen, so here are some non negative thoughts on NPH.

NPH worked well for us for the first 3/4 of a year or so for each of our kids.

I have come to see that was successful because the NPH was supplementing partially functioning beta cells that could make up the difference but not carry the load of insulin production.

So, I see it as a judgment call to go with more injections in a basal insulin (Lantus) and bolus program vs. initially fewer injections with a program using NPH. Most of us are in a newbie state of shock about giving shots at all, and are not really in the best place to make an informed choice about more vs less shots and insulin curves at diagnosis. I can't fault a Doc for an initial NPH program, particularly with a needle phobic parent, like I was.

Part of the art of medicine is the whole patient thing. It is appropriate and correct for the care givers to consider the stress of giving shots and the patient reaction to that.

I think it is important that as we become experienced, possibly opinionated, professional diabetes parents (PDP someone get me a copy right on that!) that we keep in mind where we came from. I had a hard time with shots at all at first. I would have had more stress with a Lantus program with a basal insulin for every thing the kid ate. Maybe just Lantus would have worked. I can’t say.

What is important is getting on insulin and learning to manage it. That is a life saving change. Once you have done that selecting different management tools like insulin, pumps, pens etc is about convenience and incrementally better results. Life saving vs. incrementally better.

There isn’t one person on any diabetes web board who wouldn't use NPH tomorrow if the world supply of Lantus and or pumps disappeared.

As PDP we need to keep in mind that holistic thing and that some of us (ME) were needle phobic (kind of funny to think that way now.) NPH may not be the cutting edge but it is a lifetime better than the no insulin at all of a hand full of decades ago.

I, for one, am perfectly content that using NPH was a good first step for us. I am also comfortable that moving to a pump was something we were ready for but it may not be right for everyone all the time. I hope there will be advances that provide us with other and for us better approaches in time.