Insulin Switch - Humalog to Novolin R...?

Treatment Insulin
#1

As of this year my insurance needs prior authorization for both types of insulin I'm prescribed: Humalog and Humulin N.
I'm now 27 and have been on these two types of insulin since my diagnosis at age 9.
Upon my attempt to re-fill my script for Humulin N, my pharmacy tried to contact my Dr's office for authorization but since my Dr's office is inept and does not accept faxes or phone calls from pharmacies (or anywhere else for that matter), I would need to make an appointment just to get my Dr. to send off authorization for this insulin. Having been on this insulin for about 18 years and having just seen my doc, I'd rather not go right back in and spend half a day at the Dr's office just for this. However, talking with the receptionist at the office, she said the doc would call me in one vial of Novolin N to hold me over until the appointment. But wait, Novolin N? That's not even what I take. And besides, I can get Novolin N at Wal-Mart without a prescription for less than my co-pay. So I told her nevermind.
After doing some research I found that Humulin N and Novolin N appear to be similar enough to hopefully not cause much disruption in my routine/blood sugars. So, okay, I'll try that, it's what the doc was gonna call in for me anyway, no big deal.
HOWEVER, when I discovered that Humalog would also need prior authorization I became concerned, as I don't know of a comparable type available for a reasonable price without a script. Novolin R is the only option I'm finding, which seems to have a longer onset, peak and duration than Humalog.
So I'm debating whether I want to make the switch or suck it up and make an appointment just for a Humalog auth. Ugh.
I still have a couple vials so the need is not immediate.. By the time I run out it may be time to see the doc anyway.
But my questions are:

Has anyone switched from Humalog to Novolin R? How was the transition?
Does anyone use Novolin R? Do you use it in combination with another insulin and what type?
Does anyone use Novolin R and Novolin N combo? How does it work for you?

Any info/input/thoughts/etc. appreciated! :)

#2

Humulin N and Novolin N are both NPH, just different brands. They are the same insulin, though, so should have the same onset, peak, and duration.

R insulin has a longer onset and peak and duration than Humalog. When I was on R, I had to snack in the morning in order to offset the peak of the R. It also needs to be taken at least 30-60 minutes before a meal to give it time to kick in.

When I was taking R and NPH together, I took two shots a day for years (R and NPH at breakfast and dinner). This required a very regimented schedule of meals and snacks which I could not disrupt at all without going extremely high or low. Later, my endocrinologist switched me to three shots a day (R and NPH at breakfast, R at dinner, and NPH at bedtime) which helped reduced overnight lows.

Have you looked into MDI (multiple daily injections - four or more shots a day) at all? This regimen uses a flatter basal insulin like Lantus or Levemir, instead of NPH, and uses carbohydrate counting and an adjustable dose of Humalog at each meal. A lot of people take Lantus or Levemir before breakfast and before bed, and take Humalog or Novolog or Apidra before each meal and snack or whenever they need a correction. It's a more intensive insulin regimen, but it allows for much more flexibility and (usually) better control than using NPH. Although I see you have a pretty good A1c and a CGM, so maybe the NPH is working for you.

#3

I’ve never used R and NPH, but I keep quite a few vials in my fridge because they’re cheap in case of emergency— like if the whole supply chain got disrupted.



If your insurance requires prior authorization for humalog, it is very likely that they have novolog (or maybe apidra) in their formulary not requiring pre auth. Same for N… Your insurance likely covers lantus or levemir instead.



Jen is right N = N and R=R no difference between brands.



I would call your insurance and ask what insulins are in their formulary or preferred then call your doctor or go sit in their waiting room until they change your rx… Their assistants usually take care of it, it shouldn’t require an appointment unless they consider you “overdue” for one anyway. It sounds like just a matter of getting on the same page with your insurance though. They can refuse prior authorizations if you don’t have documentation of trying, and failing, with their preferred brands.

#4

I switched from Novolin R to Humalog and I will tell you they are markedly different. Novolin/Humulin R is slower than Humalog. This will mean that you need to increase the amount of time before the meal for you injection, I used to inject 30-45 minutes before a meal. R also has a longer duration of action, you have to be careful as it lasts 5-7 hours as opposed to 5 or so for Humalog.

Novolin R can be used with any other insulin, the only thing is that there are only a few combinations of insulins that can be mixed with R.

When I started four years ago I did a basal/bolus regime with NPH and R. Most people find it doesn't work as well as a regime with modern insulins like Levemir and Humalog. However those that are following a low carb diet may actually find that R works well for them as low carb diets tend to have a long blood sugar rise as meals have a blood sugar response that is more dominated by protein.

#5

I would echo the question about considering MDI. I was on R/NPH regime for about 20 years, and the switch to MDI was like getting out of prison. Totally life-changing. Is insurance coverage a problem? I know the pens a lot of people use (I did) are proprietary and therefore more expensive but I believe you can do it using syringes and generics.

#6

despite when some here have said, I've used Novolog and Humalog interchangeable with no change in my pump settings. I'm not about to claim that for others, that may not be the case.

. Since I get free Humalog, that's mostly what our fridge is stocked with, but we still have several bottles of Novolog in there. I grab whatever is handy and put it in the medicine cabinet where I do set changes. I've even had both insulins in the same tubing. NEVER had a problem.
#7

I switched to Humalog from Novolog when I switched from Medtronic to a Snap pump. No difference for me either. Everyone's metabolism is their own of course, but I don't think there's anyway of knowing without trying it.

#8

phoenixbound ,

They are talking about the differences between Novolin R/Humulin R (regular insulin) vs Novalog/Humalog (rapid acting insulin).

Regular insulin and rapid acting insulin are not interchangeable.

#9

Good point. The question about switching from Humalog to Novolin R kind of raised the question, but yes, an "R" insulin is VERY different from a bolusing insulin like Novalog/Humalog.

Apparently she's been using a bolusing insulin with an NPH insulin ("Humalog and Humulin N") and I'd guess that's the source of the insurance company's confusion. The old regimen was R/NPH, so since she's on an NPH they want to give her an R to go with it. But apparently she's been on a sort of hybrid regimen, using the N insulin as (I guess?) a kind of basal. Not sure why you'd want to use N that way (or at all!) but insurance companies being as rule-bound as they are, I'm guessing that's where the problem is.

Bottom line is that, if this is what she's been doing, she should NOT be accepting an R insulin as a substitute. It's going to behave completely differently and could be dangerous.

#10

oops, I read "novolin" as "novolog". my apologies. I'm going to sit in the corner now! :)

#11

I suspect, being early in the calendar year, that it may just be an issue of a formulary change from humalog to novolog with her insurance… Definitely warrants a phone call to her rx plan to investigate

#12

Thanks so much for the input, everyone!

It sounded kind of nice at first, to be able to get my insulin at Wal-Mart with no scripts needed and cheaper than my co-pays. But I've realized that the trade-off doesn't seem worth it to me, as the difference in performance from Rapid to a Regular insulin is more than I'm willing to deal with.

Sam, good suggestion about checking with my insurance to see what sort of Rapid acting brands they prefer. I'll be doing that. Thanks!

#13

Thanks for the comments, guys!

With the longer onset of R vs. Humalog, that's not something I want to work with. Thanks for sharing your experiences with R!
As for my regimen vs. MDI: I am currently on a scheduled regimen of 2 shots a day - Humalog & NPH - at breakfast and dinner. Although I sometimes take as many as 3 or 4 additional correction doses, but only some days, depending on how my sugars are running, what I'm eating, time of the month, etc. etc...
This has worked pretty well for me but of course keeps me on a rather strict schedule of injections, meals and snacks. And usually that's not a problem.. usually... But I think if I were going to change my insulin routine to 3 or more shots on a daily basis then I would prefer trying a pump. Which I may end up doing anyway. We shall see :)

#14

Well Hello, first thing I want to tell you is that humalog and novolin R are 2 totally different medications. Humalog is rapid acting where you eat 15 minutes after you inject, and peaks in about in about 1 1/2 hours hours, and is out in 4. now novolin R is Regular insulin. you have to take about 30-45 minutes before you eat. it peaks in 2-4 hours and will be out in 6-8 hours. It is very difficult to use (actually annnoying)You need to go to your doctor and beg (literally) for prescription for humalog. Now N is the same (NPH)the walmart brand is fine for that. but do not take r insulin. This is My reccomendation for your Diabetes.
Take Care of yourself.
Scott

#15

If you don't mind my asking, I'm curious about the regimen you're on. Usually you'd
use the rapid Humalog/Novolog to bolus for meals, and pair it with a long-lasting, non-peaking insulin like Lantus to provide the basal level of insulin in mimicry of what a normal pancreas does. But you're pairing it with an N, which slowly rises in effect and really kicks in at a certain point many hours after you take it. Seems like this would make figuring out meal boluses really tricky. Or is that not what you're doing? Is there some reason why the more standard MDI approach doesn't work for you?

#16

From her above comment, she's using a two-shot-a-day regimen similar to the old R/NPH regimen, except that she's using Humalog in place of R (which I did as well once Humalog came out but before Lantus came along).

#17

two insulins I've referred to as "the devil's insulins" are NPH and regular. Bad timing vs food intake and LONG, lingering tail. NPH is just weird. I know that people who have used NPH have had issues that I believe would be alleviated by switching exclusively to Humalog/Novolog and Lantus or other long acting.

#18

Ah, thanks for that explanation. It does seem like you'd find a full-fledged MDI regimen or a pump a lot less restrictive to your lifestyle and more logical to manage, especially if you're having to do a lot of testing and corrections in your current practice anyway--sounds like Multiple Daily Injections by another name :-) Versus a pump, MDI is maybe a bit simpler to start off with and teaches you 80% of what you need to know for using a pump, but I'd definitely encourage you to look into both.

#19

When I was dx'd R/NPH was the standard treatment and I was on it for FAR too long. Basically you'd shoot up both first thing in the a.m. and it's like you've bought your ticket for the roller coaster. Those two big hills are gonna hit when they're gonna hit, not when you want 'em to, and you'd better be ready for 'em when they do. "Devil's insulins" is pretty good; I referred to it as the Eat Now Or Die!!! regime.

I gotta say, I still vividly remember that first week on MDI when I looked at my watch and saw 12:00 go by, then 12:30, then 1:00 p.m....like Coyote when he runs off the cliff and he's still hanging there, feet propellering in mid-air... only I WASN'T plummeting into oblivion greying out with cone vision and shaking from adrenalin but actually felt perfectly fine. People talk about how liberated they felt going from MDI to a pump, but for me the pump transition was nothing compared to the transition to MDI.

#20

Interesting. I must have skipped that regimen. When I finally (FINALLY!) got a referral to Joslin and an endo who actually understood the disease Lantus had been available for quite a while, fortunately for me. I remember on my first visit my Dr looking at my A1C and at my treatment regime and saying "Well, you're not doing too badly considering that the way you're managing your disease makes no goddamn sense whatsoever."