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.
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.
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:
Not really, no. Just something in my physiology that doesn't like that molecule. "Your Diabetes May Vary." No guarantees.
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).