R vs. Humalog, N vs. Lantus
Question:
As some of you might know, I’ve been trying to figure out ways of lowering the cost of my diabetes since I was booted from my insurance plan. I’m wondering now if I should switch to lower-cost insulins. When I became diabetic, I had an R/N combination. I’ve since been moved up to Humalog/Lantus. From my understanding, these are the most expensive insulins on the market. I believe it. When price comparing, the Lantus at Rite Aid was around $51 (Walmart was about $0.50 cheaper), and the Humalog at Rite Aid was around $65 (Walmart was about $4 cheaper). Any thoughts on this? If I get switched to the lower-costing insulins, maybe I can afford to actually go to a doctor, possibly even an occasional eye doctor, too. Again, as many of you might know, it’s been around a year and a half since I’ve been to a doctor, and the last time I went he wasn’t entirely pleased with me and gave me the standard fair about how he had a patient my age (22 at the time) who had to be on dialysis because her kidney’s failed, etc. etc. etc. Ken
Response:
- Hide quoted text — Show quoted text – >As some of you might know, I’ve been trying to figure out ways of lowering >the cost of my diabetes since I was booted from my insurance plan. I’m >wondering now if I should switch to lower-cost insulins. When I became >diabetic, I had an R/N combination. I’ve since been moved up to >Humalog/Lantus. From my understanding, these are the most expensive >insulins on the market. I believe it. When price comparing, the Lantus at >Rite Aid was around $51 (Walmart was about $0.50 cheaper), and the Humalog >at Rite Aid was around $65 (Walmart was about $4 cheaper). Any thoughts on >this? If I get switched to the lower-costing insulins, maybe I can afford >to actually go to a doctor, possibly even an occasional eye doctor, too. >Again, as many of you might know, it’s been around a year and a half since >I’ve been to a doctor, and the last time I went he wasn’t entirely pleased >with me and gave me the standard fair about how he had a patient my age (22 >at the time) who had to be on dialysis because her kidney’s failed, etc. >etc. etc. >Ken
I hit an HbA1c of 5.9 while on the Regular + NPH combination. The Humalog + Ultralente or Humalog + Lantus combo is much easier to use, but you can control with the cheaper insulins. I use Ultralente as my basal. I shoot 3 times a day, 7 am, 5 pm, and 9 pm. That gives me full 24-hour coverage with more basal dribbling in during my bad times, i.e. my fierce morning effect hours. Ultralente is tricky to use. The insulin crystals will settle out while you are looking at them. I shake the vial, insert the syringe, then shake it again while the needle is in the septum. Many literature sources say "never shake insulin" because you will end up with air bubbles which will enter your syringe. However, I believe that is an NPH warning, not an Ultralente warning. I just don’t have any problems with air bubbles. I get six weeks to a bottle of Ultralente then discard it at about 75% consumed because I am nervous about any slow drift in composition caused by the mixing/settling issue. Ultralente and NPH cost about the same. I made NPH work by shooting it 4 times a day. I have noticed references to "tight control" by the research docs and they always refer to shooting NPH 4 times as day. It has a peak at 4-6 hours after injection so you time your shots for 3-4 hours before each meal plus a last shot of the day around midnight. That is a royal pain in the ankle, but it is feasible. Humalog gives you the power of shooting a few minutes before a meal and being able to rely on an insulin peak coinciding with a glucose peak from digestion. However, if you shoot regular an hour to an hour and a half early, you can get about the same effect. It’s very inconvenient to do that, e.g. shoot your meal-time Regular while traveling home from work. Otherwise, delay your meals and sit around hungry while the Regular is building up an effect. It’s also risky since you often can’t guarantee when and what you will eat. Also, hypo-unaware folks would have a lot of trouble with that technique. However, folks did it for 40 (?) years before Humalog came along. The more slower-digesting foods you eat, the easier it will be to use Regular. An example of a really rigorous Regular + NPH schedule: Wake at 5:30 am, shoot Regular Breakfast at 7:00 am Shoot lunchtime NPH at 9 am Shoot lunchtime Regular at 11 am Lunch at 12 noon Shoot Dinner-time NPH at 3 pm Shoot Dinner-time Regular at 5 pm Dinner at 6 pm Shoot snack-time Regular at 8 pm Snack at 9 pm Shoot night-time NPH at Midnight. (Sorta obvious why I switched to 7 am, 5 pm, 9 pm Ultralente for a basal) You can move those shots closer together, move them closer to the meals, and move them to more convenient times, but you start to sacrifice control when you do so. You do what you can. There are a lot of folks in "wait and see" over the concept of using Humalog, Novolog, and Lantus with children and pregnant women. They do this kind of stuff all the time. Good Luck Old Al (Humalog + Ultralente via 4 shots per day, or 5 or 7 or 9 or as many as needed)
Response:
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