Is NPH insulin dead? Of the 211 8 to 15 year olds attending diabetes camp this week, a mere 12 (5%) of them used an insulin regimen that included some form of NPH insulin (i.e., the cloudy one). Basal-bolus insulin regimens (e.g., Lantus-Humalog or Levemir-Novolog) have all but killed the older split-mixed insulin schedules (NPH-Novolog/Humalog in AM, Novolog/Humalog in PM and NPH at dinner or bedtime).

But there is more to this story. NPH never really had many strong advocates (or funding) over the last couple of decades. It was considered to be too unpredictable (and this is somewhat true). With the emergence of analog insulin preparations in the late 1990’s such as Lantus and later Levemir, the die was cast. These new insulins were empowered by large amounts of money in their respective pipelines; NPH had about a snowball’s chance in west Texas on a summer day. Numerous studies, many funded by the parent companies of Lantus and Levemir, dealt blow after blow to NPH’s clinical usefulness (at least compared to these new kids on the block). Armies of sales representatives descended in mass on physicians’ offices across the country armed with samples and literature on these agents, or through medical conferences for doctors that highlighted the incredible virtues of these new and improved insulins over the old and obsolete NPH.

But by my direct observations at diabetes camp this year and over the past several years, there may still be a role for NPH to play. I could not help but notice that many NPH using campers actually as a group had better control than did groups of campers on pumps or basal-bolus insulin schedules, at least based on the A1c levels. It begs a big question as to whether this insulin should really be put out to pasture. I use NPH in my practice as one of several tools in my diabetes armamentarium. To exclude it altogether is, in my opinion unwise.

Today’s Diabetes Challenge Question of the Day asks: What role (if any) should NPH insulin play in the management of persons with type 1 diabetes? Should NPH insulin be discontinued altogether? Cite any examples to support your position one way or the other. How many of you don’t even know what NPH insulin is?

Wrapping up

Camp will be over in about 24 hours. The webinar was a success last night. I look forward to meeting with Parents over dinner on Friday evening at 5:15 PM in the dining hall. It has been a pleasure leading the team that cared for your most precious family assets. I hope you will consider the Texas Lions Camp in the future, and refer others to our program so we might serve them.

Last 5 posts by Steve

• Halloween and Diabetes CAN mix! - October 5th, 2009
• Introducing Healthy Families of South Texas - October 5th, 2009
• Complications 101 - About Kidney Failure - August 23rd, 2009
• The Sleep Bolus - August 18th, 2009
• The Dirty Truth Behind DCCT - August 16th, 2009

This entry was posted on Thursday, July 30th, 2009 at 8:08 pm and is filed under TLC 2009. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.