Here's the thing.  You need long-acting insulin.  You are uninsured.  You have limited funds.  You can’t afford Lantus or Levemir.  What can you do?

Well, I’m happy to say, from experience, you can safely use NPH insulin which you can buy from Walmart for $22 without a prescription.  It wouldn’t be my first choice but it can be done and it can be done safely.  So your next question is, how?

• Use small doses
• Use three injections approximately eight hours apart
• NPH has a peak so carefully work the peak into your eating schedule.   

What Doesn’t Work?

 NPH insulin used to be given in large doses once or twice a day which coincided with meals.  But then you had to eat the same amount of food at the same time every day without variance or you had some dramatic high or low blood sugar effects.  From years of experience, most of us NPH veterans can tell you the technique doesn’t work very well, isn’t very flexible and does not lead to good blood sugar control. 

What Can Work?

 Use NPH only as a background insulin as a substitute for Lantus or Levemir.  

What can safely work is to take the total amount of insulin you need (figuring that out I’ll save for another day) and divide it by three.  Determine when NPH peaks for you; in small doses that is likely to be four to six hours.  Position the peaks to coincide with your normal meal times or when you need a bit more insulin working, such as first thing in the morning to counter dawn phenomenon.  Subtract to figure out when you should inject to properly coincide with your needs. 

Example:        For you NPH peaks in six hours.  You eat at 5:00 p.m.  Take your insulin around 12 p.m. so the NPH will peak around 6 p.m. when your food is digesting.  You’ll offset the NPH with Regular and/or a rapid-acting insulin (again another story) but you won’t have a huge low when the NPH peaks because you’ve used a much smaller dose and it crosses a need for more insulin anyway. 

One note … many insulin products tend to last longer in larger doses.  Thus, the smaller the dose the sooner it tends to peak.  This can apply to any long, intermediate or rapid acting insulin product. 

What Do I Do? 

 I was using Lente (a bit longer acting than NPH) up until last year.  I switched to Levemir because they discontinued Lente.  Turns out for $116 per bottle, Levemir only gets me about 8 hours of solid working time and it still has a peak!  I get no more duration than Lente did for $30 a bottle but has a slightly delayed peak. 

So, using two shots a day, I either had to supplement the approximately four hour gaps or go to three doses a day.  I chose to experiment with three doses a day.  I didn’t want to take, nor did I think I needed, more total insulin; I just needed more coverage time.  So I took the 8 units I was taking and divided it by 3.  That got me 3, 2 ½ and 2 ½ units.  That works well.  I take 3 units at 7 a.m., 2 ½ units at 3 p.m. and 2 ½ units at 11 p.m.  I take the extra ½ unit in the morning to cover any insulin resistance from dawn phenomenon.   

Another Tip

Most practitioners tend to tell patients to inject in their stomachs.  For a variety of reasons, I have never used my stomach.  I use my arms and my behind.  I use my arms when I want a speedier absorption or when I'm in public and my behind when I want to slow it down, it doesn't matter or I'm at home.  So, normally, I use my behind for my long-acting insulin.  No reason to speed up long-acting insulin as I see it.  And after more than 31 years, I have no scar tissue on my behind to hinder absorption.  No lumps, no bumps, no scar tissue – seems like a win-win to me.