Novolin R vs. Novolog

Hi all :slight_smile: I had a question, we are between insurances right now and have no prescription coverage. I was thinking of going onto Novolin R for the month because of the considerable cost savings. I have read that you need to take it 1/2 hour before you eat and have a longer peak/last time. Is there anything other than that I should know?

Thanks
Jillie

I like Novolin R. I find that you can’t cover fast acting carbs as well as with Novolg, because it has a slower release time and just doesn’t match the fast release of glucose from bread, potatoes, grains etc. I tend to eat lower carb anyway and think R works better for that.

As with all people with diabetes and each type of insulin, your own mileage may vary (YMMV), so the only way to know for sure is to try it. Certainly, you should at least tell your doctor about your plans or needs in this regard, but keep in mind that many docs will offer you some free samples of the same thing without regard to your long-term needs. Don’t feel like you need their permission: its YOUR body and YOU’RE the one paying the bills! I can share my own experience using Humalog, Novolog and Apidra relative to using Regular, and while I found that most were slightly faster, I did not find them dramatically faster – leading me to question the value of using an analog that costs almost twice as much money if insurance wasn’t paying it!

I wrote a response to another post which had a very similar question you may want to check out here (don’t worry, my links open in new windows). Be sure to check out the Diabetes Health article I noted there, because it basically gives you the science behind why smaller shots of insulin get absorbed faster, peak sooner, and are out of your system quicker. This is an important fact, because it means is that you can use regular insulin and get fairly quick action if the dosage size is smaller, therefore it may make sense if you’re going to dose for a meal and let’s say it requires a dosage of 12 units. Instead of one, you could split the dosage into 2 or even 3 tinier dosages of 6 or 4 units (depending on the total number of units) and see that insulin work much faster than if you gave a single dosage of 12 units. This, of course, is just an example but the point is a powerful tool you might consider in your decision. I generally try to split my dosages even with rapid-acting insulin analogs, and have found that it does work very well, but some people are needle-phobics (pens are convenient in this regard). Also, note that although there is not currently any generic insulin (see my article on that whole topic here), Wal-Mart sells a version of Novolin (including Novolin R and Novlin N) which retails for around $18 or so (I don’t recall the last time I checked the prices out), but compare that to Novolog which retails for about $70, and you see the huge price differential.

Finally, I would also suggest checking out what some of the subsequent research (I cited a 2007 study from Germany, but there have also been studies in Switzerland, the UK and Canada which have found the same thing) on the clinical trials for insulin analogs actually find, namely that the science does not prove that they deliver superior glycemic control. Among the most serious issues with the clinical trials for rapid-acting insulin analogs is that not a single one of the trials was blinded, which is considered the gold-standard of medical/scientific research. The lack of study blinding means there is a very real risk that patients in those trials, knowing the type of insulin they were using, might have behaved differently (such as by testing more frequently, for example) than they would normally, which would subsequently lead to unacceptable bias in the actual results of those trials. Science has proven unequivocally that if a patient with diabetes tests more often, they almost always have better glycemic control regardless of what type of insulin (or other drug) they use – therefore, the lack of study blinding in the trials for rapid-acting insulin analogs renders those results inapplicable to the diabetes population at large. In other words, one could argue successfully that the behavior change is what was responsible for the reduction in HbA1c, not necessarily the insulin analog that was being tested! YMMV!!

BTW, I forgot the article on generic insulin, which can be found at:

http://sstrumello.blogspot.com/2007/01/business-of-diabetes-real-story-behind.html

You need to take Novalin R between 45 minutes and 1 hour before eating.

It is active for 5-8 hours depending on the size of your dose with much of it used up by 3 hours with a small dose. Smaller dose, shorter time, but I did find that even with only 2 or 3 unit doses, there was a slight effect on my basal insulin. When I switched from R to Novolog, I had to add a basal insulin to get decent fasting bgs. With R, not. (I still have a bit of basal production left as I have MODY not Type 1.)

R works best with slower carbs and lower carbs. Don’t try to cover 60 grams of fast carbs as it won’t work well. Test with a food you are familiar with to see the activity curve in your own body.

Dr. Bernstein suggests splitting the dose into two injections if you use more than 9 units at once because the larger dose will be slower in action.

OTOH, because R is slower, you won’t plummet into a low and should get more warning that you are dropping and can correct with glucose.

I am a bit confused on this one is Novilin R the same as NovoRapid in Canada?

NovoRapid is Novolog.

Here are three links that describe the insulin action & peak times of various insulins. The third link has a graph:

http://www.diabetes.ca/Section_About/insulin3.asp
http://www.diabetesnet.com/diabetes_treatments/insulin_action_times.php
http://www.ianblumer.com/insulin_choice.htm

As you can see, the action time and peak for regular insulin (used to be called “Toronto” insulin) is longer and later than rapid acting insulin, so you need to adjust the timing of your dosage accordingly, and be aware that you’ll have insulin on board for a longer period of time.

I have checked with my doctor and she has said that it would be fine to switch, but she only gave me the information about the half hour before and longer last time.
We are appealing the decision to cancel our insurance, but until then we are not covered, and open enrollment is in 9 days but doesn’t go into effect until July 9 th … rock and a hard place right now with insurance, but the doctors office is being really helpful. Thanks for all the replies.

Jillie

Wow!! Thank you for all that info, I love research so your answer played right into my gotta know everything about it-ness!!!

Jillie :smiley:

The peak is also significantly longer for U-100 insulin relative to U-40 or U-80 (no longer sold in the U.S., but it raises the question just how big of an advance analogues really are); analogues like to claim they are better matches, but much depends on the size of your dose, the angle and where you inject, the temperature, etc. As I’ve noted on many occasions on various posts, numerous meta-analysis have concluded that virtually of the clinical trials for analogues are flawed for a number of reasons (notably because many weren’t blinded – the gold standard of medical research) and that there is no reliable scientific evidence of superiority to regular insulin, but we do know for a fact that they cost, on average, 50% more (not really a big deal if insurance covers them, but different if you pay out-of-pocket).