To Change Insulins or Not To Change Insulins, this is the question

I have used Humulin R insulin for 17 years now; I am a 61-year-old female. I have been without healthcare that would pay for my insulin since 2007. I have been buying the Humulin over-the-counter all of this time.

Now, the Humulin as more than quadrupled in price to $114.00 per 10ml vial. I was laid off of my job in January 2014 and have been having difficulty being able to afford my Humulin so my blood sugar was running high. When I have enough Humulin R to take I can control my BS very well and I feel well. So, I applied for Medicaid for the first time in my life.

I have a new doctor who now wants to put me on Lantus and Humalog. He thinks the Humulin is not controlling my blood sugar because my A1c was 9.9 at my first visit. The real reason the A1c was that high is because I DIDN'T HAVE ACCESS TO ENOUGH INSULIN FOR THE PREVIOUS 6 MONTHS. This doctor says the Humulin is old technology and he is very insistent for me to change insulins. I did not request this change in insulin.

I read a lot of comments online that people have a lot of bad side effects with Lantus and that it does not control blood sugar in some cases. I'm so confused. Should I insist on staying on Humulin? Any input would be appreciated. Thanks :)

Your doctor is right; you were on a very old insulin regimen and a basal/bolus combination (Lantus and Humalog is long acting for background insulin and Humalog for meals) is the best ways to control blood sugar and also give you more flexibility in terms of mealtimes. I'm assuming you have Medicaid now which will pay for it so why not get the best treatment? You need to get that A1C down as soon as you can and you will feel much better! I'm glad you got coverage! The new regimen will take some time to get the dosage correct and I highly recommend the book Using Insulin by John Walsh to learn to tweak your doses, use an Insulin:Carb ratio and correct highs. It is well worth the learning curve!

Zoe, do you take Lantus?

No, I've been on a pump for 3 years, Nettie, but I did at one time. It worked just fine, but I did switch to Levemir when I was concerned about possible reasons for weight gain.

A pump is another option to consider for best results. I've heard that it's easier to get Medicare to cover pumps when you are on one prior to starting and I see you're 61. (I'm on Medicare and my pump supplies are now 100% covered)

I still use Humalin. I tried Lantus as soon as it was available (several years ago) and developed "global edema" where every part of my body swelled. I have tried it a couple more times in the last 15 years and the same thing happened. The doc said it was unusual, but reluctantly let me go back to the Humalin. I have good control.
Yes, Humalin is considered old fashioned by the medical community.
Could you try the Lantus for a few weeks as see how it goes?
You, as a medical consumer, have the right to advocate for your best treatment. Be very honest with your doctor and continue to discuss this. I know that some times (actually most times) the doctors are in a hurry, but if need be, I always say "hey, wait, we're not done talking about this.)

My doctor first wanted me on Levemir because Colorado Medicaid just took Lantus off the Preferred Drug List. But, my doc's office just called me and he got approval for me to get the Lantus because am very allergic to the brewer's yeast manufacture method of the Levemir. I nearly died from taking Novolin manufactured with brewer's yeast several years ago. Anyway, thanks for your input.

They're pretty similar, as are the three fast acting insulins, just some people do better on one or the other.

I've never used Lantus, so I can't help you there. I did use Humulin back in the 90s. It acted much like the Regular animal insulins that I used before. I liked it since it was identical in its makeup to the insulin that the body makes.

What I like about the rapid acting insulin analogs, like Humalog, is that they start acting, peak, and finish more quickly than the old Regular insulins as well as Humulin. This means that you have a better chance of matching the rise in blood sugar caused by eating. Even the modern analog insulins, like Humalog, have a hard time keeping up with some foods.

I would switch to Humalog if offered the choice and you can afford it. It's much better than the old Regular formulations, in terms of better coverage and fewer lows.

There are many here that use Lantus and Levemir, the so-called background or long-acting insulins. Sometimes people split the dose and take it more than once per day in order to provide more even coverage. I've read positive and negative remarks about both.

Good luck.

Hi Kathy, thank you so much for joining this discussion. I am glad to meet someone else that uses Humulin. I have decided to ask my doctor to let me use the Humulin R for a few months so I can show him it works. As I said above, my A1c was high (9.9) only because I haven't been able to afford enough insulin since I got laid off work in January. I will be able to show my doctor that I can control my BS with Humulin and my A1c will be much better. If he doesn't agree, then I'll just have to find another doctor.

I feel well on the Humulin. I have never had a bad side effect from it. I am worried about the swelling, and other side effects. After all, I am 61 years old and I would like to have some quality-of-life for whatever years remain.

I forgot to mention in my first post that my new doctor did take blood tests when I first saw him on August 11. Even though I have been taking only Humulin R for 17 years, ALL OF MY BLOOD WORK WAS NORMAL (well except for my blood sugar because I had been out of insulin for a while.) But my kidneys are good, my cholesteral is normal, my triglycerides normal, my liver is good. Anyway, thanks so much for your input. You've helped me so much to calm my worries and I appreciate your help.

Hi Terry, thanks for the reminder about Humalog. My doctor has actually already given me a prescription for the Humalog rapid acting. And you are right, the Humulin takes a while to start working. Humalog does not use brewer's yeast in the manufacture process so I don't have to worry about being allergic to it.

Thanks again for your input. I appreciation your help.

You do realize that they sell Relion brand insulin at Walmart for $25/vial. The Relion is currently Novolin which is substantially equivalent to Humulin. It comes as Regular, NPH and as mix. There are three Walmarts in Aurora, CO. If you have trouble affording Lantus or the other modern insulins you can always get it at Walmart.

Hi Brian, thanks for the advice. I can't take Novolin because I a go into anaphylactic shock from the brewer's yeast in it. The only time I have been hospitalized in the past 35 years is when I took Novolin - I nearly died.

Humulin is manufactured with genetically-modified e-coli and I am not allergic to it. Wal-mart used to have the Humulin for $25, however, earlier this year the price went up to $113 and some cents per 10ml bottle. I was getting the Humulin from Walmart even when the price went up. But, now I am completely without income or savings and that's why I got on Medicaid for the first time in my life.

I do get my Reli-On Prime test strips at Walmart. They only cost $9 for 50 strips. On Medicaid they are free which I just found out yesterday.

Thanks for your input Brian. I really appreciate the help.

Somebody correct me if I'm wrong, but if you switch to Humalog I think you will need to switch to Lantus as well. Can you combine the old style insulins with the new ones?

I'm not sure because I was only diagnosed 7 years ago so didn't experience the older ones. I did see a friend's husband who was on them crash pretty hard one Thanksgiving as dinner was delayed a bit beyond when he expected. Didn't look like fun! Personally, as a 65 year old also concerned with quality of life I find the pump gives me that. No more need for shots, no need to cart around a lot of stuff, I can bolus for exactly what I'm eating whether salad or pasta and I can eat whenever I want or skip a meal if I need/want to. Ok, I sound like an evangelist or someone with stock in modern insulins or pumps; I'll be quiet now!

I'm not sure which insulins would be best for you but I would try the newer ones and see how you do with them. Levemir is good. I don't know if medicaid covers them completely but there are assistance programs to help with the insulin manufacturers also.

I've never heard of any warning or bad account of using old style insulins (like NPH) along with the newer rapid acting analogs. I think Dr. Bernstein recommends using NPH for certain eating situations while still using rapid acting. It's kind of like an extended bolus for higher fat and protein meals.

I agree with you that the pump contributes to more lifestyle flexibility but does have its own set of chores. It's nice not to have to think about combining the two different action curves.

an alternative long acting insulin is levemir. i recently changed to it after 6 years on humalin n. i had delayed changing because i figured i was doing fine on humulin. however, i can honestly say levemir is better than humalin. no more morning lows. very happy.

But the OP has already posted several times that she cannot take Novo insulins (and these include levemir) because she is allergic to the yeast used in their manufacture.

There's no reason why she shouldn't combine Humalog and NPH. This was the standard basal/bolus combination for several years after the introduction of Humalog (which was the first analog insulin to be developed). That said, IMO Lantus will give much more predictable and flatter coverage.

AFAIK, Sonofi Aventis (the makers of Lantus) produce their insulins in E.coli so there shouldn't be a problem with allergenicity (although the OP might want to double-check this).


Slightly off-topic, but the price paid for insulin in the USA is SCANDALOUS. Here in the UK we don't have to pay for insulin but I know that the price the NHS (i.e. the Government) pays the pharma companies for a 10 ml vial of any of the 3 rapid analogs is about £16 (??US$28) and £42 ($70) for a pack of 5 disposable Lantus pen.

Someones' being ripped off there...

"Old fashioned" doesn't mean "doesn't work". Humulin, in terms of clearing carbs or bringing down a high, works as well as it ever did, and as well as the newer analogs.

However, humulin and longer-acting nepenthe are far, far less flexible in terms of treatment regimen.

BTW, while it sounds like it isn't an issue for you any more, were you to find yourself having to buy your own insulin again Walmart has both R and N 10ml vials for $25, OTC.

[insert Omnipod fanboy cheerleading here, let the pump wars begin!]

J/K :-)

Yes -- Americans. To subsidize the price Brits, and other Europeans, pay for the stuff.

Lilly is not making money hand over fist. Their annual net profit percentage -- earnings -- is far less than Microsoft, Google, and a gazillion other companies.

It costs A LOT to fund the research and clinical testing necessary to bring a drug to market. Europeans refuse to pay for that, and instead leech off the backs of Americans to pay for this for them.

Do I sound bitter and angry? You bet I do, because I am. There's no colloquialism more true than "there's no free lunch". Were the rest of the world's diabetics paying a fair price for insulin, it might then cost ALL of us (including Americans) $50/vial, instead of we Americans paying around US$125, while the rest of you demand we pay for yours too.