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.
I used Regular + NPH for many years on MDI, and then started with MM pump with Regular, since Humalog/Novolog were not yet available. Regular has a different timing, and was harder to match with mealtimes, and takes longer for a correction to bring down a high BG. If you do low / lower carb, it might not be as much difference, but you'll probably still need some adjustments.
Here is a good summary for the different insulins.
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.
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.
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 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.
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.
You are right Tim. Regular and I are divorced for life. But I really recommend to not stop with Humalog insulin. Try also brands like NovoRapid and Apidra if your endo is supporting that.
This thread keeps getting more interesting! Some users say Regular is preferred, that the action is either similar to Humalog or better for their diabetes. Others say it's a completely different experience. I'm guessing that, for me, if I jump back to regular I'm going to be in the "don't see much difference" camp. For example, I already have to bolus pre-meal time, some times as much as an hour to match digestion. And no, I don't have gastroparesis (sp) according to my endo. But alot of the posters on this thread see an huge difference in onset and duration of the two insulins. Very interesting. It sure goes to "your mileage may vary..."
I'm nervous about switching back to regular, but based on what I'm seeing here maybe it wouldn't be such a big deal for me.
Yes, the individual differences seem to be huge. For some Humalog might be like water for others it is quick and sufficient. On paper the analog insulins are supposed to work faster. Regular insulin forms complex hexameric structures in the vial. These structures need to dissolve so the insulin can be absorbed into the blood stream which takes time. The analog insulins are modified so that they will form less complex structures in the vial.
If I recall it correctly the insulin VIAject was a faster regular insulin. The trick was to use a lower concentration like 20 IU per 100ml instead of 100 IU. This lower concentration will also allow the regular to dissolve quicker. Obviously you will have to inject more to get to the same amount of insulin units. I am not sure if VIAject is available on the market.
Viaject received a "complete response" letter from the FDA requessting additional phase 3 trials with Biodel's preferred formulation. Rather than do this , they decided to study some newer formulations.
They are trying to create an insulin even faster than Novolog/Humalog/Apidra:
Their idea is to add some ingredients (which they claim are "generally recognized as safe") to humulin to prevent the hexamer formation, as opposed to the analog insulins which modify the insulin structure itself. They claim "Clinical studies indicate that Biodel’s lead ultra-rapid-acting insulin product candidate, BIOD-123, may be delivered into the bloodstream faster than regular human insulin and rapid-acting insulins."
They have a little flash video cartoon explaing how it works here:
They are claiming "In the Phase 1 clinical trial, absorption rates of BIOD-123 and BIOD-125 were significantly faster than that of Humalog® as indicated by 64% and 54% reductions, respectively, in mean times to half maximal insulin concentrations (p < 0.001 for both BIOD-123 and BIOD-125 compared to Humalog®)"
Here is a link to a journal article where they talk about its development:
Basically they are adding a common preservative, EDTA, found in many processed foods, to destabilize the formation of hexamers. Their early efforts with viaJect caused too much pain at the injection site and so they have been reformulating.
Walmart is actually advertising an i nsulin for $24 dollars and change. Not sure what kind it is.