So I stopped by the Wal-mart Pharmacy last week and found that they sell Regular insulin (maybe now call Novolin?) for about $30 a bottle. So I'm now thinking of switching from Humalog, at about $150/bottle back to the Regular. Anybody done it and, if so, are there any watchouts, downsides, etc?
I'll certainly ask my doc before doing it, but just thought I'd check here for any personal experiences.
Thanks.
Dave
From what everyone here says it will make it harder to manage your blood sugar and you will have highs and lows especially if you don't eat at regular times. But if you don't have insurance and can't afford the higher cost it may be a necessity you will just have to do more testing and eat at regular times. And maybe regular foods? I'll let someone speak in more detail to how to manage with Regular.
I see you have a pump which is expensive! If I were you and I needed to cut expenses, I'd probably go back to shots but keep the modern insulins.
You don't need to eat on a schedule with Regular.
I've used Regular because I need the longer acting action & slower start time because of gastroparesis. You just need to bolus sooner because it takes about 45 minutes to start working. Bear in mind it also lasts about 5 hours. Not helpful for correcting highs quickly. Your I:C ratio will be slightly different. I like Regular. It's smooth & level.
Apidra is offering free insulin. Check out their web site.
At one stage I was using NPH for basal, Regular for meals and Humalog for corrections. It certainly reduces costs. I would take the Regular an hour before eating.
I think I was thinking of NPH; I thought most people take them together. And yes, good point, Apidra has a "no co-pay" for all of 2013. But it is limited to $100 per 90 days, so if your co-pay is higher than that you will pay the difference. Also it doesn't apply to people who don't have insurance.
I have used Regular for a long time. It will take significantly longer until it will unfold its activity. This means you will have to pre-bolus before you can eat. The typical waiting time after the injection will be 15 to 20 minutes. Without this waiting time you will experience a huge spike at the 2 hour mark (the insulin just came to late to catch the digested carbs). Furthermore the insulin will stay significantly longer in your body. From my experience it will be active from 4 to 6 hours depending on the dosage. Thus you will be much more prone to lows from additional physical activity. These lows will be much more severe because there is still plenty of insulin in your body. It is nasty and can limit your quality of life. The only useful application of regular is for patients with gastroparesis. Here the slower profile might fit perfectly to the slower digestion. With a difference of $120 I can understand that it might look tempting. Please let us know about your experiences with regular.
Walmart is actually advertising an i nsulin for $24 dollars and change. Not sure what kind it is.
What Walmart is selling under its Reli-on brand is Novo-Nordisk's regular human insulin aka Novolin. They sell in in both NPH and R forms as well as a 70/30 mix.
Financial reasons would be the only consideration for me to switch back to Regular insulins. Regular and NPH just never gave me the level of control I have now, not only when doing MDI, but on a pump as well. Of course if it's Regular or no insulin at all due to insurance or financial reasons the obvious choice would be go back and make do the best I can.
I used Regular (R) for about a year after I started insulin. It not only was cheap, but I could buy it over the counter. While R may be used as an alternative to modern analog insulin, it has a much longer duration of action. I found that I had to inject R at least 30 minutes before a meal and up to 1 hr before if a meal involving any high glycemic action. And because the duration of action is 5-7 hours, you run the risk of stacking. You can't eat snacks without clear stacking and even for meals you may well still have insulin on board from your last meal. This stacking during the day essentially means that using R as a bolus overlaps with your basal.
That being said, I do follow a low carb diet and meals that are fat/protein dominant are digested over 3-5 hours. R is actually better for these kinds of meals.
Should you choose to make the change, I found information for pharmacists that suggests that you keep your doses unit-for-unit the same and that advance your mealtime dose to 30 minutes before a meal. And since you use a pump, you will need to change the duration of action. The safest would be to change it to 7 hours and then advance it back as you getter a better understanding of the tail of R.
Thanks, all. Good advice, I'm sure.
I'm struck by the many responses which indicate a high level of confidence in the control of onset and duration of a given insulin's action. While I recognize this leads to tremendous control benefits I have difficulty with it. For me, the "active insulin" feature on new Minimed pumps has been a good add as a control mechanism. But, for the most part, being able to time insulin onset and action has never been a sure thing. Congrats to all those who have achieved this high level of control!
I have to say that for me, a CGM has been an eye opener in understanding insulin onset and action times as well as food digestion times. It makes it possible to see when different foods start raising blood sugar and when the insulin starts to take action to control it. It also is a great aid in setting basal rates by time of day. Even testing 12-15 times a day did not supply as much information.
I use Regular plus a faster-acting insulin such as Novolog or Apidra. (Humalog doesn't work for me. I mean it doesn't work -- might as well be water.)
Compared to Humalog or Novolog or Apidra, Regular will differ in the following ways:
(1) It will take longer to begin working, so you will need to build in more lead time between injecting and eating. As with everything concerning diabetes, the exact effect varies from individual to individual. There are people for whom it starts working in as little as 20 minutes. For me it's nearly an hour. The average seems to be between 30 and 45 minutes.
(2) The effect will be more gradual and will last longer, usually around 4 or 5 hours. (Again, you will have to test and measure to see how it actually behaves for you specifically.) This means it will give a poorer response curve for high carb meals, and a better response curve for slower-digesting protein. I choose my insulin in part based on what the meal will consist of.
(3) For most people, Regular will be less powerful than the fast-acting analogs. Again, the difference will depend on the individual. For me, it takes 1 1/2 units of Regular to get the same effect as 1 unit of, say, Novolog.
As usual, you can only take any of these as rough guidelines. The only way to know how it will work for you is to try it and test, test, test. And log the results. That's the only way to obtain reliable data.
Wow, very interesting. Thanks, David.
Do you have any idea, or does any of your team, why Humalog doesn't work for you?
Wondering if there might be something I should look into on this. Humalog works for me, but not in the ways others on this thread have characterized it.
Dave
Does anyone have information on the no copay apidra offer?
Yes, it is good for all of 2013. They pay up to $100 of your 3 month copay. So for most of us it's completely free. You just go to their website and print out and activate a coupon and bring it to your pharmacy. Here is the website:
http://www.apidra.com/apidra/saving.aspx?WT.mc_id=APEM13
Not really, no. Just something in my physiology that doesn't like that molecule. "Your Diabetes May Vary." No guarantees.
Holger, I think you are being a too severe on the "problems" of Regular.
I myself feel that Regular is a good match to a low-carb diet, probably a better match than the fast-acting analogs (at least without square wave bolus in a pump). I think it has a lot of useful applications.
I feel that the quick action of the fact-acting analogs (sometimes faster than the fast-acting carbs!) is a bigger hypo hazard than the long tail of regular. Both have to be watched carefully obviously.
Nothing in my experience (having used both Regular and Humalog, the first for 31 years, the second for about 5 years now) indicates that there is any substantially different effect between them, on insulin sensitity improvement exercise. If this means that exercise is more regualar and less sporadic, that's a good thing.
I moved from Novolog to Novolin R in summer 2012 and I thought Novolin R would be much slower. But it hasn't been for me. It kicks in faster, and has a slightly longer tail. But not by much. I feel like Regular has been better for my blood sugars and I wouldn't switch back if you paid me (well, maybe if you paid me a lot).