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