History of humalog plus lantus

[DanG]

Humalog is made by Eli Lilly, and Lantus is made by Sanofi Aventis.

Some questions about this situation:

Question 1: How did the MD come up with a diabetes management scheme using two different insulins from two different manufacturers?

Question 2: How old is this management scheme been used? How long have you been using humalog/lantus, or the novo nordisk products? That is, how long have these products been on the market for diabetics?

I used lente U-100 for 30 years (lente seemed to work fine, until the manufacturer cancelled production - bad move in my mind). I have been using the humalog/lantus scheme for the past 3 years. I found diabetesforums not too long ago, so I am sometimes congering up a few oddball questions.

Thanks for any input. I am sure some here have researched these type questions before, or have handy information summarizing the answers.

[murphysl]

Hopefully, someone can answer your questions better than I can, but I thought the following related information might be of some interest to you.

For questions about why we have newer insulins replacing older ones, like the Lente that worked well for you for 30 years (32 years for me), I would recommend a book called "Too Profitable to Cure" by Brent Hoadley, a Type 1 for 50+ years. I, too, think discontinuing Lente (and Ultra Lente) was a big mistake, not just for us, but for some guardians of diabetic dogs and cats who were not able to regulate their pets on any other insulin (see the links to another forum regarding this below). I now import my insulin from another country because neither Lantus nor Humulin N works well for me.

Lilly Humulin L - Visitor Opinion Post

Humulin U - Visitor Opinion Post

Humulin L Discontinued - Visitor Opinion Post

Discontinuing Humulin-U And Humulin-L Is Killing My Dog - Visitor Opinion Post

[BlueSky]

Question 1: How did the MD come up with a diabetes management scheme using two different insulins from two different manufacturers?

Question 2: How old is this management scheme been used? How long have you been using humalog/lantus, or the novo nordisk products? That is, how long have these products been on the market for diabetics?.....

Sounds like you are having doubts about your new insulin regimen. Humalog and Lantus are both modern, state-of-the-art insulins. Why wouldn't you want to be using products made by different manufacturers? Humalog and Lantus are both leading products in their respective classes.

Humalog has been around since 1996, when it was approved by the FDA. Lantus and Novolog came onto the market in 2000. Levemir, another Novo Nordisk product, was the most recent entrant, arriving on the market in 2005.

I started using Humalog as soon as it became available, with Humulin N (NPH). It takes a while for new products to become available in this part of the world, and I only switched to Lantus in 2003. It was a big improvement over Humulin N. At the same time, I also switched to Novolog, mainly because I wanted to use the Innovo Pen. I am now considering switching back to Humalog, so I can use the Humapen Memoir.

[NoraWI]

What I would like to know is why Ely Lilly decided to stop production of two very old and widely used insulins (Lente & Ultra Lente) that were available without Rx? The only benefit from discontinuing these insulins was accrued by two of their competitors. The basals Lantus and NovoLog are both "designer" insulins with actions regulated by various chemicals added to them. IMO, what the discontinuation of simple insulin production accomplished was to limit the market and herd all users to synthesized PATENTED products.

I again ask... what did Ely Lilly have to gain?

[DeusXM]

What I would like to know is why Ely Lilly decided to stop production of two very old and widely used insulins (Lente & Ultra Lente) that were available without Rx?

They're not widely used anymore. The vast majority of diabetes patients are now on Lantus or Levemir. There simply isn't any money to be made anymore in producing the older basal insulins, and it probably cost Ely Lilly more to produce Lente and Ultra Lente than they were making from it.

The basals Lantus and NovoLog are both "designer" insulins with actions regulated by various chemicals added to them. IMO, what the discontinuation of simple insulin production accomplished was to limit the market and herd all users to synthesized PATENTED products.

Firstly, Novolog isn't a basal. Secondly, ALL synthetic insulins with the exception of Regular are 'designer' insulins. Check the ingredients for Lente - it has zinc chloride in it, which is what is used to slow down its action profile. The problem is that 'simple' insulin products simply don't meet the needs of most people with diabetes - for instance, with Lente you can't fast in the same way you can with Lantus. However I do strongly believe that there should be a range of alternatives available.

Question 1: How did the MD come up with a diabetes management scheme using two different insulins from two different manufacturers?

Manufacturer has very little to do with choice of insulin. Doctors prescribe based on the quality of the product. Eli Lilly, who make Humalog, don't make a flat profile basal insulin and so you would have to look to a different company to supply your basal. However, this doesn't matter. Insulins made by different companies work perfectly fine together and there are no benefits and quite a few drawbacks to using insulins from the same company.

Question 2: How old is this management scheme been used? How long have you been using humalog/lantus, or the novo nordisk products? That is, how long have these products been on the market for diabetics?

Humalog and Novolog/rapid have been used as bolus insulins for about 10 years now, Lantus has been around for about 7, and Levemir has been around for about 5. This management scheme is 'the' scheme for treating diabetes with injections - it offers the greatest flexibility of lifestyle and best A1C results. Of course, there is a small minority of people who have trouble with one or more of these insulins, which is precisely why alternatives (including animal-derived insulins) should be made available.

[SueM]

Try this site you might find some of the info you want here

Insulin Dependent Diabetes Trust

[DanG]

I now import my insulin from another country because neither Lantus nor Humulin N works well for me.

ooooo - I am jealous.
someone here last Fall told me about importing Lente, but I could not get assurance that the program worked.
Now I have your word that the program works.
Does insurance cover cost - or are you on your own?
May I ask what you pay for Lente, and how often you order?
Perhaps a bit too intrusive, but would you consider a group purchase, as in, I pay you and you send me some next time your order is due?
Thanks for the links. Sounds too conspiratorial to be true, as many things today. Oh well.

[Funnygrl]

I'm really not a fan of the conspiracy theories out there- that diabetes will ever be cured because it's too profitable, that animal insulins are better and synthetics suck, or that lente isn't available for whatever reason other than that it really doesn't serve a place in the current diabetes market anymore.

I highly recommend the books "Using Insulin" and "Think Like a Pancreas."

It really sounds to me like your endo knows what he is doing- he has you on a state of the art insulin plan that has been used successfully by many, many people.

[DanG]

Manufacturer has very little to do with choice of insulin. Doctors prescribe based on the quality of the product. Eli Lilly, who make Humalog, don't make a flat profile basal insulin and so you would have to look to a different company to supply your basal. However, this doesn't matter. Insulins made by different companies work perfectly fine together and there are no benefits and quite a few drawbacks to using insulins from the same company.

Why did I know DeusXM would have something to say on this? I almost directly asked for a DeusXM reply in original posting.
Thanks.

My curiosity is relative to the development and marketing. Lilly developed a product that perhaps should be useable by itself, otherwise how to market a product that is partial treatment. i.e. Lilly says: No, you cannot live with humalog only, you must wait for development of a basal insulin which we do not manufacture... oh, well.

Sure, the proper suite of designer insulins du jour is lantus and humalog, but as you say - there is plenty of marketplace to use some other options, I would think - so why not offer a lente? It worked for many many years without real problem - ask SueM, or murphysl, or me. I would still use lente if I could obtain the stuff. Of course, you must understand that I don't do ipod, iphone, mac, hdtv, car younger than 23 years, etc.

I agree with the olde New England saw: use it up, wear it out, make it do, or do without. That is, I was living fine without prescription using lente. Now I am FORCED - yelling, yes - to live with designer insulin. It still peeves me three years later. You said admirable thing - the offering of alternatives is good for the marketplace - but this marketplace is without alternatives... that is unless I consider death an alternative...

[Funnygrl]

You want alternatives?

Here are your current insulin offerings:
Pump Novolog
Pump Humalog
Pump Apidra
Pump Regular
Lantus + Novolog
Lantus + Humalog
Lantus + Apidra
Lantus + Regular
Levemir + Novolog
Levemir + Humalog
Levemir + Regular
NPH + Humalog
NPH + Novolog
NPH + Apidra
NPH + Regular
Premixed

You need more choices?

As for one product being enough, with the exception of pumping, I don't really understand how this would work.

Now, I'm not up on L, it was discontinued before I was diabetic, but, isn't the action almost identical to N?

[Gary_W]

Why did I know DeusXM would have something to say on this? I almost directly asked for a DeusXM reply in original posting.
Thanks.

My curiosity is relative to the development and marketing. Lilly developed a product that perhaps should be useable by itself, otherwise how to market a product that is partial treatment. i.e. Lilly says: No, you cannot live with humalog only, you must wait for development of a basal insulin which we do not manufacture... oh, well.

Sure, the proper suite of designer insulins du jour is lantus and humalog, but as you say - there is plenty of marketplace to use some other options, I would think - so why not offer a lente? It worked for many many years without real problem - ask SueM, or murphysl, or me. I would still use lente if I could obtain the stuff. Of course, you must understand that I don't do ipod, iphone, mac, hdtv, car younger than 23 years, etc.

I agree with the olde New England saw: use it up, wear it out, make it do, or do without. That is, I was living fine without prescription using lente. Now I am FORCED - yelling, yes - to live with designer insulin. It still peeves me three years later. You said admirable thing - the offering of alternatives is good for the marketplace - but this marketplace is without alternatives... that is unless I consider death an alternative...

Before Lantus came out, you could still use Humalog or Novorapid (Novolog on your side of the pond). You just used an 'older' form of basal insulin such as lente or NPH.

Nowadays, you have 3 main players in the insulin world that I am aware of. Sanofi Aventis, Lilly and Novo Nordisk. Sanofi make both a peakless basal and a rapid analogue (Lantus and Apidra). Novo Nordisk do likewise with Novorapid and Levemir. It is only Lilly being the odd ones out with only 1/2 the market need covered as far as 'modern' insulin goes.

One main difference with newer basal insulins is that Lantus / Levemir are supposed to have no peak or a minimal peak which, if that is the case with you, should make your bolus doses easier to work out as the basal is not interacting in any way. If you've been used to a peak from the Lente then I can imagine the difference would be rather striking.

Besides the inconvenience of having to get a prescription and the upset at enforced change (always the worst kind) do you actually have a problem with Lantus in terms of your control? If so, what is it? I had the dose worked out incorrectly which is something I did wrong for years with the full blessing of the local doctors.... Until recently I wasn't too chuffed with Lantus either but in my case it was me not the insulin. Not saying that's the case with you but just fishing for more info

Gary

[murphysl]

ooooo - I am jealous.
someone here last Fall told me about importing Lente, but I could not get assurance that the program worked.
Now I have your word that the program works.
Does insurance cover cost - or are you on your own?
May I ask what you pay for Lente, and how often you order?
Perhaps a bit too intrusive, but would you consider a group purchase, as in, I pay you and you send me some next time your order is due?
Thanks for the links. Sounds too conspiratorial to be true, as many things today. Oh well.

I'm still working on getting the Lente. In the meantime, I purchased some porcine NPH & some porcine regular from Canada. No Rx or paperwork of any kind is required as it is when buying it from other countries, so they got these to me in less than a week. These are working much better than the Humulin N and Humulin R, but I'm still hoping for some Lente. I didn't realize how much I had depended on the lunchtime peak from the semilente part of the Lente. I will keep you on my list, and let you know when I have sucessfully obtained some Lente. I will also check into the legality of group orders--that would certainly save $--the FDA will allow importing up to a six-month supply. My insurance didn't want to pay for it, so I'm trying to buy it from Argentina (where the US dollar is worth about three Argentinian dollars) rather than the UK (where our dollar is worth a little more than 1/2 pound). It has been a slow process because the Argentinian company that makes Lente, Laboratorios Beta, will not sell to individuals--they only sell to pharmacies in large quantities. So, I am trying to locate a pharmacy in Argentina who would be willing to sell and ship it to me. I don't know Spanish, so I have been relying on Spanish-speaking staff at my doctor's office to help. They, like most medical offices, are very busy.

Now that I have some evidence that an insulin that is not available in the US gives me better glucose control, I am hoping that my insurance company will reconsider. That way, I could probably get some Bovine Lente from the UK--hopefully six months worth. Feel free to send me a personal message if you are more comfortable with that than posting on the thread. Either is fine with me

[DanG]

You need more choices?

That list hardly comprises a choice.
It is numerous forms of delivery of lantus plus humalog.
Lente was one shot per day.
The current MDI routine is 4 shots per day.
I never did the regular insulins with numerous shots per day.
I believe there were people taking numerous shots per day using NPH and Regular and others - I don't know. I used Lente - one shot per day.

I learned to live with the beast (Lente) and did fine. That is the beef. One shot per day is no longer an option - that is the choice that was taken from the marketplace. By removing Lente from the marketplace, I guess that defines no interest by consumers - strange justification methodology for saying the marketplace did not want the product.

[DanG]

Besides the inconvenience of having to get a prescription and the upset at enforced change (always the worst kind) do you actually have a problem with Lantus in terms of your control? If so, what is it? I had the dose worked out incorrectly which is something I did wrong for years with the full blessing of the local doctors.... Until recently I wasn't too chuffed with Lantus either but in my case it was me not the insulin. Not saying that's the case with you but just fishing for more info

I don't really have an ability to know if Lente or Lantus/Humalog provide better control. As I say, I learn to adjust to whatever I am shoved into. I don't have an option these days. I MUST do MDI 4 shots per day humalog/lantus, whereas before, I did one shot per day of Lente. Since the Lente is not in my marketplace, I have no means of comparing the two. It is MDI or die. Or, in other words, make money for big pharma.

I am functioning fine with lantus - it is really the "enforced change" that was initially upsetting. I don't do doctors. I see one once per year so I can ask for prescription - which was not required for Lente. I deal with diabetes as it is part of life, like losing hair, or cutting fingernails, etc. I need to make it work. Right now it works. Prior to "enforced change" it also worked. Oh, well.

Well, I really didn't ask my original question as a springboard about big pharma, but I guess it has sorta turned into that. All you young punks using designer insulins know nothing about the olden days of Lente insulin. So it is what it is today.

[Funnygrl]

I have a really hard time believing you had any level of control on one shot of lente a day. Sorry.