5,000 Deductible


#21

I started pumping with Regular insulin in pump. It will work. However, with 670 auto mode there may be more issues due to its learning mode.

I get my Novolog at a much lower price using one of the savings cards, in addition to my insurance.


#22

Thanks, I’ll try that.


#23

I had my ways of getting it beforehand but I would have had to pay full price yes.


#24

So sad! That is terrible.


#25

OMG, @MM1, I have always wanted to know about pumping with R. Did you notice anything to be very different (except maybe some dosage adjustments). Do you have any other information about that experience? Big change in dosage on R? Less predictable BG results? Exactly the same? I’ve always wondered if we are on the expensive stuff, just because its expensive. Whats your instinct on that?


#26

I’m interested in knowing more too. Dr. Bernstein recommends MDI bolus with Regular and says if you need to use Novolog or Humalog, to remember to cut it back by half. That tells me if I want to use Regular, for bolus injections rather than using my pump to bolus, I’d need to use twice as much Regular and I would need to prebolus earlier. I am very interested in hearing more from someone who uses it in a pump. @MM1 perhaps you could start a new topic on the subject?


#27

Rapid acting analog insulin (RAAI) formulations did not come on the scene until 1996. I used insulin pumps with Regular insulins from 1987 until I switched to Humalog in 1996. I remember using pork, Humulin and Velosulin Regular insulins.

I don’t remember any significant dose size changes but the slower onset and peak and longer duration did mean that you had to mind insulin stacking more and a longer pre-bolus time. My control was not as good as with the modern rapid acting analog insulins but it was good enough. I would definitely consider using Regular in a pump if I no longer had access to RAAI formulations.

I would much rather use Regular in a pump than to deal with NPH. I had some nasty lows with NPH. It had a peak and you better be eating when that peak arrives or be sitting in hyperglycemia. To make matters worse, that peak did not always come at the same time, sometimes 6 hours, sometimes 5.5 hours, sometimes 5 hours. Some people were able to use NPH successfully but I was not one of them. If I had to use NPH again, I would inject it three times per day and set alarms on my phone to alert me to its nominal peak action.


#28

I started pumping in 1996 or 97, with Regular, switching from using NPH, REG injections prior to pump.
At that time, no CGMS, and meter BGs were only recommended 3-4 times per day, for bolus calculation. With pump, I was taught carb counting to use with bolus wizard. Prior to that used meal exchanges which were constant for each meal, to match the static NPH, REG dosages prescribed. Patients were told not to adjust dosage or meal plan servings. This is what made the pump so appealing, to have less strict meal times and choices.

Regular has much longer time to kick in, and lingers in system longer. So it was common to go 200+ after every meal, but come down 5 hours later, unless you were eating the next meal already.

I was not doing lower carb at that time, and A1C averaged around 8-9.

Exercise was also more challenging due to duration of Regular. At time of suspend or reduction, it takes longer to take effect. So most times just supplemented food instead of temp basal.

I think I was switched to Humalog about 2-3 years later, and was able to reduce a1cs and have more flexibility.


#29

Note - Dr. Bernstein’s recommendation to use R rather than the analog insulins is based on the assumption of adopting his entire system. Yes, the onset of R is slower and lasts longer, but if you are eating a very low-carb diet and depending primarily on protein (and associated fats) for the bulk of your calories, the glucose created in glyconeogenesis will hit the blood stream much later than it would when you consume carbs, and BG levels would remain higher for longer. For that reason, the slower/longer R makes sense. (Dr. Bernstein does not generally recommend NPH.)

All that being said, when the reason to use R/NPH therapy is because of cost saving, the much earlier boluses and very rigid meals and meal times becomes essential.


#30

I agree you have to prebolus earlier with Regular. I do not agree on the “cut back by half”.

I transitioned from NPH Basal+Regular MDI to Lantus Basal + Humalog MDI and total units basal, total units bolus stayed exactly the same. The timing for bolus changed a lot.


#31

@Tim12 Thank you for your input; it helps!

I believe we’re all unique beings and what works for one, may or may not work for another. I do believe Dr. Bernstein has a handle on dosing regular insulin with MDI (he’s using Levemir as the basal) - using his experience (personal and patient-base) to suggest starting points and then adjusts from there, using the law of small numbers. One example of his insulin strength theory is from here:

NO (Novolog) and AP (Apidra) insulins are about 50 percent more potent than regular ®, the only remaining rapid-acting, true human insulin. Humalog is about two and a half times as potent as regular. Bernstein, Richard K. Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars (p. 364). Little, Brown and Company. Kindle Edition.

Someday I would like to try using regular in my pump as a single insulin (like I do now using Novolog), but it’s not in the cards in my near future. I’ll recall this conversation and keep it in mind when I do attempt the change, knowing if there isn’t any change (by using half as much insulin), I’m not alone! Thank you again for your input!


#32

My 20 yr old daughter has used Humalog, Novolog & Apidra. They all work very differently for her. She’s never had any signs of allergies or site reactions. Humalog requires an earlier prebolus & lasts longer. Apidra worked much faster & her BGs were smoother overall. Due to insurance, she’s used Novolog the past 4 years.

Due to issues with her new endo’s office we’ve had recent experience with R (no Rx=no Novolog). She used her remaining Novolog for basal through her pump & used R by injection for meals. We started with 80% of the Novolog dose (recommended by Dr Steven Ponder
https://www.sugarsurfing.com/single-post/2017/09/25/Changing-insulins-during-a-disaster). The first day results were disappointing, with post meal BGs remaining >200. The 2nd-3rd days we increased to 90% with slightly lower BGs but still not at goal. The 4th day we increased to 100%. Her post meal BGs were acceptable (100-120), it just took longer to get there (DIA was approx 7 hrs according to her CGM). I should mention she has insulin resistance due to PCOS. Her I:C is 1:3 for breakfast & 1:5 for other meals. Her meals are limited to a max of 20g carbs. Most days she eats 2 meals & sometimes an evening snack. I’m grateful she eats low carb. I would hate to see what the results of a high carb meal would be with R.


#33

I completely disagree with Bernstein’s theory about activity differences at that large level. I saw no dosage difference going form animal regular to human regular (Humulin) for bolus. I saw no dosage difference going from human regular to humalog for bolus.

I certainly did observe a timing difference between regular and Humalog.

Now if someone told me their dose of Humalog was 20% larger or smaller than Regular or the other way around, I would believe that. 20% change in dose isn’t completely in the noise and it’s something that most T1’s would very definitely notice when it happens.

There may be some folks who are somewhat allergic to animal-source regular, or even Humulin, and they may very well see a 250% effectiveness boost like Bernstein describes switching to Humalog. But I cannot believe it happening in general.


#34

Have you looked at Walmart for test strips? I found my contour test strips are considerably cheaper than through my insurance when I purchase them in bulk mailorder.


#35

check out Livongo.com. They provide a full set of test equipment - meter, strips, lancets for a relatively low price. They also monitor your test results and text you with guidance when you’re high or low.


#36

I always believed this, too, but more people than you might think have done or are doing it. I’ve been in contact with people in my D groups on FB who are using it now. You have to adjust your pump settings to account for the longer active time, and you still have to eat to the insulin, bolusing well ahead of time and sticking to the plan of when and what you’re going to eat (with your fingers crossed), but it is doable. A PITA, but doable.

As an emergency backup I think you’re definitely better off using R in your pump than having to resort to N for “basal” (which it isn’t, really). It’s the R/N combination that is really the pits because of the unpredictable things that can happen as one starts coming on before the other wears off, difficulty of carb counting when IOB is so hard to predict and so on.


#37

We switched from Humalog to Novalog (because that’s what insurance wanted). The Epi-pens were about $1,200 so I didn’t pay the bill (deductible $2,700 which has now been hit but then it wasn’t). CVS recommened I call the doctor and I did - Dr’s office gave us 3 epi-pens and by the time we used them up the deductible was met.

As for coupons, I have one for Levemir and it knocked almost $400 off the price so those do help.

Our meter is a Verio One Touch and strips were getting expensive (we are pretty new to T1D, our daughter was diagnosed in March). CVS again told me I could get a prescription for them and ended up paying only $30 for 600 test strips which was a big help (100 strips normally run $75-$100). Now that we are on the Dexcom G5 we use wayyyy less strips.


#38

Yes I used to have a 1,500 deductible. Those were the days when I could just meet the deductible. I hated it so much and now I long for it. I shouldn’t complain though, Canada insulin is certainly doable and I’m looking forward to finding other great ways to save. As I’ve calmed my anger and delved into it I’m actually surprised at the savings I’ve found and that makes me even more confident that I could absolutely survive without insurance.


#39

Absolutely. 100%. Insurance is good. It is the only protection one can have for the unknowns in life and should be tremendously valued as such. Everyone here knows they have diabetes. If anyone is convinced that their diabetes requires insurance or it itself will kill them then they are in a very bad and dark place…


#40

Do you mean not having insurance at all, or just choosing to get your diabetes related expenses without using insurance ?

I was diagnosed with cancer a few years ago, and would NOT want to be without insurance if something like that happens again.

I had a trip to ER earlier this year for a kidney stone. That visit, hospital charges, dr visits, charges from radiology/imaging services, etc totaled over $25,000 billed. With insurance it was knocked down to about $4000 allowed charges. The good thing is it used up my deductible, so now my diabetes related stuff I pay only the 20% co-insurance for my part, for the rest of the year.