How long has MDI been available?

[TommyC1]

I was DXed about 15 years ago. Just got off the NPH and onto MDI last summer.
From reading I have the idea that Novalog, Humulog, Lantus, and Levimir have been available for quite some time.
But I don't have a clear idea as to how long. Or if MDI and matching insulin to carbs became common as soon as those were available or some time later.
Anybody have a timeline on those?

Thanks,
Tommy

[Subby]

I'd be interested in some dates of some of those events, if someone can hazzard some info. But, I'd say that MDI (multiple daily injections) really began when the basal/bolus regimen was worked out. So, back when you were on NPH and a fast acting insulin 3x daily, (you did take boluses, right?) that there was MDI. Yes, I sure could be wrong!

I remember when I was dxed (about 1991) that the most common term I heard for this approach vs the older approach of say 2 shots a day, was "intensive therapy".

As for carb counting, that's an interesting question, I have no idea.

[Subby]

Hmm, re-reading maybe you did just take NPH by itself? How you managed with just basal I have no idea - I'm impressed you obviously coped - it's really good you've moved to MDI if that's the case. Anyway, I can only say that in 91 I was put straight onto MDI, with NPH and Actrapid. I guess an older timer will have a better idea when it was introduced.

[DeusXM]

Off the top of my head, Novorapid and Humalog have been available since at least 1998, while Lantus hit the market in about 2001, and Levemir around 2003.

If you were on NPH and a bolus insulin then you already were on MDI, although as far as I know, NPH/Insulatard has been contraindicated since the arrival of Lantus.

[It Ain't Over]

MDI would not have started until after home testing was available. Trying to remember the year, but it was earlier that 1985, that was the first I was shown home bg testing and MDI. I had no money and no insurance for a few years prior and so did not go to the dr at all. Seems I read in Bersteins book that he got a hold on his first tester in 74. That was before it became available to those of us that use it. When it first came out it was carefully guarded for use only at the md office.

[kgm0612]

Let's try this again: Here's a link with dates that I think will be helpful to you.



Karen

[kgm0612]

The Link won't post no matter what I type in! Sorry

[sarahspins]

Humalog - 1996
Novolog/NovoRapid - 2001
Lantus - 2001
Apidra - 2005
Levemir - 2006 (late 2005 for some countries outside the USA)

MDI has really been around as long as people were able to utilize the concept - the major disadvantage for most was not the insulins available, but the lack of accurate home testing, which wasn't really available until the mid-80's. Many people also found MDI to be too much work with R and N, and preferred the old 2-shot regimen which was standard for a long time (which I see as good enough to keep someone alive, but about the *worst* option available). More shots = more work, and a lot of people back then really didn't see the difference it would make to their long-term health.

[kgm0612]

1921- Insulin was discovered.

1922- Bovine Insulin

1936- Protamine- a low-weight protein was used to develop a "slow-release" insulin. Protamine Zince Insulin (PZI) lasted 24-36 hours.

1950- NPH

1951- Lente Insulins (IZS), such as semilente, lente & ultralente

1956- The first antidiabetic oral drugs sulfonamide (tolbutamide, carbutamide) and biquanide (metformin, phenformin) were introduced.

1974- Chromatographic purification techniques allowed the production of highly purified animal insulin. This insulin was called "monocomponent MC" by Novo and "single peak" insulin by Eli Lily.

1975- Fully Synthetic Insulin was synthesized in laboratories of Ciba-Geigy in Basel, but because of economic reasons, large-scale production & subsequent marketing were not undertaken.

1978- Scientists from Genentech in San Fransisco, CA, using a genetically manipulated plasmid of E.Coli bacteria, succeeded in producing insulin with the same amino sequence as seen in humans.

1982- The race to produce "human" insulin sing gene technology was won by Eli Lily when the FDA approved Humulin R (rapid) and Humulin N (NPH) for the US market.
This was then followed by Novo's semisynthetic insulins, Actrapid HM & Monotard HM.

Since 1996- Different insulin anologues have been introduced, Humalog, Novolog, Lantus, Apridra, Levemir, NovoRapid, etc.

[xMenace]

Karen, preview the post and put your own text into the link before posting, between the tags.



Intensive Insulin Therapy is MDI. They are interchangeable terms. My endo still calls it IIT.

I started in 1995 after my first 911. I think I went on Toronto and Ultra-Lente. I switched to Humalog when it came out. 1996 sounds right. I switched to Lantus when Ultra-Lente was retired. 2001 sounds right.

[TommyC1]

Thanks All,
15 years, so I was DXed in 1996.
My GP put me on two shots of NPH per day. That stayed the same through a second GP and an Endo. Actualy the Endo tried putting me on 70/30 at night. That was scarey!
I had lousey control, A1Cs in the 8-9 range, and the hypos were bad enough that I considered giving up my drivers license.
I finally had enough and went into Joslin where they seemed rather surprised that anyone was trying to live on two shots of NPH per day.
I didn't know there were other options.
But at least according to Saraspins timeline I could have been on Humulog and NPH MDI when I was Dxed. Lantus and Novalog MDI since 2001.
My A1Cs are reasonable for the first time and I have not had a hypo that I could not easily deal with since the switch.
If only I'd known.

Tommy

[gigiwong]

1921- Insulin was discovered.

1922- Bovine Insulin

1936- Protamine- a low-weight protein was used to develop a "slow-release" insulin. Protamine Zince Insulin (PZI) lasted 24-36 hours.

.....

so before 1922, being T1 is fatal, right?
I'm always glad that I am a T1 in this century.

I was also on NPH for the 1st year after diagnosed. It works fairly well if you can manage to eat carefully to meet the peak of each shot of NPH.

[SueM]

MDI would not have started until after home testing was available. Trying to remember the year, but it was earlier that 1985, that was the first I was shown home bg testing and MDI. I had no money and no insurance for a few years prior and so did not go to the dr at all. Seems I read in Bersteins book that he got a hold on his first tester in 74. That was before it became available to those of us that use it. When it first came out it was carefully guarded for use only at the md office.

Lol That's what you think :D My lovely Mum worked out how to do this in the very early 70's. I was diagnosed in 1965.
Things were a tad hit and miss without a meter in the early days but the principle used was more carbs eaten more insulin needed.
It worked very well too. I used MDI using NPH (Isophane) and soluable (neutral) insulin until may 2008 when I started pumping. I still use the bovine neutral in my pump with great success.

[BlueSky]

The NPH/Regular regimen involved having two shots of NPH and one of regular every day, and timing the shots so that peaks coincided with mealtimes. This is not MDI, which is synonomous with basal/bolus. In other words, you have a separate shot of fast acting insulin to cover each meal, and 1 or two shots of basal insulin to cover background requirements. Basal/bolus (or MDI) only got started when Humalog became available, and NPH or Lente was initially used for basal.

[Scratch]

The NPH/Regular regimen involved having two shots of NPH and one of regular every day, and timing the shots so that peaks coincided with mealtimes. This is not MDI, which is synonomous with basal/bolus. In other words, you have a separate shot of fast acting insulin to cover each meal, and 1 or two shots of basal insulin to cover background requirements. Basal/bolus (or MDI) only got started when Humalog became available, and NPH or Lente was initially used for basal.
Actually you can basal/bolus with NPH and R, I did so myself for about 3 weeks prior to using Lantus and Novolog.

You can set up basal shots with NPH and use R insulin as the fast-acting bolus insulin. It's just messier some with 6 t0 8 hours of fast-acting dependent upon injection site and a somewhat peakish basal insulin. But I was using the same sort of basal/bolus methodology while doing so, counting my carbs and trying to have the NPH basal keep my fastings steady.

Then I went to the doctor and asked for an RX for Lantus and Novolog, because they are better tools to use basal and bolus. :)

[DanG]

...NPH or Lente was initially used for basal.

So, my initial 30 years using insulin - lente only - was probably an incorrect manner of treatment? ...the things we learn. Which corroborates my theory that most doctors are idiots.

I used only lente, only one shot per day for 30 years, from 1974 to 2004, as I was directed by the doctor, and then lente became unavailable. I resisted the prospect of numerous shots per day until I could no longer purchase lente. I never visited a doctor for 25 years. When lente became unavailable, I had to find a doctor who would write a prescription for the lantus and humalog. That's all he does still - why bother with any other counsel from such a gang of idiots - don't get me wrong, they are nice people, but...

I guess my experience has jaded my opinions of the medical-industrial-complex. The more I learn, the more jaded I become.

[GeishaGirl]

The NPH/Regular regimen involved having two shots of NPH and one of regular every day, and timing the shots so that peaks coincided with mealtimes. This is not MDI, which is synonomous with basal/bolus. In other words, you have a separate shot of fast acting insulin to cover each meal, and 1 or two shots of basal insulin to cover background requirements. Basal/bolus (or MDI) only got started when Humalog became available, and NPH or Lente was initially used for basal.

Yeah, this is what my mom did. She was diagnosed in 1966 or 67, and got her pancreas transplant in 2005, and for those 38 years, she was on this system. I have NO idea why her doc never put her on a basal/bolus, but when I was diagnosed a year ago, I had to explain all of this to her. It seemed so strange...

And she's still convinced that, when it comes to insulin doses, calories are more important than carbs. So when I eat chicken there, but ignore the rice, and take no insulin, she gets upset.

[SueM]

The NPH/Regular regimen involved having two shots of NPH and one of regular every day, and timing the shots so that peaks coincided with mealtimes. This is not MDI, which is synonomous with basal/bolus. In other words, you have a separate shot of fast acting insulin to cover each meal, and 1 or two shots of basal insulin to cover background requirements. Basal/bolus (or MDI) only got started when Humalog became available, and NPH or Lente was initially used for basal.

Nope it was always 2 NPH and 2 what you call regular.
Depending on the clinitest colour. Depended what amount I had. Even back in the 1960's this was posible
I mainly had 2 and 2 but weekends I had some more at lunch time.
I doubt the Drs ever knew :) My Mum was way ahead of her time as far as diabetes was concerned.

[DeusXM]

I think it's a bit rich for you to say that most doctors are idiots. Some might say that actively avoiding them isn't exactly a smart move either, and perhaps if you had visited a doctor more than once every quarter century, you might have been shown how your treatment regime was wrong.

In my experience, doctors do not know everything and it's ludicrous to expect them to. But I certainly wouldn't have the quality of life I have if I didn't listen to them and talk to them about my condition.

[DanG]

In my experience, doctors do not know everything and it's ludicrous to expect them to. But I certainly wouldn't have the quality of life I have if I didn't listen to them and talk to them about my condition.

If I had some of the "good" experience that you have talking to the doctor - you bet, I would be there to speak with a doctor about things. Maybe not, however. The doc that got me out of the ER and started me on insulin loooong ago, told me that I would know more about my diabetes than he would ever know - I believe(d) him, and that remains to be the background of my interaction with a doctor.

The current doc has wanted me to take some other meds - I forget which, maybe blood pressure or cholesterol - but I cut off that discussion quickly as I am not prone to more life than is logical. I want to be realistic regarding life and the ultimate of life - death. I am old, I have diabetes, I don't really have other issues, but I am not going to attempt to be living longer with chemistry - insulin is the med for me, then death. I can live with that. My wife is the same way, this after watching her mom die with all that ugliness of cancer treatments - she says no thanks to doctors and their chemistry. After you see a few persons die around you, it becomes obvious that death is part of the journey. I can accept that.

[alicat61]

[QUOTE=BlueSky;467643. Basal/bolus (or MDI) only got started when Humalog became available, and NPH or Lente was initially used for basal.[/QUOTE]

:) Hi,
I disagree with this statement. I did MDI with Protophane and Actrapid insulin. At the start I would have 2 injections a day of a mixture of protophane/actrapid before breakfast and dinner. In the mid 1990's after doing some reading I changed to haveing the Protophane when I first got up then again at night, The actrapid I would have before meals, Made more sense as I worked shift work and could not be guarenteed regular meals. I then went to my endo at the time and informed him of what I had done:D
In 2006 I changed to Humalog and Lantus before this Lantus was not funded by our Govt medication scheme so was very expensive.
The actrapid and protophane worked but not as quick as the newer insulins

[DeusXM]

The doc that got me out of the ER and started me on insulin loooong ago, told me that I would know more about my diabetes than he would ever know - I believe(d) him, and that remains to be the background of my interaction with a doctor.

That's completely true, but I would still say that doesn't justify avoiding seeing a doctor for 25 years.

After you see a few persons die around you, it becomes obvious that death is part of the journey. I can accept that.

Good for you, many people can't. But I would argue that taking statins or ACE inhibitors isn't exactly comparable to chemo. Death may be the destination, but I personally intend to prolong the journey as much as possible for as long as the journey remains fun and interesting. I respect that not everyone feels this way though.

[DanG]

Death may be the destination, but I personally intend to prolong the journey as much as possible for as long as the journey remains fun and interesting. I respect that not everyone feels this way though.

Very reasonable response - thanks.
While I intend to hang around as long as I can, I remain skeptical about the methods used today for problems that are detected - throw some chemical at the problem, i.e. statins, ACE.

Insulin dependence, in itself, causes these situations fundamentally. Instead of better life through use of chemicals, I would rather change other things in life, such as diet and exercise, etc instead of throw chemicals down the chute. Plus, watching the chemicals plus nuclear treatment and then the vast quality of life with the cancer stuff in my mother-in-law 20 years ago is just enough to say forget about those methods and "die already." A while ago, I heard a radio news item on npr explaining the gen-x attitude - "die already" speaking to the boomers. I can take that - you gen-x guys have more ahead of you than an old boomer - I can pass gracefully.

[DeusXM]

Instead of better life through use of chemicals, I would rather change other things in life, such as diet and exercise

If everyone had that attitude, the world would be a healthier and happier place. Kudos. Stay healthy mate.