Novolin R and Pumps

Is anyone using novolin R with an insulin pump?

I currently use Novolog, but when I first started pumping in 1996, started with REG.

It works, but have to consider longer time it takes to be active. So if require higher basal at 6am, have to start increase maybe at 4am. Pre bolus for meals will be longer times.

I did not have CGMS at that time. If you do, then it will be easier to get settings right. It is certainly doable.

I just switched to Fiasp 10 days ago and so far it has kept me under better control than Novalog.

I am interested in updating this discussion for reviews of use of Novolin R with the OmniPod. I will be leaving my company insurance and moving into Medicare early in 2022 and am considering the lower cost Novolin R. Any lessons learned will be appreciated.
I appreciate and understand what MM1 stated: “It works, but have to consider longer time it takes to be active. So if require higher basal at 6am, have to start increase maybe at 4am. Pre bolus for meals will be longer times.”

I tried R insulin in my Medtronic pump when I was in Europe and that was all I could get.

There was no algorithm or anything to worry about.
I had a hard time predicting the peak.

I would go high, then crash.
I lived on R insulin for years but it will take getting used to to switch.

I started on an insulin pump (MM 504) in 1987. Analog insulin was not available until Humalog debuted in 1996. So I used Regular, both pork-derived and Humulin, the bioengineered exact duplicate of insulin produced by a healthy pancreas. I didn’t use R with the Omnipod so I will remain quiet on that aspect.

@MM1’s summary is a good one. During that period, I did not benefit from the use of a CGM and never perfected synching up my dosing with the digestive effects of a meal. Pre-bolusing was a dicey proposition when your only tool for monitoring glucose levels was a finger-stick meter.

I experienced a severe hypo event one day after a vigorous many hour bicycle tour of San Francisco that scaled several of its “hills.” When I returned home, I took my pre-bolus and sat down in my recliner to relax while I waited for my insulin to become active. I fell asleep and an hour or two later woke up on the floor, pump unceremoniously ripped from its site.

The point of my story is that the longer pre-bolus time needed for R to become active introduces a risk you may not appreciate. CGM use will absolutely mitigate that risk but you need to respect this riskier proposition.

Another modern tool that I use that would combine well with using R in a pump is Afrezza. It would absolutely partner up well with Regular insulin for corrections or when the needed pre-bolus time is compromised by the usual social compromises.

I conclude that using Regular insulin is viable in a pump but you need to take care during the longer pre-bolus times. Life has an unusual way to distract you with unexpected phone calls and an array of many interesting intervening topics.

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Is this planned just for time before you start medicare?
If so, you could check out discount card to get Novolog.
With medicare, and using pump, my understanding is you can get insulin under part B. (But not sure if part B applies with omnipod).

https://www.novocare.com/insulin/my99insulin.html

I get 3 vials Novolog for $99 cash pay. I prefer novolog over Humalog, but my insurance only covers humalog.

Thanks for this input. Yes, I am actually planning for Medicare costs. I also prefer Novolog over Humalog so this could be helpful. If I could get 3 Novolog vials for $99 that would cover me for 3 months so might be better than Medicare costs. I am concerned i will go over the first Medicare drug deductible limit and then get bumped to the higher costs when I add in my Dexcom and OmniPod costs.
I checked the website you gave. Do you understand this restriction to explain it to me? If you did not use My$99Insulin in 2020, and have Medicare Part D, you are not eligible to participate in My$99Insulin.

Once you are on Medicare, you become ineligible for any discount card or program that a manufacturer, drug company, or any other supplier offers. Medicare became hyper-sensitive to anything that might be connected to fraud. This has been a problem in the past. Don’t plan on using any discount program once you enroll in Medicare.

Unfortunately, Medicare does not recognize Onmipods as eligible for Part B under the durable medical equipment provision. If you were to switch to an eligible pump, all your supplies, including insulin, would be covered under Part B. If you sign up for a Supplement plan, that means zero dollars out of pocket for insulin pump supplies, including insulin.

You will run into no formulary restrictions with Part B insulin. As long as it is appropriate for use in your pump, Medicare will cover it. If Medicare covers it, so will your Supplement plan.

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The offer was introduced in 2020, when I signed up. Not sure why, but they extended offer differently depending on whether you had originally signed up in 2020, or new in 2021. And who knows what, if any offer is available in 2022.

I thought maybe you were looking for help between now and during time before you got to medicare.

There is a number you can call to see how offer may work in your case, and may or may not be continued in 2022.

In general, most discounts like this are not valid in combination with medicare.

OK, that is very clear! So now I know that OmniPod will likely not be covered under Part B unless that changes for 2022.
That’s a shame as they are working with Dexcom to create a closed loop system available in 2022 that I was looking forward to using. Terry, what pump are you using now? I know you once used OmniPod.

I am OK now as I hope to apply well ahead of time for Medicare before I leave my employer. If there is a short gap I can manage without insurance for a few weeks or go on Gobra for a short while.

I use a Medtronic MiniMed 722 pump. It’s an older pump and it’s part of an automated do-it-yourself insulin dosing system called Loop. If I weren’t using Loop, I’d likely be using the Tandem T:Slim pump since it uses the Dexcom G6 for automated insulin dosing under its Control IQ system.

The Loop system, however, is much more attractive to me as it permits a lot of user latitude in setting things like the glucose target. I set mine at 83 mg/dL whereas Tandem with CIQ cannot be set for lower than 112 mg/dL.

FYI Dexcom will be covered through DME on Medicare and does not enter into donut hole calculations.

In most cases Omnipod is unfortunately an expensive proposition with Medicare. It is usually covered under the Part D drug plan with the insulin also being charged to Part D. Some people have managed to get Part B DME insulin with their Omnipod but IMO their pharmacies are doing it incorrectly. The cost of pods ends up in donut hole calculations. I do know a few people on retiree or military plans getting good Omnipod coverage but most don’t.

I am lucky that I hated Omnipod and like @Terry4 get my tubed pump, the supplies, my Dexcom, and my insulin through Part B DME with Medicare paying 80% and my supplement plan paying the remaining 20%.

As you get closer to Medicare, one thing to know is that what we all call “Medicare” is a patchwork of tons of different types of plans. Basic Medicare is administered by the federal government. Advantage plans are plans administered by private companies which have contracted with the government to provide Medicare benefits to seniors. Supplement (Medigap) plans are administered by private companies to pay the 20% that Basic Medicare doesn’t pay and in most cases have no decision making on what is covered although they may provide other benefits. Then there are retiree plans, VA plans, benefits through TriCare, etc, and etc.

In general most Medicare advisors and reps that you may speak to in your decision making process don’t have a clue about things like Part B insulin, etc. One important thing to know is that after your initial benefit period (1st 6 months of Medicare) in most states (not all) Supplemental (Medigap) plans can use underwriting to deny you coverage. So if you start with an Advantage plan, you will always be able to switch to Basic Medicare, but you might lose the option to get a supplemental plan.

One other thing is that if you get your pump insulin through Part B there are no formularies. Most Advantage plans and Part D drug plans have formularies with preferred brands. And although Advantage plans must generally cover things that Medicare covers like CGM, they can have different rules and restrictions. For example some advantage plans may not cover Dexcom but cover Libre.

Good luck and feel free to keep asking questions.

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Laddie, the quote below is unclear but clearly important, can you explain more? We have watched some very helpful webinars from this website and also plan to call them next week for their input. (https://www.medicareschool.com/) My choices are becoming more clear by interacting with experienced diabetics like you!
We were first considering an Advantage Plan with Kaiser but understand the flexibility of the regular plans so are looking at all. We will likely be traveling overseas as well as in the States in the first several years. [quote=“Laddie, post:13, topic:74171”]
“One important thing to know is that after your initial benefit period (1st 6 months of Medicare) in most states (not all) Supplemental (Medigap) plans can use underwriting to deny you coverage. So if you start with an Advantage plan, you will always be able to switch to Basic Medicare, but you might lose the option to get a supplemental plan.” [/quote]

Oh, I am reading your comment again and I think you are saying that if we start with an Advantage Plan then wish to change then we might be denied a Medigap policy. Is that it? We live in Virginia.

I have no idea about Virginia and you probably need to talk to an independent Medicare broker in Virginia. I live in Minnesota and for sure I would have been denied a supplement after my initial benefit period.

I belong to a group on Facebook called Seniors with Sensors. We periodically talk about Medicare plans and I think I have read of people in Massachusetts and Washington saying that their states don’t allow Supplement plans to consider preexisting conditions. This article is from 2018 and mentions 4 states that outlaw Medicare underwriting. Interesting Washington State is not mentioned but the woman who said that is on some sort of military supplement or else the state has changed.

I am lucky to be a snowbird and spend 6 months in Minnesota and 6 months in Arizona. For me there was no doubt that Basic Medicare with a Supplement was the right choice. Advantage plans talk about travel benefits but sometimes the reality is not as advertised. Supplemental plans tend to be more expensive than Advantage plans and I am lucky that the premium difference is affordable for me. Plus I have doctors in various networks and it is nice to know that I won’t be restricted to doctors based on an Advantage plan network.

In the Seniors with Sensors group there are people who love their Advantage plans. And people who regret them. Most of us seem to think that Basic Medicare with a Supplement is the best choice for people living with diabetes and using D-tech. For sure in most states it is a one-way street. You can always switch from a Supplemental plan to an Advantage plan. But after your initial benefit period you can’t go from an Advantage plan to a Supplemental plan.

Unfortunately as an Omnipod user you won’t get the huge Part B benefits that I get as a tubed pump user. Some of the history is that Insulet originally did a bad job at trying to get Medicare pump coverage and jumped at the opportunity for Part D pharmacy coverage. Maybe good for Insulet but a disservice to seniors who love their Omnipods.

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And @Laddie made the same point about Part B pump insulin not being a part of the formulary.

Boy, do I feel stupid:

I’m a part b pump, traditional Medicare plus supplement guy.

2-3 years ago I got a letter from my supplement (BS of California, in my case) informing me that Novolog would no longer be in the formulary as of date X, and that I would need to change to Humalog. They didn’t mention the Part B distinction … nor did my endo when I explained why I needed a new prescription for Humalog.

Fortunately, I don’t see much difference … but it underscores how nuanced all of this is even for those of us who think we have a pretty good handle on how the system works.

@Terry4 and @Laddie, thank you both for supplying one more piece of the puzzle.

Stay safe!

John

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Glad that you didn’t suffer with that unnecessary insulin switch. Our system of health care access is needlessly complicated. I think that the payers (except Medicare) use those complications to their economic advantage.

I think non-medical switching of formularies for insulin should be outlawed. As those of us who have lived a long time using insulin to survive, we know that various insulins are not always interchangeable.

When I use Novolog with an infusion pump, I experience raised red welts at the site. These “pump bumps” take a long time to heal and reduce my available infusion sites over time. They also disturb the all-important ongoing insulin absorption.

I think, in the case of insulin, the person with diabetes alone should be able to veto that decision. Most doctors will support you but why should they and their staff be burdened with this unnecessary task?

And I wouldn’t feel stupid to miss this information. I regularly learn things in the diabetes peer support community that I could or should know but didn’t.

Here is feedback on my use of Novolin with OmniPod.
My first day was crazy high and low but then I began to adjust my Basal routine for the OmniPod. Now I appear to be more stable than with using Humalog. I am a member of a Masters’ Swim program and my two sessions swimming I had less trouble keeping my BG stable! All this is leading me to try Novolin R again in my OmniPod change today. (BTW, I also get the red welts when I use Humalog so this may be another reason to switch.

Laddie, and others, I did have an online video discussion with a 3rd party group and they confirmed (after research) that the OmniPod is not covered anywhere for Part B. (I hope Insulet can change that especially when the newer version is connected with Dexcom!)
So I am now researching the best pump for me. Could you answer a couple of questions, if you know?

  1. Is the tubing and catheter covered under part B, durable equipment as well as the actual pump/monitor?
  2. Which ones in your experience connect directly with Dexcom and/or accurate meters?
  3. I am an avid lap swimmer and the waterproof nature of the OmniPod is what introduced me to pumps. I appreciate that it can continue a basal dose while I am swimming and I can reduce the dose for exercise. So to swim with a tubed pump it looks like I would remove the tube and pump and have NO basal insulin for the hour that I swim. That will likely not work for me for swimming.
  4. So any thoughts/experience about tubed pumps and swimming?
    Thanks much and certainly no hurry for anyone’s response.