Switching from NPH to Lantus... should I be worried? (w/ cliffs)

[Maddogg]

So I saw my doctor yesterday to discuss some problems I've been having this year with hypos. I've had 4 hypoglycemic seizures so far this year, 2 of them I had to be taken to the hospital. Yes... I know this is bad. I've never ever had seizures prior to this year so I figured something had to change.
So he's going to switch me from Humulin N to Lantus. I was currently taking 70 units of Humulin (split dose) daily. So he'll start me off on Lantus at a basal rate of 40 but told me I can increase/tweek it if need be. I don't think 40 will be enough (i'll probrably need between 50-60 units). but we'll see

I've never taken Lantus before, I've tried Levemir and that stuff didn't work very well for me. It was inconsistent and unpredictable, so I stop taking it after I was done the first box.
But I've heard similar complaints about Lantus... I've also heard that Lantus can cause you to gain weight and possibly cause cancer. Are any of these allegations true? I'm not really worried about the cancer so much, but I certainly don't want to gain weight.

Cliffs:
-Have had 4 hypoglyemic seizures this year! (never had them before this year)
-Saw my doctor, believes I should switch from NPH to Lantus
-Used to take Levemir (years ago), didn't work well so switched back to NPH
-I've also heard negative things about Lantus (similar to comments about Levemir), including cancer risk and weight gain...
-Worried that I'll gain weight from switching to Lantus.
-Need feedback

[Subby]

The cancer link was shaky at best. I don't know the exact state of play at this stage, I'll leave it to others who may have followed it more carefully.

As for the other problems people might find on Lantus, for example I had side effects like fatigue and weird head feelings... the actual action was predictable enough for me. I truly think these side effects seem to hit unpredictably and with any insulin for any person, that the only way to know if it suits your body or not is just to try it. Same goes for weight gain.

Just trying insulins, is the only way I've found the best alternatives, empirical evidence on your body is the only way to find out, in my opinion. If it doesn't work for you - well, you've just found out one more thing, eh. Watch the highs, that's a very big reduction in dose your endo has gone for!

[DeusXM]

Have had 4 hypoglyemic seizures this year! (never had them before this year)

This would most likely be the fault of the NPH. NPH has an absolutely evil peak action that can and will create very severe hypos. I've also been told the zinc in NPH impairs hypoglycaemic awareness, but I couldn't find any empirical proof of that.

Saw my doctor, believes I should switch from NPH to Lantus

Your doctor is exactly right, I would say, with the usual disclaimer that I'm not your doc and don't know everything about your case blah blah blah.

Used to take Levemir (years ago), didn't work well so switched back to NPH

For some people, Levemir just doesn't work. I had to take nearly double the amount of Levemir that I would of any other basal insulin and I would still be running high.

I've also heard negative things about Lantus (similar to comments about Levemir), including cancer risk and weight gain...

Lantus has been 'proven' to have a far lower rate of weight gain to NPH, in fact NPH is regarded as probably the most significantly weight-gaining insulin around, as you need to feed it. As for cancer, the jury is out on that one and there hasn't been a comprehensive study. Even in the unlikely event it does cause cancer though, would you rather be living with the risk of multiple, immediately fatal hypo seizures, or the risk of developing something less likely, potentially more dangerous, but at least you can see it coming?

I doubt you'll gain weight on Lantus, in fact I'd even wager you might lose weight on it. You may be amazed by the improvement you'll see if you go onto Lantus. I know I was.

[Maddogg]

Thanks for the quick feedback... :) As you can see, I'm rarely on this forum (don't have internet access at home since I don't want dial up), and I rarely have time to go on here from work.
I usually come here when I need help and I'm always amazed by the helpful and fast feedback I also get, not to mention the positive support.

Thanks for the help :)

[paramountz]

I have been on lantus for many years with no side effects my only gripe is how much it money it is. Are you taking a bolus insulin as well?

[Maddogg]

Bolus? No I'm currently taking Humulin N and Humalog, and will be switching to Lantus and Humalog.

And yeah my doctor said that the Lantus was more expensive, but I'll supposively be taking less of it than the NPH so maybe it will balance the price out?? How much more expensive is Lantus as oppose to NPH? I think I pay around 5-7$ per box (5 cartridges) for my Humulin N and Humalog with my drug plan, how much more is the Lantus?

[TommyC1]

I only wish I'd switched from NPH to lantus sooner. It's been a godsend to me. I've been on Lantus for roughly 18 months now.
My hypos are far fewer and far easier to treat. I've had no visits from the EMT's vs roughly 6 the year before I changed.
I've lost weight and improved my a1c considerably.
Feel like I've got my life back.

I started counting carbs and matching my rapid insulin to my carb intake at the same time. I credit that more than the Lantus for my weight loss. But I can't see how Lantus would cause weight gain any more than any other insulin.
I also started testing my bloodsugar more which I'm sure has helped with the hypos.
But I do give most of the credit there to Lantus. For me it's MUCH more predictable.

[strack350]

What paramountz meant by bolus was are you taking fast acting insulin "Humalog" to cover your meals, etc.., I think you will get along good with lantus once you get your dosing figured out. I've switched from NPH to Levemir, but have heard good thing about lantus also, keep us posted on your progress;)

[poodlebone]

With insurance you may find that your co-pay for the Humulin N and Lantus are the same. All insulins on my plan have the same co-pay. If you had to pay out of pocket then Lantus is definitely a lot more expensive.

I started out taking Humulin Regular & NPH. Then went to Humalog & NPH, then Lantus & Humalog. I developed hypo unawareness and had many extremely bad lows that casued seizures, passing out, 911 calls etc. I was not seeing an endo at the time, basically because I hate going to the doctor and figured seeing one doctor (PCP) was bad enough. After passing out at work again a co-worker stood over me as I looked up an endo and called for an appointment. The endo immediately switched me from NPH to Lantus and the change was noticeable right away. I still had lows, especially at first, but they weren't as bad as on NPH. I found that Lantus didn't last 24 hours for me so I had to take two injections. It wasn't a big deal since that's what I was doing on NPH anyway. After only a few months on Lantus I switched to an insulin pump which is the ideal treatment for me.

[sarahspins]

Bolus refers to a dose of a rapid insulin.. if you're taking your Humalog with meals that is considered "bolusing" even if you aren't pumping :)

I lost weight when moving from NPH to Lantus... so don't let the weight gain really worry you - most of the "complaints" about weight gain are from T2's transitioning to insulin and taking rather large amounts of it to gain control. Most T1's don't really fit into that pattern.. and you will most likely take less Lantus than NPH. Yes, it's possible to gain weight on Lantus if your dose is seriously off and you're taking too much, but you'd likely know if that was the case, because you'd still be battling hypos fairly often.

As far as cost.. I am not sure about how your drug plan works in Canada... but I can say that in the US, comparing the vial prices for NPH (not Relion) with Lantus, Lantus is about twice the price... but that said, all insulins have the same co-pay for me except for Apidra (of course the one I use has to cost more, right?)... so NPH pens (can we even get those in teh US?) would cost me the same as Lantus... your drug plan may be similar. Actually, I would expect the pricing to be about what you pay for Humalog... as all of the analog prices tend to be very close.

[Maddogg]

Thanks for all the information guys, I've learned quite a few new things about Lantus and its much appreciated...
I still have 3 boxes of NPH that I need to finish before I start the Lantus, I don't really want to throw them away and waste insulin, although I'm wondering if I should. :confused: I'm looking forward to starting the Lantus, should be a good change after being on Humulin N for 7 or 8 yrs.
My drug plan covers 90% of the prescription, so I just pay 10% of the total cost.

Thanks for everything!

[Subby]

I think ending up in ER 2 times this year is good enough reason to try something new ASAP. Another terrible low could be a lot more expensive to you, than turfing some troublesome insulin... and of course hold onto it, and if the Lantus doesn't work out, you can just go back to the NPH in your fridge, minimal waste. In fact it's good to be sure you still have some NPH left when you try the Lantus, so that if it really doesn't go well, you can go immediately back to what you are familiar with without stuffing around with scripts, picking new NPH up, etc.

Best of luck, hope it's a new stable step for you.

[TommyC1]

Thanks for all the information guys, I've learned quite a few new things about Lantus and its much appreciated...
I still have 3 boxes of NPH that I need to finish before I start the Lantus, I don't really want to throw them away and waste insulin, although I'm wondering if I should. :confused: I'm looking forward to starting the Lantus, should be a good change after being on Humulin N for 7 or 8 yrs.
My drug plan covers 90% of the prescription, so I just pay 10% of the total cost.

Thanks for everything!

If you are having trouble with hypos, do yourself a favor and throw out the NPH.
If you drive a car or operate any machinery more dangerous than a teaspoon it's just not worth the risk.

[Maddogg]

Yeah, I'm thinking of finishing the box I have right now (2 cartridges left), and throwing out the 3 boxes that I have left in the fridge, the 3 boxes probably cost me less than 20$ and that sure as **** ain't worth another trip to the hospital. I'd like the make the rest of the year seizure free :)

[DeusXM]

I'd just get onto the Lantus as soon as you can and keep the NPH in the fridge as an emergency back-up. No point chucking it if it's in date, and no point staying on it if you can use a better alternative.