Humalog -vs- Novolog (for Toddlers)

So, after hearing some people recommend Novolog over Humalog for our 2 year old, I started researching the two to see the differences…what I found confuses the crap out of me…maybe someone here can explain why our Endo prescribed Humalog in the first place??

So, according to the website “Healthline.com”, Link

“Novolog can be used by adults and children at least 2 years old who have type 1 or type 2 diabetes. Adults and most children with type 1 diabetes can use Humalog, but the drug hasn’t been studied in children younger than 3 years. Adults with type 2 diabetes are sometimes prescribed Humalog, too.”

So, I went to the Humalog website to verify this information. When I looked up the Full Prescribing Information, here is what it reads, Link

“Pediatrics: Not studied in children with type 2 diabetes or in children with type 1 diabetes <3 years of age.”

"8.4 Pediatric Use
HUMALOG is approved for use in children for subcutaneous daily injections [see Clinical Studies (14)]. Only the U-100 formulation of HUMALOG is approved for use in children by continuous subcutaneous infusion in insulin pumps.

HUMALOG has not been studied in pediatric patients younger than 3 years of age. HUMALOG has not been studied in pediatric patients with type 2 diabetes.

As in adults, the dosage of HUMALOG must be individualized in pediatric patients based on metabolic needs and results of frequent monitoring of blood glucose."

So, I’m wondering why the hell we would have been prescribed Humalog over Novolog in the first place for our 2 year old son??? Am I just missing something here?

So I wanted to start a thread to:

a) Figure out, collectively, why you think our Endo prescribed Humalog over Novolog before I bring this up to the Endo team, and …
b) Get your takes on the pros and cons of Humalog -vs- Novolog.

I’ve already read that Novolog is more fast acting than Humalog, but from all I can tell they’re about the same price.

I’m confused because Novolog IS approved in children younger than 3, it’s faster acting, and it’s equivalent in pricing…

Does this boil down to an insurance issue? If so, what do I have to do to get on Novolog instead of Humalog? Earlier I heard I may need to prove that Humalog isn’t working? If that’s the case, seeing my numbers, and hearing what’s going on with my toddler, do you feel that Humalog maybe ISN’T working?

Thanks beforehand as always!

You need to ask you doc why and discuss the concerns and options. And then ask for a new RX for Novolog. Do check with your own insurance to learn what is covered.

Hopefully someone more knowledgable from the toddler perspective will weigh in, but meanwhile, from an adult T1 perspective: experiences with Humalog vs Novolog seem to vary widely. There clearly are some people who react to them very differently, but my impression is that for most people they’re pretty much indistinguishable. I’ve been back and forth between them and couldn’t detect any difference in terms of how fast they worked or side effects (none). I suspect the “not studied in children… with type 1 diabetes <3 years of age” means exactly that: not studied. I don’t think that equates to “not recommended.” Again given their broad similarity in other populations, the prescription may simply reflect the vagaries of pharmaceutical insurance. That’s not to say it isn’t worth exploring the alternative; like I say, there are posters here on TUD who are very averse to one or the other so it’s not impossible that your kid is in that group, but I think it’s more the exception than the rule.

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I can answer your questions from an insurance perspective. Some insurances do have preferred brands. Those drugs are lower tiered and the insurance company may have contracted for a better rate for those drugs. Insulins are kinda iffy. Some insurances there really isn’t any preferred choice, others there is. At one time my insurance wouldn’t cover lantus unless you had tried and failed Levemir. Essentially a failure is defined as 30 days of less than desirable results and samples by most plans are not considered to be part of the treatment. I would say your son’s results would constitute enough concern they would be accepted as a trial and failure of Humalog. You really need to check your plans prescription coverage, see if there is any trial and failure of one before we’ll cover the other. Doctors sometimes prescribed based on preference. My endo prefers Humalog over Novalog. Likes Lantus over Levemir, so as long as there is not kick back from insurance, that would be the starting medication. If it didn’t work, then would adjust and change from there.

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Humalog is not unsafe to use in toddlers. I suspect insurance coverage had a lot to do with why your son’s endo prescribed Humalog. My daughter started out with Humalog, then she switched to Novolog. I was hoping for a faster onset of action so she wouldn’t have to wait as long between pre-bolusing and starting her meals. As far as my daughter’s experience, there was no difference between Novolog and Humalog. Next, she tried Apidra and is still using this rapid-acting insulin analogue. It works well: onset of action is much swifter and DIA seems to be shorter, which I believe helps avoid some potential problems with stacking. But the different insulins behave differently for everyone. YDMV!

Ok. Thanks everyone!

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Bear in mind that not having FDA approval simply means it hasn’t gone through the required studies, nothing more.

My daughter was started on Humalog & Levemir at dx. The following day she was transferred to a nearby peds hospital where they immediately switched her to Novolog, NPH & Lantus. Why? Because the ped endo preferred those insulins, while the dr who dx’d her wasn’t prescribing Lantus at all & wouldn’t have even considered NPH for a child. 2 months after dx, with a new endo we again were switched. This time to Levemir, NPH & Novolog. Over the years we’ve used whatever the insurance prefers. When our plan changes, the first thing I do is check the formulary to make sure what we’re using is covered.

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As noted elsewhere in the thread, rules of thumb like that need to be taken with a pound of salt. If there’s one indisputable truth about diabetes, it’s that each person’s reaction to things (food, medication, exercise, phase of the moon, etc.) is potentially (and often actually) different from the next person’s. There’s an acronym for it: YDMV (Your Diabetes May Vary).

So a statement such as “Novolog is faster acting” may be true for the person who says it, but not for you or someone else. Example: the majority medical belief is that all three of the fast acting insulins (Humalog, Novolog, Apidra) are pretty much the same in this regard. Well, not for me. Novolog takes almost 30 minutes to begin working, Apidra takes about 15, and Humalog doesn’t work at all. I mean, not at all. May as well be a placebo.

Thus the only real, dependable answers to questions like that have to be determined, empirically, by each user. To make it even more annoying, these things change over time, because our physiology changes over time. It’s obvious that children’s bodies are constantly changing, but it happens to adults too; usually not as often or as fast, but just the same.

Rules of thumb are good starting points, but that’s all they are.[quote=“kitkat2, post:4, topic:55453”]
from an insurance perspective. Some insurances do have preferred brands
[/quote]

True, though based again on experience, I would replace “some” with “many”.

There are many factors at work to determine why doctors prescribe what they prescribe. For one, many doctors work in clinics where there are policies in place for what to prescribe when alternatives exist. Some doctors may have been convinced by an exceptionally persuasive sales rep. There are also medications that have been determined by experience to be effective and safe when used “off label”, i.e., for a purpose other than that for which they were originally developed. (Metformin, it turns out, reduces the risk of certain cancers, to use a trivial example.) So that “experience bank” plays into it, too. There are many factors.

But it’s certainly true that insurance plans have preferences. One of my insulins was dropped from my plan’s formulary on Jan. 1 so I now have to pay retail for it, until Fall when I can switch plans. Grrrr.

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