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miketurco

switching to N and R

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miketurco

I've been using lantus and novolog. Both work for me, but I'm not insured. And wow, this stuff costs a lot. I'm paying a hundred bucks a pop for the novolog pens and something close to that for the lantus.

 

I do have prescription cards, but between walmart screwups and (what seems to be) lack of good will on the part of the manufacturers, I usually end up paying full price for this stuff. Which stinks.

 

I'm thinking of going to N and R. I'd save a lot of money. I do realize I'd have to re-titrate and also go from using a pen to using a needle. I also know that the curve is different in terms of peaks and so forth, and that I'll have to figure that out too.

 

Other than that, any real concerns? Assuming that I'm able to adjust my schedule and so forth, does it really make a difference?

 

Thanks

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moe22

My Mother-takes Levmier  which she takes  at night ( still consider a Type2), but her Dr. switch her from Janivua  to  Starlix (which she take 3x a day as opposed to  once a day)saves her around $300:00 dollars a year

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miketurco

Went to Walmart and talked to the pharmacist. Bought a 1000u vial of Novolin R for $25. I usually pay about $100 for 300u of Novolog. The syringes seemed to be about the same price as the pen tips, and I was able to get the same gauge needle. So.... will see how it goes. As I understand the I:C ratio is pretty much the same, but I'll be sure to test.

 

Just thinking out loud here, but I might be better off with R. It's not as fast acting, so lows may come on more slowly and be easier to treat. And it takes longer to get out of your system, which in theory sounds like it may be better for me.

 

I've got five or six pens of lantus in the fridge. If things go well with the R, then I'll start using the N when the lantus is gone. Or maybe I'll just use more of the R and skip basal all together.

 

Will report back after I've gotten into the swing with the new stuff.

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aggie168

From everything I heard and seen, the I:C is very similar for most people. It is similar to switching from Novolog to Humalog. Very minor adjustment on dosage, if even necessary. :)

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Cora

You are going to have to do a lot of testing, and above all else, watch out for stacking. The peaks and effective insulin time will vary for you - both because it's you personally, and may also vary depending onwhere you inject. For me, R peaked at roughly the 4 hour mark, and lasted for 6 - 8 hours (but the tail was minimal) For the N....sorry, I hated that stuff. It peaked at roughly 8 hours, making it reliable enough, but how long it lasted would vary (with little predictability for me). So, with these 2 insulins you will be forced to eat at certain times. So a lot less food freedom (but obviously, more money for good food, so that's the trade off). And especially watch what goes on around the dinner hour (lunch time R may combine with the peak of the N, and you'll get a double whammy - and a pretty hard low. So this can make an I:C ratio (again, especially for dinner) very difficult to calculate.

 

An example. Suppose you eat your lunch and take your R. By about 4 pm it's peaking (ok, maybe between 3 pm and 5 pm, depending). But, in addition to that, the N you took in the morning (say around 8 am) is also peaking at roughly that time. So what do you eat? And when? And how much? This is what we T1s in the old days had to deal with and why the docs forced us onto rigid diets eat at the same time every day.

 

On the plus side, a bedtime injection of N can really help with dawn phenomenon. Again, lots of testing involved and it will also affect I:C calculations for breakfast.

 

Sorry I'm being such a downer, but it was a terrific day for me when more modern insulins came out. Best of luck to you/

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DeusXM

Aside from the insulin stacking issue (which was a MAJOR problem for me, even when combining Novorapid with Insulatard), the other major issue is to do with insulin theory.

 

The principle behind using insulin is that the bolus insulin mimics the pancreatic response to food and your basal mimics the pancreatic response to your basal glucose output.

 

No insulins at present exactly match either of these. Lantus and Levemir are a compromise in that they're notionally flat, which at least allows some predictability. Older insulins are much more problematic unless you can get their peak to coincide exactly with peak basal glucose output. This is VERY hard to do and the most likely scenario is you'll find you have too much basal when you don't need it, and too little when you do.

 

Then there's the bolus insulins. When you eat something carby, it usually hits your blood stream pretty quickly - within the first fifteen minutes. When it finishes...well, that's entirely dependent on the food you eat and that can vary anywhere between 1 hour to 4 hours, if not more. 

 

So this is a major problem with the older bolus insulins as they don't properly hit their stride for a good couple of hours - by which point, the food you eat is likely to have pushed your blood sugar up pretty high, and you might also be 'lucky' enough to then have a massive yo-yo effect where the remaining bolus insulin kills the high and then takes you low. This is a problem with Novorapid etc. too but because the action times are shorter, the margin for error is lower.

 

I am fairly sure that if you switch to these insulins, you will not be able to eat low-carb and you will find your meals need to have a very specific combination of carbs and fats to ensure their digestion profile runs nearer to the extremely unusual action profile of your basal insulin.

 

It is possible to get control with these older insulins but the amount of work required is phenomenal to the point that your entire life becomes about managing your insulin - and for me, that sorta defeats the point of treating diabetes. I treat my diabetes so I can get on and live my life, whereas with the older insulins, you're really treating your diabetes so you can go on treating your diabetes.

 

On a slightly political note, I think it's an outrage that you have to seriously consider alternatives purely for financial reasons when from your A1C results, what you're on now is clearly working so well.

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jwags

I thought you were going to get insurance through your wife's company. Any time you have a major life change, birth, marriage, new job you are eligible to apply for insurance. Have you tried getting insurance through the exchange? It won't be cheap but you will have coverage.

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miketurco

I thought you were going to get insurance through your wife's company. Any time you have a major life change, birth, marriage, new job you are eligible to apply for insurance. Have you tried getting insurance through the exchange? It won't be cheap but you will have coverage.

 

Long story. I'll be paying for insurance myself, Maura is a housewife. Something seems to be corrupt in my account when it comes to the exchange -- just won't work for me. Insurance isn't a good deal for me. Unless, Gd forbid, something terrible happens, I'll never hit the deductibles. I almost/maybe could have with lantus and novolog, but not with $25/bottle N and R. 

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miketurco

Aside from the insulin stacking issue (which was a MAJOR problem for me, even when combining Novorapid with Insulatard), the other major issue is to do with insulin theory.

 

The principle behind using insulin is that the bolus insulin mimics the pancreatic response to food and your basal mimics the pancreatic response to your basal glucose output.

 

No insulins at present exactly match either of these. Lantus and Levemir are a compromise in that they're notionally flat, which at least allows some predictability. Older insulins are much more problematic unless you can get their peak to coincide exactly with peak basal glucose output. This is VERY hard to do and the most likely scenario is you'll find you have too much basal when you don't need it, and too little when you do.

 

Then there's the bolus insulins. When you eat something carby, it usually hits your blood stream pretty quickly - within the first fifteen minutes. When it finishes...well, that's entirely dependent on the food you eat and that can vary anywhere between 1 hour to 4 hours, if not more. 

 

So this is a major problem with the older bolus insulins as they don't properly hit their stride for a good couple of hours - by which point, the food you eat is likely to have pushed your blood sugar up pretty high, and you might also be 'lucky' enough to then have a massive yo-yo effect where the remaining bolus insulin kills the high and then takes you low. This is a problem with Novorapid etc. too but because the action times are shorter, the margin for error is lower.

 

I am fairly sure that if you switch to these insulins, you will not be able to eat low-carb and you will find your meals need to have a very specific combination of carbs and fats to ensure their digestion profile runs nearer to the extremely unusual action profile of your basal insulin.

 

It is possible to get control with these older insulins but the amount of work required is phenomenal to the point that your entire life becomes about managing your insulin - and for me, that sorta defeats the point of treating diabetes. I treat my diabetes so I can get on and live my life, whereas with the older insulins, you're really treating your diabetes so you can go on treating your diabetes.

 

On a slightly political note, I think it's an outrage that you have to seriously consider alternatives purely for financial reasons when from your A1C results, what you're on now is clearly working so well.

 

I clearly have a long way to go with figuring this out. And for what it's worth, I don't mind doing it. I find the whole concept of diabetes fascinating, front to back. I'm sure that will wear off over the years, but it hasn't yet.

 

Regarding dosages, I have a stinky situation. My IR (or whatever it may be) changes a lot during the day. Therefore Lantus (of which I have a lot left) is not a particularly good insulin for me. I need to be able to vary the amount of available exo insulin in my system throughout the day.

 

When I'm being really good with exercise/diet/insulin, I wake up between 100-110 and then go high within the next hour or two. Usually (with insulin) somewhere between 130 and 140 -- with or without food. Otherwise, (again, when i'm really good,) my numbers throughout the rest of the day run between 85 and 110 or so. (Except for stress, post workout peaks and, I think, something/something to do with sunspots.)

 

It's a fine line to walk. With basal, a little too much and I get nasty lows. A little too little and my fasting goes through the roof (relatively speaking). And my basal changes all the time. Just by a few units, but still, I need to constantly adjust. As to bolus, the idea of pre-correcting a somewhat unpredictable dump is frightening. I hate lows.

 

Regarding bolus, I usually take one shot, first thing in the morning, to pre-correct for the coming morning dump. And that's it. (The dump comes one to two hours after waking.) Then I either don't eat or just have a little something fatty for breakfast. I know that's really unorthodox. But without that morning bolus, I'd be pushing through 200 in no time. 

 

It's only been a couple days, but the R seems to be working really well for me. I do have to work on the timing. I have two/three months worth of lantus in the fridge, so I'm in no hurry to go to N. Once I optimize (cough) the timing of the R, I'll give N a shot. If I'm able to time that peak right, I may not need to pre-correct in the morning. In theory, anyway.

 

I'll be testing my a1c in about a month. Things have been up-and-down since that last test. If it goes up at all, I'll be really bummed.

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LHarless

I took N & R for many years.

I eventually figured out that the 70/30 mix was perfect for me.

The only issue I had with it was that it forced me to eat a certain amount of carbs each meal.

With MDI you can adjust much easier.

With Type R you need to inject an hour before the meal.

I had my worst lows with it as well.

I registered a 30 on my meter one time and found myself drinking honey syrup from a little bear like it was a baby bottle.

In short....Your new insulin will dictate what you have to eat.

MDI...You dictate what you eat.

I wish you well.

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