Lantus vs Humulin N?


#1

Extra pokes and cost aside, is there anything I should be concerned about when transitioning from Lantus to Humulin N? I wouldn't switch if I still had insurance. Lantus is so expensive!

I think this might be more my (maybe) not fully understanding how it all works, but if I currently take 40 units of Lantus a day, would it be comparable to 40 units of Humulin twice a day, or 20 units twice a day? I'm prepared for a rollercoaster ride while I get it "just right" ...

I've heard before people say that Humulin N is "absolutely awful" but never an elaboration on that.

So I'm a little nervous, still have some Lantus I'm using up now so I haven't started it YET, but I was unable to really get all my questions answered in the 10-15 minutes I'm "allowed" at the clinic.

Thanks!

(I hope I don't sound too stupid LOL. I'm still pretty new at insulin.)

((And I also value other people's opinions and input over the doctor too, really ... I mean - she doesn't use it))


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#2

I did MDI with NPH as the basal for decades.

I split the basal up into 4 shots, each about 6 hours from each other. I don't think it would be useful as a basal at just twice a day - it would be quite a rollercoaster ride.

If you look at the activity curves, it's obvious that NPH or Humulin (not fast acting) is not a straight substitute for Lantus. (What they call "glargine" in the chart is Lantus.) (Although the curve shows Lantus as being very fast, in fact it has its own irregularities, I think the place I cribbed the chart from was trying to sell Lantus as being perfectly flat but I can tell you that it isn't that flat.). But 4 NPH shots, staggered 6 hours from each other, smooths out the one big bump into 4 smaller bumps and the result is pretty flat if not perfectly flat. The areas under the curve (remember calculus class?) are the same for any of the insulins but the time-shape aspect of the curves is different.


Others badmouth NPH, but I actually got pretty good with using it as a basal this way. I'm not going to say the NPH absorption curves were perfect or ideal, just that I got used to it because the alternatives at the time (e.g. Ultra-Lente) were not so easy to get and probably even less ideal than NPH. Geeze, I have't heard of Ultra-Lente in decades!

Wal-Mart NPH is probably circa $30 a vial so a lot cheaper than Lantus. While that might seem cheap, I compare that to the price when I was a kid, which was closer to $6 or $7 a vial.


#3

I can not imagine going on only R. You will have no basal insulin.
I nearly killed myself on NPH and R together a few times.
Lilly makes Ultra Lente which is still in production, It is the same price as HumulinR and it works a lot like Lantus, You need to split your dose and take it twice a day instead of once though. You can mix it with regular or lispro too which saves an injection or 2.
I used it for 2 years before Lantus came on the market and it was just fine


#4

When I got my pump (2008...) I was taking NPH and the doc mentioned that the peak (as shown in the graph?) had only a 53% chance of peaking when it was supposed to? This was sort of alarming to learn but explained a lot of the inconsistency I perceived. I never tried the 4x shots day method but I suspect that Tim is correct that that might help reduce some of the "woah, where did that come from" stuff that I recall experiencing. Unfortunately, I don't have super scientific results that I can point to, as I am not a big logger, but that's what I recall...


#5
I was taking NPH and the doc mentioned that the peak (as shown in the graph?) had only a 53% chance of peaking when it was supposed to?

53% would be doing pretty good. 4x a day makes any of the unexpected dips or spikes smaller in amplitude. In my experience some other curves on the graph are far far less reliable than NPH's... e.g. a single Lantus shot a day, the advertising material (and I'm pretty sure the graph I showed falls into that bucket) tells you last 24 hours and is perfectly flat. I guarantee you, there is ZERO percent chance of that being true. But Lantus twice a day... that's not too different than NPH 4 times a day.

When I was first diagnosed, some T1 folks were getting by on one NPH shot a day, or on one Ultralente shot a day. Don't see many people here missing the good old days of Ultralente (although I'm sure with some accomodations that it could be made to work just like I made NPH work for a couple of decades.) Of course nobody knew their bg at all back then, no home bg meters, but we did have urine tests and I'm sure we were above 180 (the spill threshold) most all the time.


#6

I've not used Lantus, only Levemir and NPH. I actually did fine on NPH, my dose was a little bit higher on NPH (than Levemir) but pretty close. I did not have any problem with variability with NPH, its peak actually worked in my favor allowing me to take a higher dose overnight. My morning numbers are actually worse on Levemir.

NPH is actually a suspension, so you have to take care when preparing the insulin. You need to carefully roll the vial/pen to mix it all up. If you don't do it properly you will get "mixed" results. Since NPH is a mixture produced with protamine, your body may develop some reaction to the protamine. Some medical procedures use things like heparin which cause a bad reaction. So always remember to remind doctors that you have taken NPH even if you stop later on. You may always carry some allergic reaction to protamine. A small risk, but something to remember.


#7

Here's a fun set of graph. Plagiarized from "Diabetes Mellitus: A Fundamental and Clinical Text 3rd Edition".

BTW, in case you guys haven't figured it out, I love graphs.

It shows different regimes that have been popular or at least used over the years.

First three graphs are not really basal+bolus centered:

R+N once a day. Note that the very large NPH dose lasts a long time.

R+N twice a day. Note that the smaller NPH dose lasts a shorter time.

Lente + a fast acting analog insulin with each meal. Note that Lente definitely does not stretch the way NPH does. I haven't seen Lente or Ultralente in a long time. This IMHO is not basal+bolus, the Lente just doesn't work like a basal.

Fourth graph actually begins to have the basal+bolus concept. NPH twice a day plus fast acting with each meal. IMHO this is just sort of the bare minimum in basal+bolus.

Fifth graph is NPH 4 times a day with a fast acting 3 times a day. This is similar to what I did for a couple of decades (where "fast acting" was regular). Works pretty good IMHO, because each individual NPH dose is small and the additive curves of all 4 NPH shots is really quite flat in a highly consistent way.

I think graphs 6 is fast acting in a pump. A 7 shows more modern (say post-2000) MDI routines with analogue insulins for both basal and bolus. Note the inaccurate mythology that lantus or levemir is perfectly flat. Not true!!!!!!

Graph 8 shows what I've heard some folks here talk about, 3 different insulins, with a NPH as a "kicker" in the evening maybe to help work against dawn phenomenon over night.



#8

When I used NPH, I found that three shots of it a day worked well for me. I did have some hypos, but was able to deal with them. That said, it can be pretty rough, especially at higher doses.

Personally, I would look into trying to get hold of Lantus somehow. Check with the manufacturer and see if they offer an assistance program. If you go to a clinic, see if they (or anyone they know) have free samples. Check Canadian prices as well; all you'll need is an Rx from your doc and you should be able to get some.

If you're new at insulin and used to lantus, I would really do what you can to find affordable lantus somehow.


#9

I'm glad to see I'm not the only one who REALLY loves charts and graphs. They make me all giddy! LOL


#10

I talked to the doctor's office again and they said pretty much the same things y'all are to split them up more so they level out.

I don't mind the extra pokes, I'm just nervous about change ... any change at all really. I was on the assistance program but they changed it this year and my clinic isn't real cooperative with that kind of thing. They're the reason why I was unable to get my Humulin or Nexium through an assistance program - they messed up the paperwork repeatedly and I had to pay them to do it anyway. Well, I trust them with my care but not with much else LOL and I have no other options anymore.

Thanks so much for answering me :-)


#11

I did NPH since DX in 1999. Last year I got lantus, being a "24 hour" insulin and all i thought it might be ok. Well, i hated it...first off, it burned like hell..and bruised on injection site regularly. It did NOT last 24 hours at any dose so i would have to split into 2 doses...and since lantus can not be mixed with other insulin's, that meant 2 extra burning injections per day. No thank you. Levemir only comes in pens here in Canada, which i hate. It doesn't burn but it also doesn't last 24 hours (it actually wore off in about the same time as NPH) and it too can not be mixed with other insulin's. So it was a no go. Back to NPH and i am happy. My NPH dose is fairly low, 14 units at night, 4 units in the morning and 6 units with dinner...no excessive peaks or lows on this regimen. I will be quite upset if they stop making NPH


#12

I am thinking of doing the same thing. Lantus is so very expensive, even when you have drug insurance coverage; and Humalog is even more expensive. I have switched from my Humalog to Humulin-R, and it seems to work just fine for me. Even though Humulin is available OTC and without a prescription; if you can get your doctor to write you a prescription for either or both of the Humulin-N and the Humulin-R, your insurance will pay for a portion of it. It's worth a try. Last year the maker of Lantus took in over four [4] billion dollars - just on Lantus alone. I think they are a French pharmaceutical company; so a cure would NOT be in their best interest. It all comes down to the bottom line - Money.


#13

GTim, thank you so much for your comments and graphs!
I’m just switching from Lantus to NPH, my doctor recommends to split the dose into four shots, and I wasn’t too sure. It’ll be a total of 9 shots a day and I was pretty upset about it :slightly_frowning_face:
I was using Lantus twice a day, with hipos y night and peaks in the morning, so NO is not that flat as they want you to believe, I am 100% sure!
Now I see the point, and of course it makes sense :slightly_smiling_face:

Needless to say but, I am new here in the forum, I am really glad to have a way to share my concerns.

Thanks again for sharing!


#14

I’ve heard Lantus is a poor man’s insulin pump but Ulta Lente is a poor man’s Lantus. I used all three and it’s pretty accurate.


#15

Hello, new here. Been type 1 since 1995 and been on several types of insulin over the years. Most recently my Endo took me off humulin R and NPH even though my A1c was generally about 6.6 I am now on Humalog and Lantus and it is a bit of an adjustment. I am supposed to take 12 units of Humalog three times a day, 10 minutes before a meal and 35 units of Lantus before bedtime and he does not want me to use a sliding scale for dosage no matter what my sugar may be when I check it. I have a Dexcom G5 for about a month now and cannot help but adjust my dosage when I see where I am on the receiver.
When I get up in the morning I almost never eat breakfast and my sugar goes way up no matter what my level is in the morning. It can be 80 or 200 and my sugar goes up about 60-100 points no matter what and takes forever to come down even though I have taken 12 to 20 units of the Humalog. At this rate I don’t see my A1c doing any better, only worse.
Anyone else in this neighborhood with me? I would love to hear anyone else’s thoughts on this.
Thanks!


#16

Not sure what the story is there, but it might be worth looking for a different Endo. I am sure you can do better than that advice.

Is it always 12 units, no matter what you are eating?

Since you are already familiar with NPH, it would probably be useful to take a small amount of it at night also (not mixed with Lantus or instead of Lantus, but as a separate injection, as an adjunct). That will help your morning BG.


#17

Yep, always 12 units. I am not following that advice.


#18

Hm. Flatness of Lantus notwithstanding, there’s also Dawn Phenomenon (DP) to contend with. Virtually everyone experiences DP–it’s a natural part of the diurnal rhythm, your liver dumping glucose to prepare you for a day hunting and gathering, but it’s problematic for us diabetics. I struggled with it a lot when I was on Lantus. The problem is that upping your dose can give you hypos and still leave you with high BG in the morning if your DP is strong enough. I resorted to things like taking a bit of novolog at night by a sliding scale (read: gut instinct somewhat informed by experience) I worked out myself, but needless to say this was not a great idea. Given the effect curve, NPH might be a less risky way to do the same thing. My endo never recommended it, which is just as well as I have an aversion to that stuff like you wouldn’t believe after 20 years on it.

But one thing she did recommend was Metformin and that did help rein my DP in. You might consider it. It’s “off-label” for Type 1, but a lot of us take it. It helps with insulin sensitivity over all, which is generally a good thing–using less insulin helps with losing weight, fewer hypos and some other things, and side effects are mild to non-existent. Worth looking into.


#19

I agree, maybe a different endo??? There is a huge difference in how they treat you, I refused to go back to the first one I had and that turned out to be one of the best things that ever happened because I got the new endo that was hired and she has been a wonder.

I too will go up in the morning even without eating and always take a higher amount per carb in the morning than I do in the evening. I try to take my morning insulin an hour before I eat when I am higher. I can’t see eating when my BG is already high until it starts to drop.

The endo I have now has me take adjustments for my BG level and adjustments for my carbs and I think most are like that? Maybe your endo has their own reasons and maybe ask them why?


#20

Tim - old thread here but curious as to your previous dosing on NPH 4 times daily as basal in the past as compared to a current Lantus or Levemir dosing daily split routine.

Looks like NPH may work “ok” with that method according to this journal article:

figure5

“” FIG. 5. Strategy of intensive insulin treatment of type 1 diabetes mellitus with mealtime rapid-acting insulin analog added with NPH at each meal, in addition to bedtime NPH administration. The multiple daily NPH insulin administrations build up a relatively flat basal insulin profile over the 24-h period. This optimized NPH strategy of basal insulin supplementation has been used in previous studies. “”