NPH vs. Lantus, Type I (long)
Elizabeth Blake
I'm a 37 year old female diagnosed Type I when I was 19. Was started on the
old 2-shot (NPH.Reg AM, NPH PM) regimen and stayed that way for many year.
Got health insurance 9 years ago, my diabetes wasn't covered for the first
year, so I finally went to a doctor about 8 years ago after not seeing one
since I was diagnosed. My A1C 8 years ago was 15.something. I started
reading this group back then and began taking better care of myself, mostly
by using R before each meal. I read about Humalog but my idiot doctor (at
the time) had never heard of it, so I went to an Endo who gave me a script.
Unfortunately, the Endo that I picked at random was a throid specialist, not
diabetes. So, from that time until now I've been on NPH AM/PM and Humalog
for meals and to cover highs.
The first 5 years of that schedule actually went okay, but three years ago I
had my first seizure, at home, alone. Since then I've had several more, as
well as about 6 ambulance visits. I had another seizure a few weeks ago and
passed out at work last week. I live alone, so when I have a seizure at
home I can't do anything but wait until I can finally control my limbs
somewhat. I keep juice on my bedside table but it takes a long time before
I can get to it, open it and drink it without it flying everywhere.
My morning numbers generally seem to be either on the low side or normal,
with the occasional high (275-325) that comes out of nowhere. Usually when
I wake up low I'm fine and just drink some juice and sit for a bit before I
start my morning routine. Once I'm up, my BG usually starts to rise. If I
wake up at 86 and don't eat breakfast, when I get to work I'm in the high
200's. If I wake up low, sometimes it continues to drop or it may also
shoot way up. There's no rhyme or reason to it.
The morning dose of NPH hits me in the middle of the aftenoon and if I eat
lunch late I can get in trouble, which is what happened last week.
I'm not a morning person. I usually wake up around 9:45-10:00am and get to
work at Noon, leaving at 7:15 - 7:45. Takes me an hour to get to and from
work. I have gone low on my bus ride home quite a few times over this last
year, even though I check my BG before I leave work and eat or drink
something if I'm low. I don't think that's the NPH, but if it isn't it
means that Humalog is giving me a really nasty late kick.
I finally called my insurance to see if I need a referral to see an Endo,
and I don't. I checked the physician directory and called for an appoitment
last week, but it's not until March 15th. I'm hoping this doctor can help
me because she's listed as an Endo specializing in diabetes, and is also a
CDE. I want to ask her about Lantus and went through the Google archives a
bit looking for info.
1. From what I've read, it seems like Lantus isn't that good for people with
dawn phenomenon. With NPH, it does usually tend to keep me on the low end
but I do sometimes wake up with unexplained highs. It takes a long time to
get them down. I'll check an hour later and it will have gone up. Another
hour later and it starts to come down. Then all of a sudden I'll drop fast.
When my BG is over 150 or so, the Humalog seems to take a little while to
start working. When my BG is good and I inject before a meal my reading
1.5-2 hours later is generally fine.
2. With NPH, I always have to have a snack before bed. Cheese & crackers,
something with peanut butter, ice cream etc. Do you need to snack with
Lantus?
3. As I said before, I'm not a morning person. I wake up at 10:00am, leave
for work a little before 11:00 to catch my bus, which gets me to work by
noon. I get home around 8:30-9:00pm most nights and usually go to bed
between 1:00am -2:00am. What is an ideal time for injecting Lantus if I end
up trying it out?
Thanks.
--
Liz
oldal4865
Elizabeth Blake wrote in message <37cdl1F...@individual.net>...
As you may have noted, many of us T1 hate NPH with a passion because of
surprise hypos, seizures and the like.
". . .No rhyme or reason to it. . ." is an NPH effect all the way. NPH
is notorious for variable absorbence; fast today, slow tomorrow. A
2-shot-per-day NPH regime is particularly nasty in that area.
One way to minimize these effects is to split your daily NPH into 4 smaller
doses. Sorta worked for me but I still hate the stuff.
Your morning effect sounds just as fierce as mine. I solve my problem
with Ultralente which has a gentle peak at 12-14 hours.
That means standard basal shots at 7 am and 9 p.m., then a 3rd shot at 5
p.m.. The 5 p.m. shot gives me a peak right in the middle of the Dawn
Effect. The 9 p.m. shot gives me a second peak at mid-morning, i.e.
right in the middle of the Morning Effect (if you care to separate the two
effects. For me it's just a big blob from 4 a.m. to about 10 a.m.).
The reason I mention Ultralente and it's power to fight Dawn/Morning effect
is the fact that the new analogue insulin Levemir has about the same
activity curve as Ultralente (maybe just a bit faster).
Ultralente is about the hardest insulin to inject. It contains crystals
which settle very rapidly. Thus you must shake the vial after inserting the
syringe, then draw up immediately. Takes a bit of coordination and you
still might see some variability due to inadequate mixing.
Levemir doesn't have that problem. It's also touted as the most
non-variable basal insulin on the market.
Levemir is also compatible with Humalog, Novolog or Regular so you can mix
them in the syringe and cut down on your total shots for the day.
Ultralente will tend to slow down any of the fast insulins if you pre-mix so
I never pre-mix. That means extra shots.
Most folks find out when to inject Lantus by trial and error. One reason
is the variability in absorbence from person to person. Some folks see a
19-hour absorbence, some see 34 hour absorbence, others see everything in
between. Splitting your daily Lantus into two shots spaced 12 hours
apart nullifies the variability.
For many folks, Lantus has a 1-2 hour lag before kicking in, then has a
minor peak at about 6 hours. One way to get more power to attack Dawn
effect is to shoot a bit earlier than bed time. That way, the Lantus is
working at full speed when you go to sleep.
As with any adjustments in basal, you have to check during the night to
make certain you aren't setting the dose too high. For Lantus, you should
be alert to problems at 6 hours after shooting. Set your alarm and test a
few times.
It might be useful if you could maneuver to make the Lantus peak hit you at
about 4 a.m. when the Dawn Effect is starting. Since most folks see the
peak at 6 hours, that suggests shooting at 10 p.m. Of course, that
assumes that your fat layer doesn't generate the peak at 5 hours or 7 hours.
Lantus might work for you. If not, think about Ultralente or Levemir.
It's hard to predict what might happen with any of the modern basals since
your current 2-shot-NPH regime is so lousy that it's just too hard to say
how you will respond if you switch to a modern basal regime.
Those bedtime snacks needed to prevent 3 am hypos with NPH usually aren't
needed with Lantus. In fact, you probably would need a bit of Humalog to
cover the bedtime snack.
". . .When my BG is over 150 or so, the Humalog seems to take a little while
to start working. . ." Me too. It's probably Glucose Toxicity kicking
in. I just increase the dose and/or delay eating after the shot when I see
high bG.
Regards
Old Al
jell...@yahoo.com
I am Type I, have been since age 3 (diagnosed in 1959).
What Old Al has described in terms of Lantus absorbtion gives an
indication of the challenges. When I was on Lantus, I had real
problems with absorption, and my endo let me know that there was as
much as a 20% variability in absorption from day to day. It certainly
was challenging.
I am now pumping. It costs more, but I can reliably determine how
much insulin is needed for a given amount of food. Though not an
ideal situation, I do not worry about nightime lows, dawn phenomena
can be accounted for.
It is, however, damned expensive.
Given your irregular schedule, it might be something you might want to
consider.
On Mon, 14 Feb 2005 14:48:52 -0500, "Elizabeth Blake"
<poodl...@NOSPAMearthlink.net> wrote:
>Hi,
>
>
Alan Mackenzie
2005 14:48:52 -0500:
> Hi,
> I'm a 37 year old female diagnosed Type I when I was 19. Was started
> on the old 2-shot (NPH.Reg AM, NPH PM) regimen and stayed that way for
> many year.
Human NPH is widely hated, though some people manage with it more or less
OK. I didn't. My evening jab of 22 units lasted me 7 hours, leaving me
without basal coverage through the morning. It's been replaced by 8
units Semilente, which kicks in after about 3,4,5 hours and works
steadily through to about 14 hours.
Human NPH has a tendency to cause (symptomless) hypos at about 5 hours
after injection and fade quickly. Its makers claim it lasts 24 hours -
as I've already said, it's effect was purely vestigial for me after 7
hours.
One of the prime applications of human NPH is for use in comparative
studies with new Analogue insulins. In a random group of several hundred
T1s, the above snags of NPH will affect enough of them that _anything_
else will look good in comparison. ;-(
> Got health insurance 9 years ago, my diabetes wasn't covered for the
> first year, so I finally went to a doctor about 8 years ago after not
> seeing one since I was diagnosed. My A1C 8 years ago was 15.something.
> I started reading this group back then and began taking better care of
> myself, mostly by using R before each meal. I read about Humalog but
> my idiot doctor (at the time) had never heard of it, so I went to an
> Endo who gave me a script. Unfortunately, the Endo that I picked at
> random was a throid specialist, not diabetes. So, from that time until
> now I've been on NPH AM/PM and Humalog for meals and to cover highs.
I've been a T1 for 39½ years, now.
> The first 5 years of that schedule actually went okay, but three years
> ago I had my first seizure, at home, alone. Since then I've had
> several more, as well as about 6 ambulance visits. I had another
> seizure a few weeks ago and passed out at work last week. I live
> alone, so when I have a seizure at home I can't do anything but wait
> until I can finally control my limbs somewhat. I keep juice on my
> bedside table but it takes a long time before I can get to it, open it
> and drink it without it flying everywhere.
Does that fit in with ~5 hours after an NPH jab? As a matter of
interest, how much NPH? Are we talking about 5 units, 10 units or 40
units? And, if it's not too impertinent to ask, are you of ideal weight
getting a reasonable amount of exercise or are you perhaps a touch on the
heavy side with a somewhat sedentary existence?
> My morning numbers generally seem to be either on the low side or normal,
> with the occasional high (275-325) that comes out of nowhere.
The high "out of nowhere" is likely a liver dump of glucose, a normal
reaction to a severe hypo.
> Usually when I wake up low I'm fine and just drink some juice and sit
> for a bit before I start my morning routine. Once I'm up, my BG
> usually starts to rise. If I wake up at 86 and don't eat breakfast,
> when I get to work I'm in the high 200's. If I wake up low, sometimes
> it continues to drop or it may also shoot way up. There's no rhyme or
> reason to it. The morning dose of NPH hits me in the middle of the
> aftenoon and if I eat lunch late I can get in trouble, which is what
> happened last week.
It sounds like NPH isn't the stuff for you. If you can get anything with
"lente" in its name, that would probably do a _much_ better job for you,
just as it is doing for me. Lantus would probably also do better, though
it's more expensive and its long term safety is still a matter of
speculation.
> I'm not a morning person. I usually wake up around 9:45-10:00am and
> get to work at Noon, leaving at 7:15 - 7:45. Takes me an hour to get
> to and from work. I have gone low on my bus ride home quite a few
> times over this last year, even though I check my BG before I leave
> work and eat or drink something if I'm low. I don't think that's the
> NPH, but if it isn't it means that Humalog is giving me a really nasty
> late kick.
Who knows? As a matter of interest, why Humalog rather than regular
insulin? How well did the R work when you were using it? Does Humalog
work any better? Could it be that you're just taking too much insulin
all round? That would account both for the lows (for obvious reasons)
and the highs (liver dumps after extreme lows). My specialist doctor (a
great guy ;-) aims first to _stabilize_ T1 diabetics who're changing
insulin or who're new at the game. That means starting them on a low
dose of insulin, aiming for steady BS values around the 200 mark. Once
that's achieved, gradually increase the dose over a few weeks until the
BSs come down to 80 - 150 without losing that stability. If you weren't
soon going to see an endo, that might not have been a bad thing for you
to try.
> I finally called my insurance to see if I need a referral to see an
> Endo, and I don't. I checked the physician directory and called for an
> appoitment last week, but it's not until March 15th. I'm hoping this
> doctor can help me because she's listed as an Endo specializing in
> diabetes, and is also a CDE. I want to ask her about Lantus and went
> through the Google archives a bit looking for info.
> 1. From what I've read, it seems like Lantus isn't that good for people
> with dawn phenomenon. With NPH, it does usually tend to keep me on the
> low end but I do sometimes wake up with unexplained highs. It takes a
> long time to get them down. I'll check an hour later and it will have
> gone up. Another hour later and it starts to come down. Then all of a
> sudden I'll drop fast. When my BG is over 150 or so, the Humalog seems
> to take a little while to start working. When my BG is good and I
> inject before a meal my reading 1.5-2 hours later is generally fine.
It sounds like your regime is too chaotic at the moment to say whether
you've got a problematic dawn phenomenon or not. Get rid of the NPH
first, and get something sensible in its place, then see how things go.
If you do suffer the dreaded dawn, Semilente is the best thing to try, if
you can get it.
> 2. With NPH, I always have to have a snack before bed. Cheese &
> crackers, something with peanut butter, ice cream etc. Do you need to
> snack with Lantus?
Much less likely. I often have a bedtime snack for the Semilente.
> 3. As I said before, I'm not a morning person. I wake up at 10:00am,
> leave for work a little before 11:00 to catch my bus, which gets me to
> work by noon. I get home around 8:30-9:00pm most nights and usually go
> to bed between 1:00am -2:00am. What is an ideal time for injecting
> Lantus if I end up trying it out?
At the same time every day. (Sorry!)
Do bare the Lente family in mind. Many people in this group swear by
CPC's beef Lente, though it is problematic to import if you're living in
the USA.
Hope you get things sorted out quickly. And stay here in the group and
let us know how you're getting on!
> Thanks.
> --
> Liz
--
Alan Mackenzie (Munich, Germany)
Email: aa...@muuc.dee; to decode, wherever there is a repeated letter
(like "aa"), remove half of them (leaving, say, "a").
Elizabeth Blake
<jell...@yahoo.com> wrote in message
news:bi6211dt3ni7323eg...@4ax.com...
> Deleted your message to save some space . . .
>
> I am Type I, have been since age 3 (diagnosed in 1959).
>
> What Old Al has described in terms of Lantus absorbtion gives an
> indication of the challenges. When I was on Lantus, I had real
> problems with absorption, and my endo let me know that there was as
> much as a 20% variability in absorption from day to day. It certainly
> was challenging.
>
> I am now pumping. It costs more, but I can reliably determine how
> much insulin is needed for a given amount of food. Though not an
> ideal situation, I do not worry about nightime lows, dawn phenomena
> can be accounted for.
>
> It is, however, damned expensive.
>
> Given your irregular schedule, it might be something you might want to
> consider.
If my HMO would cover it, I would definitely consider a pump. I'm not sure
if they do cover them. I was just looking at their formulary and didn't see
anything. I have never had a problem getting my Humalog, NPH, strips and
needles so I'm grateful for that. At the rate I'm going, though, it would
probably be cheaper for them to cover a pump than repeated ambulance/ER
visits.
--
Liz
Elizabeth Blake
"Alan Mackenzie" <a...@muc.de> wrote in message news:8e9ruc...@acm.acm...
> Elizabeth Blake <poodl...@nospamearthlink.net> wrote on Mon, 14 Feb
> Human NPH is widely hated, though some people manage with it more or less
> OK. I didn't. My evening jab of 22 units lasted me 7 hours, leaving me
> without basal coverage through the morning. It's been replaced by 8
> units Semilente, which kicks in after about 3,4,5 hours and works
> steadily through to about 14 hours.
From what I can tell, and probably because of my weird schedule, the NPH is
often still going strong when I wake up. Once I'm awake I can use my meter
when I need to, fine tune with Humalog etc so I'm not too worried about
coverage during the late morning/early afternoon.
> Human NPH has a tendency to cause (symptomless) hypos at about 5 hours
> after injection and fade quickly. Its makers claim it lasts 24 hours -
> as I've already said, it's effect was purely vestigial for me after 7
> hours.
5 hours seems to be the peak for me as well. I've pretty much lost all my
hypo symptoms years ago. Now I will sometimes notice my eyesight getting
blurry but that's the only indication I'm going low.
> I've been a T1 for 39½ years, now.
My 18th anniversary is coming up in April. It's sad that I know the exact
date of my diagnosis, although I was having symptoms for weeks before
diagnosis. I was in really bad shape when I finally went to a doctor, who
sent me (with a note) right to the ER.
> Does that fit in with ~5 hours after an NPH jab? As a matter of
> interest, how much NPH? Are we talking about 5 units, 10 units or 40
> units? And, if it's not too impertinent to ask, are you of ideal weight
> getting a reasonable amount of exercise or are you perhaps a touch on the
> heavy side with a somewhat sedentary existence?
I am on the heavy side. I've gained a *lot* of weight in the past 5 years.
Partly because another problem I have is with my legs. I used to walk a
lot, both to get places and just for pleasure. Now my lower legs tighten up
and are extremely painful when I walk. Sometimes it starts after just one
block, sometimes I can make six blocks relatively pain free. My doctor
(PCP) is no help. So, combine a lot less activity with the same eating
patterns, and you get weight gain. Right now, if I could fix just one thing
I'd fix my legs. I really miss walking.
Right now, morning NPH = 13 units. I had been taking 15 and two weeks ago
cut it down, and will cut it some more and see what happens. As I said,
during the day I can check whenever I need to and make adjustments. At
night, I've been taking 35. Last year (autumn, maybe September) I was
taking 32, then my morning numbers began to climb. First I discarded the
bottle of NPH I was using and started a new one, same thing. I went up to
40 units before my morning numbers were back down. Then they were down too
much, so I've been cutting back unit by unit.
This morning when I woke up, I was 86. I woke up early today (for me),
around 8:30. By 10:00am, my normal wakeup time, I was hungry and decided
I'd make breakfast, something I usually have no time for. Made an egg, some
turkey bacon, slice of low fat cheese on a piece of toast. Stupid me,
though, didn't check my BG again. Seemed like I had just checked it, and
that 86 was still in my mind. Got to work at noon and about a half hour
later I checked again - 256. I'm sure if I had checked it before I ate, it
would have been in that range. Some mornings it goes way up from normal,
soome mornings it goes down.
> The high "out of nowhere" is likely a liver dump of glucose, a normal
> reaction to a severe hypo.
I'm a poor sleeper. I'm not sure the morning highs are from a nighttime
hypo. Whenever I wake up during the night, I go to the bathroom out of
habit. Most times I don't need to pee, but I go anyway. When I'm really
low I do become unsteady and get blurry vision. I think maybe it's the
previous night's dinner. Even when I have a normal reading before bed, my
food can sometimes take awhile to show up on my meter. Sometimes it happens
after a meal I've had plenty of times, so I really don't know.
> It sounds like NPH isn't the stuff for you. If you can get anything with
> "lente" in its name, that would probably do a _much_ better job for you,
> just as it is doing for me. Lantus would probably also do better, though
> it's more expensive and its long term safety is still a matter of
> speculation.
I'm trying to get as much info together so I can explain myself clearly when
I see the endo next month. I'm not sure if my insurance covers Lantus, as I
didn't see it on their formulary. Right now they're paying for 2 vials of
NPH a month (although I don't refill exactly every 30 days) and a box of
Humalog pens (also refill more when needed, not every 30 days).
> Who knows? As a matter of interest, why Humalog rather than regular
> insulin? How well did the R work when you were using it? Does Humalog
> work any better? Could it be that you're just taking too much insulin
> all round? That would account both for the lows (for obvious reasons)
> and the highs (liver dumps after extreme lows). My specialist doctor (a
> great guy ;-) aims first to _stabilize_ T1 diabetics who're changing
> insulin or who're new at the game. That means starting them on a low
> dose of insulin, aiming for steady BS values around the 200 mark. Once
> that's achieved, gradually increase the dose over a few weeks until the
> BSs come down to 80 - 150 without losing that stability. If you weren't
> soon going to see an endo, that might not have been a bad thing for you
> to try.
Regular lasts too long, and has a nasty peak. I have been cutting back on
the Humalog, but I also seem to get a tail peak on it. Sometimes I know it
must be a combination of the NPH kicking in and the Humalog.
> It sounds like your regime is too chaotic at the moment to say whether
> you've got a problematic dawn phenomenon or not. Get rid of the NPH
> first, and get something sensible in its place, then see how things go.
> If you do suffer the dreaded dawn, Semilente is the best thing to try, if
> you can get it.
I've never heard of Semilente, so that's another thing to look up.
> Do bare the Lente family in mind. Many people in this group swear by
> CPC's beef Lente, though it is problematic to import if you're living in
> the USA.
I am in the USA, and I have a feeling a bunch of insulins aren't available
here that are elsewhere. Pretty much seems to be all human insulins now.
> Hope you get things sorted out quickly. And stay here in the group and
> let us know how you're getting on!
Thanks for the help. I'm definitely working on questions to ask when I see
the endo next month.
--
Liz
oldal4865
Elizabeth Blake wrote in message ...
>"oldal4865" <olda...@yahoo.com> wrote in message
>news:37cirrF...@individual.net...
>
>. . . .(snip). . .
>
>5-6 years ago, I had started taking a small booster shot of NPH in the
>afternoon, because my readings when I got home from work were getting
really
>high. After awhile, it seemed to sort itself out and I dropped the
>afternoon shot. It was a small dose, maybe 3 units. It may have been I
>just had a wonky bottle of NPH.
>
>
>> Your morning effect sounds just as fierce as mine. I solve my problem
>> with Ultralente which has a gentle peak at 12-14 hours.
>>
>
>With my current NPH routine, I very often wake up with a great number,
>70's-90's. Then I get what I think you mean by a "morning effect". In
just
>an hour after being awake, it can shoot way up unless I inject Humalog and
>eat breakfast.
>
>. . .(snip). . .
>
>Is Ultralente the insulin that you're supposed to space *exactly* 12 hours
>apart? I vaguely remember thinking about asking my doctor about it, but
>didn't think I could ever keep to such a strict schedule. I would end up
>having to carry the vial with me and shoot up on the subway or something.
>
>> Levemir doesn't have that problem. It's also touted as the most
>> non-variable basal insulin on the market.
>
>I don't mind taking multiple shots. I use a pen for Humalog and syringe
for
>NPH, so I always take separate shots anyway.
>
>>. . .(snip). . .Splitting your daily Lantus into two shots spaced
>> 12 hours apart nullifies the variability.
>
and
>10pm would be very easy.
>
>. . .(snip). . .
>
>Is the Dawn Effect based solely on time, or does a person's schedule also
>factor in? Some people may go to bed at 10pm, while I may go to bed at
>2:00am. Wouldn't any dawn effect come later for me?
>
>> Lantus might work for you. If not, think about Ultralente or Levemir.
>> It's hard to predict what might happen with any of the modern basals
since
>> your current 2-shot-NPH regime is so lousy that it's just too hard to say
>> how you will respond if you switch to a modern basal regime.
>
>serious problems twice a day.
>. . .(snip). . .
>
>A couple of times I took a second shot of Humalog if my BG didn't come down
>after 1 1/2 - 2 hours. Then I ran into trouble, because then I'd crash in
a
>very short time. In 2 hours my BG might have gone down 20 points, or gone
>up, but then 20 minutes after the second shot I'm down to dangerous levels.
>Now I just wait out the first dose even if it means I don't eat for four
>hours. I've also found that if I take a second shot, the amount I'd
>normally take to cover a meal, and then eat while my BG is still high, it
>comes down faster. 90 minutes after eating (with a high starting BG) I'm
>down to normal/near normal numbers.
>
>Thanks for the reply. It gives me stuff to think about/research. My
>appointment is still a month away and I want to organize my thoughts for
>when I finally see the doctor.
>
>--
>Liz
>
>
Some more on your interesting topics:
1. On the "12 hours apart" stuff: There is no restriction on Ultralente.
My 1st and 2nd shot are approximately 10 hours apart; my 2nd and 3rd tend
to be 4 hours apart. But that's only approximate. I shoot Ultralente
when I shoot my bolus for a meal. Thus, my Ultralente schedule is
actually my meal schedule.
Folks splitting their daily Lantus are encouraged to shoot 12 hours apart.
However, that's just a rule of thumb more or less guaranteed to avoid any
problems. Shooting early or late in that 12 hour schedule will slightly
increase or decrease your dose for an hour or so during the day. Odds are
that you'll never notice.
However, trumpeting such a schedule makes it easier to remember to take
both shots! Forget one and you'll probably notice.
2. Booster shot of NPH: That's a trap. NPH is supposed to be a basal
insulin. You are not supposed to use a basal to adjust hour to hour
sugars. When the docs say "Corrective Bolus", they mean a corrective bolus
of your fast insulin.
3. Morning Effect: Right on. That's exactly what happens to me though
not quite as dramatic. One reason it's so noticeable for you is because of
the NPH and it's inability to deal with mid-morning sugars. Ultralente
can beat much of that problem.
Dawn Effect and Morning Effect are hormone effects related to your circadian
rhythm. It all depends on how thoroughly you have time-shifted to any
given schedule. I have no idea of how to measure that.
4. Pump: Of course, the pump beats all of those problems. One of the
powers of a pump is zoned or variable basal rates. You figure out which
basal rate you need for every 3-4 hour period during the day, set it, and
forget it**. All our fiddling with multiple basal shots is designed to
more or less approximate the zoned rates you can get with a pump.
Pump OTC costs: $6000 up front and ~$2000 a year for disposable supplies.
(**after one humungous optimization effort)
5. ". . .I can't see how anything could be any worse than NPH, when it can
cause serious problems twice a day. . ."
One of the big reasons is trying to get by with only two shots of NPH a
day. I used 4 and was thinking about 5 just before I switched to
Ultralente. In general, any basal works better if you split it into
multiple daily shots.
My opinion: The 2 shot per day of NPH regime is a hold-over from the beef
insulin days. Beef NPH is a fairly slow insulin and often worked well at 2
per day. However, we now use Human NPH which is much faster than beef.
Unfortunately, big parts of the medical profession don't appreciate the
switch.
Something to think about:
The Pump has the best basal delivery around: It splits the basal into
24 shots, one per hour.
Emergency basal: If everything related to your basal goes to H*ll,
you can stop the roller-coaster by using R insulin as a basal. However,
that means injecting every 3 hours, night and day. Eight shots of R a
day, evenly spaced, makes a fine basal. A bit inconvenient but it's
always available in an emergency. Works better than 2 x NPH too. (The
point of this paragraph: Several small shots of a basal is better than a
few large shots)
Some of the better docs prefer 4 x NPH too, e.g.
from: http://www.medscape.com/viewarticle/440106
". . .Dr. Bolli has used NPH (at one third the rapid-acting insulin dose) as
a basal insulin in combination with the rapid-acting insulin lispro at
mealtime. Since clamp studies revealed a peak effect of NPH at 4-6 hours,
Dr. Bolli instituted a 4-times-daily regimen of NPH in combination with
insulin lispro. . ."
6. On corrective bolus dose: I test at 2 hours after a meal. If my sugar
is too high, I shoot a Corrective Bolus**. My default dose would be 1
unit for every 50 mg/dL that I am too high. I do use a sliding scale to
compensate for Glucose Toxicity which ends up as 1 unit for each 25 mg/dL if
I am over 200. The Glucose Toxicity correction is a strong YMMV function.
(**Capitalized cause it's a medical term, invented by the docs)
What you should keep in mind when performing a Corrective Bolus is that you
absorbed ~24% of the before-meal Humalog bolus after one hour, ~65% after 2
hour, ~87% after 3 hours. In effect, you have 1/3 of your original
bolus still dribbling out of your fat layer when you perform your
2-hour-after-eating test and contemplate a Corrective Bolus.
Regards
Old Al
RK
only dx'd 4yrs almost 5yrs now. I pump. Was the
best move I made. I'm one of the ones that Lantus
only lasted on me for 19hrs then I had to take NPH
to suppliment the rest of the 24hrs.
My pump and supplies are all covered under my
insurance. Yes, it's expensive, but very well worth
it. You might want to call your insurance co, and
ask them about pump coverage. I know mine was
covered under DME (Durable Medical Equipment)
and my supplies a month are under my prescription
coverage.
Good Luck.
--
RK - t1 pumping
*Disclaimer: i'm not a doctor. I only share personal
experience of being a diabetic. I have no textbook
learning, only life itself.
PUBLIC SERVICE ANNOUNCEMENT:
Bob _thinks_ he's a T1 but he's really
only a T2 on insulin.. he also gives very poor advice
which ultimately CAN and WILL KILL you if you follow
it. Killfile him NOW, save yourself grief.
----------------------
In tribute to the United States of America and the State
of Israel, two bastions of strength in a world filled with strife and
terrorism.
"Elizabeth Blake" <poodl...@NOSPAMearthlink.net> wrote in message
news:37cdl1F...@individual.net...
: Hi,
:
:
willbill
<big snip>
<Beef NPH is a fairly slow insulin and often worked well at 2
> per day.>
wrong! :(
beef NPH and beef PZI are *THE*
two best true 1x insulins
(still available from CP (Wales),
as well as beef-Lente (which is
also still available in India)
in my experience, beef-Lente is
_*THE*_ best for type-1 diabetics!
i've not used beef-NPH. i may have
used "beef"-PZI 48 years ago (1x;
"beef" meaning a beef/pork mix))
i'll grant that 2x of beef-NPH
is also very ok for type-1s like
you and me
my experience with beef and pork
mean that i've got a clue and you don't
given that you've never used glargine
or levemir, kindly quit recommending them
bill t1 since '57, ex 8-yr pumper, pork/beef-L 1x, simple MDI
willbill
> 3. As I said before, I'm not a morning person.
me either! will you marry me? :)
> I wake up at 10:00am, leave
> for work a little before 11:00 to catch my bus,
nice schedule for a night person. :)
> which gets me to work by
> noon. I get home around 8:30-9:00pm most nights and usually go to bed
> between 1:00am -2:00am. What is an ideal time for injecting Lantus if I end
> up trying it out?
try switching to 50/50 2x of "human-UL"
spaced 12 hours apart, with pork-R
as your meal insulin (max of 2x/day,
not counting small correction shots)
you can get both of these OTC from www.hocks.com
mail order at reasonable prices
best, bill t1 since '57, ex 8-yr pumper, pork/beef-L 1x, simple MDI
jack bi812 and jill @ went ispwest up the hill .com
willbill
> I'm a 37 year old female diagnosed Type I when I was 19. Was started on the
> old 2-shot (NPH.Reg AM, NPH PM) regimen and stayed that way for many year.
> Got health insurance 9 years ago, my diabetes wasn't covered for the first
> year, so I finally went to a doctor about 8 years ago after not seeing one
> since I was diagnosed.
> My A1C 8 years ago was 15.something.
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
that's very bad
afaik, worst mine was was roughly 9/10
roughly 7/8/9 years ago, while still
on synthetic insulin via pump
("human"-R/7 years; Humalog/1 year)
> I started
> reading this group back then and began taking better care of myself,
really?
that's a year before me
imo, and if you've got a blind scientific
outlook, t1 coughran and reid (not necessarily
in that order) are *impressive*
t1 scott king (editor of a diabetes mag)
is also impressive, but has the good sense
to not post here
> mostly
> by using R before each meal. I read about Humalog but my idiot doctor (at
> the time) had never heard of it, so I went to an Endo who gave me a script.
> Unfortunately, the Endo that I picked at random was a throid specialist, not
> diabetes. So, from that time until now I've been on NPH AM/PM and Humalog
> for meals and to cover highs.
>
> The first 5 years of that schedule actually went okay,
in my experience with synthetic insulin (8 years),
it takes 2+ years for issues to show up for t1s
> but three years ago I
> had my first seizure, at home, alone. Since then I've had several more, as
> well as about 6 ambulance visits. I had another seizure a few weeks ago and
> passed out at work last week. I live alone, so when I have a seizure at
> home I can't do anything but wait until I can finally control my limbs
> somewhat. I keep juice on my bedside table but it takes a long time before
> I can get to it, open it and drink it without it flying everywhere.
i used pork-NPH in a fixed 2x routine (with some pork-R)
roughly 1980-1990
i had 4 or 5 SEVERE unconscious hypos during that time. :(
that was what got me to use an insulin pump, which
got me a real clue as to what my basal needs are. :)
imo, the *only* NPH insulin worth using (by t1
diabetics) is beef-NPH (note that i've never used it)
willbill
> Elizabeth Blake wrote
>>I'm not a morning person. I usually wake up around 9:45-10:00am and
>>get to work at Noon, leaving at 7:15 - 7:45. Takes me an hour to get
>>to and from work. I have gone low on my bus ride home quite a few
>>times over this last year, even though I check my BG before I leave
>>work and eat or drink something if I'm low. I don't think that's the
>>NPH, but if it isn't it means that Humalog is giving me a really nasty
>>late kick.
>
>
> Who knows? As a matter of interest, why Humalog rather than regular
> insulin? How well did the R work when you were using it? Does Humalog
> work any better? Could it be that you're just taking too much insulin
> all round? That would account both for the lows (for obvious reasons)
> and the highs (liver dumps after extreme lows). My specialist doctor (a
> great guy ;-) aims first to _stabilize_ T1 diabetics who're changing
> insulin or who're new at the game. That means starting them on a low
> dose of insulin, aiming for steady BS values around the 200 mark. Once
> that's achieved, gradually increase the dose over a few weeks until the
> BSs come down to 80 - 150 without losing that stability. If you weren't
> soon going to see an endo, that might not have been a bad thing for you
> to try.
how does the profile of your current pork-R compare
to your recently discontinued "human"-R?
bill t1 since '57
willbill
> I am on the heavy side. I've gained a *lot* of weight in the past 5 years.
> Partly because another problem I have is with my legs. I used to walk a
> lot, both to get places and just for pleasure. Now my lower legs tighten up
> and are extremely painful when I walk. Sometimes it starts after just one
> block, sometimes I can make six blocks relatively pain free. My doctor
> (PCP) is no help. So, combine a lot less activity with the same eating
> patterns, and you get weight gain. Right now, if I could fix just one thing
> I'd fix my legs. I really miss walking.
do you have thyroid problems? if you've not
been tested for it, run a TSH test and a
free T4 test. thyroid problems have a wide
range of seemingly unrelated symptoms
thyroid problems run higher with normal females
(7:1 higher, female:male), and also have a higher
incidence within the diabetic community (i'm
uncertain if the 7:1 ratio holds up for diabetics)
> I've never heard of Semilente, so that's another thing to look up.
SL (SemiLente) is yet another terrific insulin
that got ditched (in the USA) by the Lilly weasels
bill t1 since '57
Elizabeth Blake
> 2. Booster shot of NPH: That's a trap. NPH is supposed to be a basal
> insulin. You are not supposed to use a basal to adjust hour to hour
> sugars. When the docs say "Corrective Bolus", they mean a corrective
bolus
> of your fast insulin.
I didn't mean that I took an extra shot of NPH to correct a high
immediately. I had noticed that I was running high at around the same time
each day so I had added an extra small shot of NPH in the afternoon, about 5
hours before the highs were showing up.
> One of the big reasons is trying to get by with only two shots of NPH a
> day. I used 4 and was thinking about 5 just before I switched to
> Ultralente. In general, any basal works better if you split it into
> multiple daily shots.
Don't you run the risk of more lows with more basal shots? Especially NPH
which can be very peaky.
> Emergency basal: If everything related to your basal goes to H*ll,
> you can stop the roller-coaster by using R insulin as a basal. However,
> that means injecting every 3 hours, night and day. Eight shots of R a
> day, evenly spaced, makes a fine basal. A bit inconvenient but it's
> always available in an emergency. Works better than 2 x NPH too. (The
> point of this paragraph: Several small shots of a basal is better than a
> few large shots)
I know I'd never be able to do an 8X basal routine. I don't mind multiple
injections but if they need to be done at specific times I'll tend to screw
up. 2X NPH is easy enough to do, since I'm home for both shots.
> 6. On corrective bolus dose: I test at 2 hours after a meal. If my
sugar
> is too high, I shoot a Corrective Bolus**. My default dose would be 1
> unit for every 50 mg/dL that I am too high. I do use a sliding scale to
> compensate for Glucose Toxicity which ends up as 1 unit for each 25 mg/dL
if
> I am over 200. The Glucose Toxicity correction is a strong YMMV
function.
I seem to have problems with Glucose Toxicity, which I had never heard of
until you mentioned it in another post. Like you, if I'm more than
moderately high my insulin needs double before it will come down, and it can
take awhile to work.
> What you should keep in mind when performing a Corrective Bolus is that
you
> absorbed ~24% of the before-meal Humalog bolus after one hour, ~65% after
2
> hour, ~87% after 3 hours. In effect, you have 1/3 of your original
> bolus still dribbling out of your fat layer when you perform your
> 2-hour-after-eating test and contemplate a Corrective Bolus.
Another reason why I'm trying to watch my Humalog bolus before meals. When
I test 90-120 minutes after eating and see that I'm perfectly fine, I just
keep on doing whatever I'm working on and another hour or two later I end up
being too low. But then if I cut the dose, my postprandial reading may end
up being too high and that's what everyone says really counts - the numbers
after you eat.
--
Liz
Elizabeth Blake
news:cuu42...@enews1.newsguy.com...
> Elizabeth Blake wrote:
>
> > 3. As I said before, I'm not a morning person.
>
> me either! will you marry me? :)
Hey, as long as you don't try talking to me in the morning!
> > I wake up at 10:00am, leave
> > for work a little before 11:00 to catch my bus,
>
> nice schedule for a night person. :)
Yes, but then it's awful when I have to get up early for anything (like a
doctor's appointment).
> try switching to 50/50 2x of "human-UL"
> spaced 12 hours apart, with pork-R
> as your meal insulin (max of 2x/day,
> not counting small correction shots)
If you take Pork-R for meals only twice a day, doesn't that mean you need to
count on the tail end of one shot to cover a meal? That means eating at a
certain time every day.
--
Liz
Elizabeth Blake
> Elizabeth Blake wrote:
>
> > I'm a 37 year old female diagnosed Type I when I was 19. Was started on
the
> > old 2-shot (NPH.Reg AM, NPH PM) regimen and stayed that way for many
year.
> > Got health insurance 9 years ago, my diabetes wasn't covered for the
first
> > year, so I finally went to a doctor about 8 years ago after not seeing
one
> > since I was diagnosed.
> > My A1C 8 years ago was 15.something.
> ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
>
> that's very bad
>
> afaik, worst mine was was roughly 9/10
> roughly 7/8/9 years ago, while still
> on synthetic insulin via pump
> ("human"-R/7 years; Humalog/1 year)
Well, at least my A1C did steadily decline after that. A couple of years
ago, when I was experiencing many lows, it actually got down to 4.something.
Last check was in November, 6.2 (I think). The previous few was in the 5
range but because of the lows I was trying to be more careful, and it went
up.
> in my experience with synthetic insulin (8 years),
> it takes 2+ years for issues to show up for t1s
I've always been on Humulin insulins since diagnosi (1987), although I've
used Novolin N/R when I couldn't get the Humulin. At the time I remember
the doctor in the hospital telling me how great the human insulins were and
that nobody was going to use animal insulin again.
--
Liz
Elizabeth Blake
> Elizabeth Blake wrote:
>
> > I am on the heavy side. I've gained a *lot* of weight in the past 5
years.
> > Partly because another problem I have is with my legs. I used to walk a
> > lot, both to get places and just for pleasure. Now my lower legs
tighten up
> > and are extremely painful when I walk. Sometimes it starts after just
one
> > block, sometimes I can make six blocks relatively pain free. My doctor
> > (PCP) is no help. So, combine a lot less activity with the same eating
> > patterns, and you get weight gain. Right now, if I could fix just one
thing
> > I'd fix my legs. I really miss walking.
>
>
> do you have thyroid problems? if you've not
> been tested for it, run a TSH test and a
> free T4 test. thyroid problems have a wide
> range of seemingly unrelated symptoms
I've been on Levoxyl for the past 5 years or so. When my previous PCP first
prescribed it he told me that once it built up in my system I'd start
feeling a lot better and have more energy but that never happened. I
started on a low dose, 50mcg and am now up to 100.
I have no idea what test was done to determine I had a thyroid problem but I
think it was one of the standard tests they ran every time I went & they
drew blood. Is there a more in-depth test they can run? The last time I
went to an endo was before I was diagnosed as being hypothyroid. That endo
I saw was a thyroid specialist, not diabetes, so it didn't do me much good.
I'll ask the endo about it when I go next month.
--
Liz
oldal4865
Elizabeth Blake wrote in message ...
>
>--
>Liz
>
>
"more lows with more basal shots". . .In one sense yes, you will see
more insulin peaks but each will be much smaller. Split your daily basal
quota into enough small shots and you never notice the peaks/lows.
The whole discussion of the 8 shots of R as a basal is just for emergencies
and to illustrate that fast insulins such R, which in general are unsuited
as convenient basals, make fine basals if you shoot small doses, several
times a day.
(Our poster Guy had some Godawful problems with erratic basal absorbence
[NPH I think] either sending him to the Emergency room or sending his bG
well over 300 due to basal fade. During one bad stretch, he used the 8 x
R technique to normalize his sugars and give him some breathing room to try
to figure out what was going on.
Most basal insulins use chemical tricks of one sort or another to slow their
absorbence and let us supply a day's basal with a few shots. However,
when the chemical tricks fail, [and they do, especially the amine trick
used for NPH], all H*ll can break loose. )
The Pumpers use Humalog or Novolog, the fastest insulins around, as
superior basal insulins because they can split their daily into 24 small
doses.
(Engineer with 3 cups of tea in him = talk, talk, talk. . . .)
Regards
Old Al
willbill
> "willbill" wrote ...
> Well, at least my A1C did steadily decline after that. A couple of years
> ago, when I was experiencing many lows, it actually got down to 4.something.
> Last check was in November, 6.2 (I think).
my A1c's have all been in the lab normal
range (for normal people) this past 7 years.
keeping a written daily log (fairly easy to do)
has been the key for me
Feb.'04 i started using these excellent
home A1C test kits (currently roughly $16
at Wal-Mart and maybe a buck or two less
at www.hocks.com). from my records:
2-19-'04 = 5.6; 2-22-'04 = 5.9; 3-1-'04 = 5.1;
6-26-'04 = 6.1; 12-15-'04 = 6.3 (suggested normal
for diabetics with these kits = 7.0 - 7.9)
the slightly higher june/december values
are due to my switch away from 2x of pork-L
(for my background) to 1x (this past 10 months)
> The previous few was in the 5
> range but because of the lows I was trying to be more careful, and it went up.
i get the impression that you don't keep
copies of your test results. if that's
true, you need to start doing that.
namely *both* the test results that
your doc orders as well as stuff like
home A1c test results
>
>>in my experience with synthetic insulin (8 years),
>>it takes 2+ years for issues to show up for t1s
>
>
> I've always been on Humulin insulins since diagnosi (1987), although I've
> used Novolin N/R when I couldn't get the Humulin. At the time I remember
> the doctor in the hospital telling me how great the human insulins were and
> that nobody was going to use animal insulin again.
time has proven that "human" insulin isn't that great
why else would we have Lantus and Levemir?????
my own experience (and that of the small set of other
t1 diabetics that have switched back) with switching
away from synthetic insulin (after 8 years) makes
me fairly certain that the large majority of t1s
would do *much* better with 50+% of animal insulin
in their routine
quoting t1 dumas: FFT (food for thought. :) )
bill t1 since '57
willbill
> "willbill" wrote ...
>>Elizabeth Blake wrote:
>>
>>>3. As I said before, I'm not a morning person.
>>
>>me either! will you marry me? :)
>
>
> Hey, as long as you don't try talking to me in the morning!
:)
>>>I wake up at 10:00am, leave
>>>for work a little before 11:00 to catch my bus,
>>
>>nice schedule for a night person. :)
>
>
> Yes, but then it's awful when I have to get up early
> for anything (like a doctor's appointment).
i once took a contract job where
i had to get up at 4:00AM! (in order
to avoid driving through heavy traffic)
i was sooooo proud of myself
that i was able to do it!! :)
>>try switching to 50/50 2x of "human-UL"
>>spaced 12 hours apart, with pork-R
>>as your meal insulin (max of 2x/day,
>>not counting small correction shots)
>
>
> If you take Pork-R for meals only twice a day, doesn't that mean you need to
> count on the tail end of one shot to cover a meal? That means eating at a
> certain time every day.
it does NOT mean eating at a certain time every day!
imo and personal experience, within an MDI routine,
all of the R insulins are best kept to a max of 2x
(not counting small correction shots (which can
occasionally be fairly sizeable))
within an MDI routine, the way you get to that
is to rethink your diet. that will take a minimum
of 1 year and maybe as much as 3 years (or more)
for example, if you are out with someone for
lunch/dinner and your blood sugar is high
(but you already have some insulin active
above your basal needs), simply have a very
plain salad with a bit of olive oil and
vinegar (preferrably apple cider vinegar)
in other words, you don't always have
to take more meal insulin
bill t1 since '57
willbill
> "willbill" wrote ...
> I've been on Levoxyl for the past 5 years or so. When my previous PCP first
> prescribed it he told me that once it built up in my system I'd start
> feeling a lot better and have more energy but that never happened. I
> started on a low dose, 50mcg and am now up to 100.
odds are that you are still taking too little
at a minimum, you should be running these
thyroid tests: 1) TSH, 2) T4F, 3) T3F
>
> I have no idea what test was done to determine I had a thyroid problem but I
> think it was one of the standard tests they ran every time I went & they
> drew blood. Is there a more in-depth test they can run?
see above
you also need to insist that your doc provide
you with copies of your test results
fwiw, i've likely had minor thyroid issues
for as long as i've been diabetic. following
a severe accident (nov.'01) i became severely
hypo thyroid. i now take: .5 grain Armour
and 91 mcg Synthroid each morning at or close
to rising. with my insulin routine, breakfast
is the one meal i can skip so that i can get
the most consistent day-to-day absorption
of the T4 and T3 oral hormones i'm taking
bill t1 since '57
willbill
and one other question: are you now using
roughly more or less or the same amounts
of pork-R?
(i.e. as you were previously with "human"-R)
bill t1 since '57
Alan Mackenzie
2005 03:14:58 GMT:
[ .... ]
> I've always been on Humulin insulins since diagnosi (1987), although
> I've used Novolin N/R when I couldn't get the Humulin. At the time I
> remember the doctor in the hospital telling me how great the human
> insulins were and that nobody was going to use animal insulin again.
When "human" insulin was brought on the market, comparative tests with
natural insulin hadn't been done, and they still haven't. The big
pharmaceutical companies have done and are doing everything in their
power to remove natural insulin from the market. It's a long steady
campaign, mainly of disinformation. Your doctor of the time would have
been one of the targets of this, just as mine was 22 years ago.
A lot of diabetics (probably most) do just fine with "human" insulin, and
would do just as well with the natural stuff. There are many, like me
and Willbill, who can get by, sort of, on "human" insulin, but with a
reduced quality of life (absence of hypo symptoms with "human" is one of
those reductions). Then there are some who absolutely require animal
insulin, since they react allergically to the genetically engineered
stuff. A disappearance of natural insulin would mean death for them.
Alan Mackenzie
> how does the profile of your current pork-R compare to your recently
> discontinued "human"-R?
BS readings have not changed in outline one iota. A mysterious sequence
of high BS readings at bedtime began one week before I changed, and
continued several days after (until I uppped the lunchtime SL a bit).
However: I _feel_ better. Hypo symptoms, on the few occasions I've
experienced them, are pretty much the same as they were 22 years ago,
much clearer than with the vague ones on quasi-yeast insulin. I seem to
have more get-up-and-go (or, more precisly, less sit-down-and-stop) than
I did a fortnight ago, but that's a subtle change, detectable by its
effects rather than a massive mood change. The EAT! EAT! EAT! EAT! NOW!
NOW! NOW! impulse I got with the change now seems to have gone, but the
extra weight hanging around my middle hasn't (yet).
> bill t1 since '57
willbill
> However: I _feel_ better. Hypo symptoms, on the few occasions I've
> experienced them, are pretty much the same as they were 22 years ago,
> much clearer than with the vague ones on quasi-yeast insulin.
my own hypo symptoms are also
improved a bit. :)
if i'd believed the input from my
generally excellent docs of the past
i'd still be using synthetic insulin. :(
one possibility is that since pork-R
(and especially beef-R) are slower than
human-R/lispro/aspart, there is extra time
(even if it's only 20 or 30 minutes) to
notice an incoming hypo
i personally think that there are still
flaws in something "small" like the
"polishing" of the final polypeptide
(insulin is a polypeptide hormone)
see thread: "generic "human" insulin?"
by me roughly dec/4/'03. both coughran
and dumas responded (both t1s)
also see the link that coughran provided:
www.sciam.com/article.cfm?chanID=sa006&colID=7&articleID=00082DBB-09F5-1FA8-807883414B7F0000
this link is still available, so save it to your
hard drive, read it, then a day or two later
*slowly* read it again
the essence of the SA article is this:
<"... As the nation's health care costs soar ever skyward,
the competition from low-priced generics adds essential
ballast. But will the makers of generics be able to offer
cut-price knockoffs of therapies that are the fruit of
biotechnology? The Food and Drug Administration and its
European counterpart are pondering the question now,
and a great deal of money hinges on their decisions.
The patents on the first lucrative products of biotechnology
are at last approaching their expiration dates. If competing
firms are permitted to manufacture them, "biogeneric" versions
of the off-patent medicines could command
$5 billion next year,
^^^^^^^^^^^^^^^^^^^^^^
($5 billion!!)
estimates the Strategic Research Institute, a consultancy in
New York City. Regulators face a tough scientific question,
however: How should they judge whether a biogeneric is
equivalent to the brand-name therapy for which it substitutes?
Unlike drugs, which are synthesized using reproducible chemical
procedures, biotech medicines--or "biologics," as insiders
call them--are fabricated from bacteria, farm animals and other
organisms that have a life of their own. Biologics are
typically large molecules, such as hormones,
^^^^^^^^^^^^^^^^^^^^^^^^^^^^
antibodies or cytokines. Most are constructed from proteins,
which are too complicated to make from scratch. To function
properly, a protein
must be folded up a certain way and
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
must have sugars and other chemicals added
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
to particular spots on the macromolecule.
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Biotechnology companies spend years figuring out
the right combination of mutant host organism
and reactor conditions to fashion a protein therapy
that is safe and effective. It's closer to brewing
than to chemistry. As much as they would like to,
biotech firms cannot comprehend and control all the
factors that influence the purity and function of
the macromolecules that come out of their bioreactors.
The best they can do is to find a manufacturing
process that works--as proved through a series
of expensive, time-consuming clinical trials--and then
stick with it. ...">
it's worth noting that we're 14 months past
this article and still don't have any
generic insulin
> I seem to
> have more get-up-and-go (or, more precisly, less sit-down-and-stop) than
> I did a fortnight ago, but that's a subtle change, detectable by its
> effects rather than a massive mood change. The EAT! EAT! EAT! EAT! NOW!
> NOW! NOW! impulse I got with the change now seems to have gone, but the
> extra weight hanging around my middle hasn't (yet).
take less insulin, keep yer blood sugars normal,
and you'll lose weight. it may take a month
or two or three, but you *will* lose weight
bill t1 since '57