Lantus vs. Lente / Ultralente
Radioactive Man
days, although I haven't been able to find any raw data. From looking
at the curves, it looks like you could get a fairly stable basal rate
by injecting the L/U insulins at ~12 hours apart (at breakfast and
supper for most people). If you're mixing insulins, you'd be able to
get by with only 3 injections per day instead of 4. Anyone who does
multiple daily injections have experience to make the comparison?
The biggest disadvantages of Lantus are the high cost and the fact
that it cannot be mixed with other insulins. I would also suspect
that some with type 1 have actually been able to take advantage of the
Lente peak in order to prevent the dreaded "dawn effect", correct?
oldal4865
Radioactive Man wrote in message
<2888sv802hi2r428e...@4ax.com>...
Exactly right. I shoot 3 shots of Ultralente per day. Two spaced 14
hours apart to handle the bulk of my basal needs, then one "kicker" at 5 pm
which goes after my morning effect. In theory, the 5 pm shot starts to
peak at about 1 am, and hits max around 5 am when the bulk of the morning
effect occurs for many folks.
I have a fierce morning effect. Forget a basal shot and I shoot up by 100
mg/dL between 3 am and 7 am.
I get close to 6 weeks out of an Ultralente vial. Many posters assert
that their Lantus becomes erratic after 4 weeks and often must be tossed
based on "time" rather than "consumption". Since in my area, Lantus
costs a bit more than twice as much as Ultralente, the ability to use an
Ultralente vial longer results in about a three-to-one cost ratio between
the two at my dose level.
Then I add 4 - 6 daily shots of Humalog to the routine. I never mix
Ultralente and Humalog in the syringe.
That routine lets me "beat" some pumpers with my 7 - 9 shot average daily
regime (always in 5% club when using Ultralente)
Ultralente is difficult to inject. Its slow absorbence is based on the
large sized insulin-zinc crystals in the suspension. However, those
large-sized particles will start to settle out as soon as you stop shaking
the vial. Thus, I find it necessary to shake - stick the needle in the
vial -shake again then immediately (and I mean immediately!) draw up my
dose.
Insulin Detemir (soon to be Insulin Levemir) mimics the absorbence pattern
of Ultralente but doesn't have that suspension problem. Also, since
Detemir doesn't contain all that zinc, there would be no reason not to mix
Humalog and "Levemir" in the syringe. . .unless there's some pH problem they
haven't mentioned yet. However, you're back to the high priced insulin
again, i.e. trading convenience for cost.
Regards
Old Al
willbill
> I have been studying some insulin activity curves over the last few
> days, although I haven't been able to find any raw data. From looking
> at the curves, it looks like you could get a fairly stable basal rate
> by injecting the L/U insulins at ~12 hours apart (at breakfast and
> supper for most people).
or L (or a L/U combo) at bedtime
if you're one of those with high
morning basal needs, together
with a shot of U (at roughly noon)
you'd dose the bedtime shot (i.e. amount)
for both the U content (L has 70% U in it)
*and* the SL content (to cover high morning
basal needs)
> If you're mixing insulins, you'd be able to
> get by with only 3 injections per day instead of 4.
agreed
> Anyone who does
> multiple daily injections have experience to make the comparison?
likely quite a few
i'm currently trying pork-L 2x (with rigid 12 hour spacing)
within an MDI routine. it works really well. :)
which is good <g> coz i've recommended to several
others that it would work as well as 2x of "human"-U
i'm using roughly half the background insulin that
i was using with my 1x of beef-L. of course, i was
dosing the beef-L for the U content at 24 hours,
whereas i can't do that with pork-L coz the pork-U
(that's in the L) isn't flat at 24 hours with 1x dosing.
of course, with 2x of pork-L i'm no longer dosing
for the U content (i'm letting the 30% SL help with
covering my basal needs), which is why my overall
L amount is way down
"human"-L is a bit peakier than pork-L, so
i think your focus on using mainly "human"-U
(taken 2x) is the correct approach for a t1
>
> The biggest disadvantages of Lantus are the high cost and the fact
> that it cannot be mixed with other insulins.
imo lantoss is a disaster, pisspro too. so i think
the moral of the story on insulin is be careful
what you ask for coz there's a good chance
you won't like what you get
but hey! the big pharmas are happy... all the
way to the bank. :) too bad there's not much
profit in "human" insulin anymore
> I would also suspect
> that some with type 1 have actually been able to take advantage of the
> Lente peak in order to prevent the dreaded "dawn effect", correct?
very good insight! :)
maybe because you said it, t1 jim dumas
will finally pick up on it and try it. :))
bill t1 since '57, ex 8-yr pumper, pork-L 2x, simple MDI/DAFNE
Alan Mackenzie
The other disadvantage of Lantus is it's incredibly fragile - trawl the
mhd archives, and you'll find many posts saying that things like
"sometimes lasts 3 months, sometimes it's dead within a fortnight".
Lente, along with the other traditional insulins, is robust indeed. 40蚓
(104蚌) is no problem at all for it, merely it's shelf life at such a
constant high temperature is reduced to a few weeks.
For the "dawn effect", Semilente is excellent stuff, if you can get it.
--
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").
Jim Dumas
>> I would also suspect
>> that some with type 1 have actually been able to take advantage of the
>> Lente peak in order to prevent the dreaded "dawn effect", correct?
>
> very good insight! :)
>
> maybe because you said it, t1 jim dumas
> will finally pick up on it and try it. :))
Yeah! Be nice, Bill. I'm still out here in the ether! (But been busy with
free stock market technical analysis software that runs on autopilot under
linux. Emails buy/sell signals to me while on the road and runs on a small
embedded [no keyboard, mouse or display] system. With the market popping
these days, you really need to know when to sell to preserve capital. This
system will keep up with the market while I drink beers at the beach.)
In any case, I still prefer NPH at bedtime to control my dawn phenomenon. I
like the 4-7h peakiness and fast tail of human NPH in the morning. I also
want to keep my immune system desensitized to protamine just in case I need
to use NPH as a basal in an emergency (if Lilly pulls ultralente, for
example). I also really like the ease of mixing NPH with R (if
hyperglycemic) as well. If I look at my daily schedule, I want high
maintenance dosing before breakfast and before bedtime. During the day I
use Humalog on the run and R for pizza/pasta.
So it ain't broke and I don't need to fix it (yet). But watching as always,
--
Jim Dumas
T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo.
lispro+R+U+NPH daily, moderate exercise, typically <6% HbA1c
willbill
> ... and R for pizza/pasta.
one of the nice things about using "human"
U/L/N for background is that you get the R
for "free" (i.e. without having to work at having
"human" in your daily routine, since you already
have it in your routine (via the background))
whereas if you use lantoss for background and
aspart or pisspro for meals, you don't get the R.
at least, not without having to work at having
"human"-R in your daily routine
bill
willbill
> For the "dawn effect", Semilente is excellent stuff, if you can get it.
one more thing that we can't thank our
not so lovely FDA for
unless, of course, you have the brains
to see that it's still there, hidden in the
"human"-Lente
bill
Jim Dumas
> The other disadvantage of Lantus is it's incredibly fragile
Just to say that I'm using Novolog (to get rid of it) that has expired
3/2003. It's clobbered me twice this week with hypoglycemia. If this were
Humalog, I'd have to increase the dose to compensate for the faster
degradation (shorter shelf-life). So I can clearly say Novolog is much
more robust than Humalog. It's just too slow for me as it peaks 3-4.4
hours post dose and has a much longer tail than Humalog, (by at least 2-3
hours for my metabolism with suspected anti-human-R antibody cross-binding
to Novolog).
So Novolog potency is impressive post-expiration,
willbill
> willbill wrote:
> > maybe because you said it, t1 jim dumas
> > will finally pick up on it and try it. :))
> Yeah! Be nice, Bill.
:)
> In any case, I still prefer NPH at bedtime to control my dawn phenomenon.
you're such a hard case, i can't hardly
begin to belive it. :(((((
maybe you're just not seeing it?
the KEY reason to use L at bedtime
(or a L/U combo) is to have 2x of U,
coz 2x of U comes close to being flat
thru 24 hours, whereas 1x of U is
nowhere close to being flat (assuming
that your routine is MDI/DAFNE)
the SL at bedtime is the best for
controlling high(er) morning basal needs
(a.k.a. "dawn phenomenon)
to give some t1 examples:
1. those using 8u (or less) for background:
are likely to have flat needs and better to
take 2 equal shots spaced 12 hours apart
even if they don't have flat basal needs, the
u100 insulin that the fucking FDA has forced
upon us (in the USA), does not lend itself to
anything other than taking equal amounts
those t1s using more (say 20U or more) for background:
2. use equal amounts when taken upon rising
and 12 hours later
3. use 11/9 when taken at noon/bedtime
(everyone has higher morning basal needs,
and using Aida shows that taking these
U amounts gives a fairly flat cure with slightly
higher basal amounts in the early AM)
4. use 11/9 U at noon/bedtime, but use L
(or a L/U combo) for the bedtime 9U
so if you used only "human"-L at bedtime,
you'd then use 11U at noon and 13L at bedtime,
which gives 11/9 of U at noon/bedtime, and 4 of
SL at bedtime
and yes, if you needed more than 4 of SL at bedtime,
then you'd have to do something like using N, like
you do. but i'm betting that you don't need that and
that the issue is simply for you to *try* it (L) for real. :)
Jim Dumas
> coz 2x of U comes close to being flat
> thru 24 hours
Flat basal doesn't work for me.
I need a peak at night.
willbill
> willbill wrote:
>
> > coz 2x of U comes close to being flat
> > thru 24 hours
>
> Flat basal doesn't work for me.
>
> I need a peak at night.
try re-reading what i wrote. :)
if a U/L noon/bedtime peaks
too late for you, then move the
shot times to a few hour earlier
and minimize yer evening meal.
that's one of the key things that
most t1s do wrong (i.e. eat too
great of a carb count in the evening)
that causes them to mistakenly think
that they need more background
insulin in the late evening/early morning
bill t1 since '57
Jim Dumas
> try re-reading what i wrote. :)
>
> if a U/L noon/bedtime peaks
> too late for you, then move the
> shot times to a few hour earlier
My goal is to carry one insulin for prandial requirements and dose basally
at home. This requires basal dosing before breakfast and before bedtime.
So doseing L or U before dinner fails this requirement. (period.)
willbill
> My goal is to carry one insulin for prandial requirements and dose basally
> at home. This requires basal dosing before breakfast and before bedtime.
>
> So doseing L or U before dinner fails this requirement. (period.)
interesting how closed minded you are
bill
Jim Dumas
> interesting how closed minded you are
That's a double-edged sword. I can say the same about you.
I'm happy with my current regimen. So stay the course,
willbill
> Still love ya !!!
i don't love you too
bill
willbill
> willbill wrote:
>
> > interesting how closed minded you are
> That's a double-edged sword. I can say the same about you.
i'm not closed minded about using different insulins
and/or dosing strategies. my 46 year diabetic "career"
shows that in spades
on insulin, i mainly have an issue with big pharma insulin bigots,
like biggs, who used to slyly tout "human" to us (over beef and pork),
but who now touts the 3 analog insulins (soon to be 5)
too bad there's not much profit in "human" insulin anymore
bill t1 since '57, ex 8-yr pumper, pork-L 2x, simple MDI/DAFNE
willbill
> P.S. Keep on posting!
by the way, do you pay out of pocket
fer yer lantoss?
given that yer in business fer yerself,
my hunch is that you do
50 bucks a bottle
whooooo!
but enquiring minds want to know. :)
bill
Jim Dumas
Hi Bill,
The girlfriend and I are talking about getting married. Since she is USAF
retired, I would also get VA benefits as a dependent. So this will short
circuit the rising costs of drugs for me. So as a small businessman, I
will no longer have to worry about health care for myself.
Food for thought,
Jim Dumas
> i'm not closed minded about using different insulins
> and/or dosing strategies. my 46 year diabetic "career"
> shows that in spades
First, happy Thanksgiving.
Next, since my immune system seems to be over-active, (I suffer from rosacea
so my immune system is attacking my skin for some reason), I do not plan to
make unnecessary changes that could cause a chain reaction with my touchy
immune system. (Period.) This means I will not change to the newer insulin
molecules that could push my immune system into uncharted waters for my
metabolism. (Period.)
As an aside, lets say I find an MD that I train on this Glucose Transform
method. (S)He provides an independent observation of my change in insulin
action as I change to these new insulin molecules. But when I changed, my
insulin therapy became unstable. Now I have a potential lawsuit to clobber
big pharma as they provoked my immune system reaction that destroyed my
stable insulin therapy.
More food for thought,
Alan Mackenzie
16:57:32 GMT:
> The girlfriend and I are talking about getting married.
WOOHOO!! Go for it, Jim!
> Jim Dumas
Jim Dumas
> Jim Dumas <j-d...@no.spam!mindspring.com> wrote on Thu, 27 Nov 2003
> 16:57:32 GMT:
>
>> The girlfriend and I are talking about getting married.
>
> WOOHOO!! Go for it, Jim!
Yeah Alan!
It's been almost two years now that we revisited our 24 year old romance.
Since we haven't killed each other yet, I guess we're compatible. She has
a 22 year old son that's a PITA. (The kid thinks we old folks are stupid
and he's the only brilliant person created in God's image.) But we don't
see him much so no big deal.
Should be interesting,
Radioactive Man
wrote:
>
>Radioactive Man wrote in message
><2888sv802hi2r428e...@4ax.com>...
>>I have been studying some insulin activity curves over the last few
>>days, although I haven't been able to find any raw data. From looking
>>at the curves, it looks like you could get a fairly stable basal rate
>>by injecting the L/U insulins at ~12 hours apart (at breakfast and
>>supper for most people). If you're mixing insulins, you'd be able to
>>get by with only 3 injections per day instead of 4. Anyone who does
>>multiple daily injections have experience to make the comparison?
>>
>>The biggest disadvantages of Lantus are the high cost and the fact
>>that it cannot be mixed with other insulins. I would also suspect
>>that some with type 1 have actually been able to take advantage of the
>>Lente peak in order to prevent the dreaded "dawn effect", correct?
>
> Exactly right. I shoot 3 shots of Ultralente per day. Two spaced 14
>hours apart to handle the bulk of my basal needs, then one "kicker" at 5 pm
>which goes after my morning effect. In theory, the 5 pm shot starts to
>peak at about 1 am, and hits max around 5 am when the bulk of the morning
>effect occurs for many folks.
That's why I'd like to find some actual raw data for insulin activity
per unit injected as a function of time - I could put that in a
spreadsheet and model the effects of various basal injection regimens.
In your case, I suspect you are using the small lunchtime dose of
ultralente to add a tail where the humalog drops off, right?
Depending on what foods I eat, I sometimes have a problem with the
lack of a tail on Novolog - I get normal or slightly low numbers after
1 hour, but highs 2 or 3 hours later. For that reason, I choose to
use regular insulin as a pre-meal bolus whenever it is possible, the
exptions being when I don't get a 30 minute heads up on the next meal
or if I'm eating a higher-GI meal. Novolog works very well with the
whole-wheat pancakes I often eat in the mornings, but not so well with
salad bars and such.
For handling the dawn effect, have you had better or worse results
with Lente than Ultralente? From looking at the charts, I can see
that Lente has and earlier peak than Ultranlente.
>
>I have a fierce morning effect. Forget a basal shot and I shoot up by 100
>mg/dL between 3 am and 7 am.
>
>I get close to 6 weeks out of an Ultralente vial. Many posters assert
>that their Lantus becomes erratic after 4 weeks and often must be tossed
>based on "time" rather than "consumption". Since in my area, Lantus
>costs a bit more than twice as much as Ultralente, the ability to use an
>Ultralente vial longer results in about a three-to-one cost ratio between
>the two at my dose level.
I've been using the same vial of Lantus (6 - 8 units per day), since I
was diagnosed in the summer. Since my own pancreas is still making
enough insulin to handle the basal requirements, I don't really know
how effective that Lantus still is. I almost always wake up with
numbers in the 70 - 100 range, but I don't really know what of that is
due to the Lantus and what is due to natural insulin.
>
>Then I add 4 - 6 daily shots of Humalog to the routine. I never mix
>Ultralente and Humalog in the syringe.
Has mixing the two insulins caused problems in the past? From what
I've read from the endocrinology texts, pharmceutical brochures and
such, I would have thought that would be permissible.
>
>That routine lets me "beat" some pumpers with my 7 - 9 shot average daily
>regime (always in 5% club when using Ultralente)
Well, it is hard to say we're "beating" the pumpers if we're injecting
ourselves 7 - 9 times per day. In my case, the usual is 3 or 4 and
the max is 5 or 6, but I do not yet (and hopefully never will) have
full-blown type 1.
oldal4865
Radioactive Man wrote in message ...
>per unit injected as a function of time - I could put that in a
>spreadsheet and model the effects of various basal injection regimens.
>
>In your case, I suspect you are using the small lunchtime dose of
>ultralente to add a tail where the humalog drops off, right?
>Depending on what foods I eat, I sometimes have a problem with the
>lack of a tail on Novolog - I get normal or slightly low numbers after
>1 hour, but highs 2 or 3 hours later. For that reason, I choose to
>use regular insulin as a pre-meal bolus whenever it is possible, the
>exptions being when I don't get a 30 minute heads up on the next meal
>or if I'm eating a higher-GI meal. Novolog works very well with the
>whole-wheat pancakes I often eat in the mornings, but not so well with
>salad bars and such.
>
>For handling the dawn effect, have you had better or worse results
>with Lente than Ultralente? From looking at the charts, I can see
>that Lente has and earlier peak than Ultranlente.
>
>>
>I've been using the same vial of Lantus (6 - 8 units per day), since I
>was diagnosed in the summer. Since my own pancreas is still making
>enough insulin to handle the basal requirements, I don't really know
>how effective that Lantus still is. I almost always wake up with
>numbers in the 70 - 100 range, but I don't really know what of that is
>due to the Lantus and what is due to natural insulin.
>
>>
>>Then I add 4 - 6 daily shots of Humalog to the routine. I never mix
>>Ultralente and Humalog in the syringe.
>
>Has mixing the two insulins caused problems in the past? From what
>I've read from the endocrinology texts, pharmceutical brochures and
>such, I would have thought that would be permissible.
>
>>
>>That routine lets me "beat" some pumpers with my 7 - 9 shot average daily
>>regime (always in 5% club when using Ultralente)
>
>Well, it is hard to say we're "beating" the pumpers if we're injecting
>ourselves 7 - 9 times per day. In my case, the usual is 3 or 4 and
>the max is 5 or 6, but I do not yet (and hopefully never will) have
>full-blown type 1.
>
>>
>>Regards
>> Old Al
>>
>
Some points of discussion, easiest ones first.
"beating some pumpers" That was a reference to HbA1c. My highest
HbA1c on H + U has been 5.9, I normally run closer to 5.7. IOW, by
accepting all those shots, I almost attain pumpers' freedom of diet yet
attain lower HbA1c than some pumpers, i.e I "beat" some of them.
Lente vs Ultralente:
Never tried Lente. Probably never will since the rumor is that it will
be discontinued.
Mixing Ultralente and Humalog in the syringe: The literature says it can
be done. I am suspicious. I am fairly certain (38 years employed in
Chemistry ) that holding the two in contact long enough will slow the
Humalog. So how long would that be and is contact within my fat layer the
same as contact within the syringe? I had two suspicious incidents when
I first tried mixing them so I stopped mixing them.
"Using the same vial of Lantus for several months" I can only quote
other posters: Highly unusual! Many posters have reported that Lantus
self-destructs in a month or less though the endo and two CDE that I have
personally asked assert they haven't run into the extra-short vial life.
"Using lunchtime Ultralente to provide a tail for when Humalog wears off"
We have a differing philosophy on this subject. I totally separate my
basal and bolus calculations. My basal stands alone, providing me with
sufficient basal to handle basal needs 24 hours a day. That's the beauty
of a modern slow-absorbing basal. By allowing one to separate basal and
bolus considerations, all the calculations are simplified and one has more
freedom of diet.
In general, I size my basal, by trial and error, to provide two "basal"
functions:
a. Guaranteeing that my circulating insulin level is always higher
than the 8 - 12 microUnits/mL minimum which triggers a low-insulin liver
dump in non-insulin resistant T1
b. Attempting to provide a level bG whenever I have an empty stomach,
e.g. not particularly rising or falling at night, or just before a meal
when my stomach is empty and my previous bolus is about pooped out.
My bolus stands alone. I never consider any basal needs when
calculating a bolus shot. Bolus handles food and instantaneous bG with no
regard to any interactions with basal.
I handle the Glycemic Index - UltraRapid Humalog balance via "Leading" and
"Lagging". I will shoot early before a high G.I. meal and late before a
low G.I. meal. I have (rarely) shot after a really low G.I, meal rather
than before.
Pumpers study these matters in detail and fiddle with their basals for
months. Simple MDI regimes like mine just approximate their basal
optimization. I do enough optimizing to minimize Morning effect and
prevent low-insulin liver dumps. I am certain some of my basal is helping
my bolus at times, and perhaps some of my bolus is helping my basal at times
but the only way I can tell is by fasting for 24-hours.
I am too lazy to do that though when the doc demands fasting blood tests or
the dreaded anal probe, my basal is sufficient to hold bG fairly steady
through the night until close to noon.
BTW: I shoot Ultralente at 7 a.m., 5-6 p.m, and 9 p.m.
Regards
Old Al
willbill
> willbill wrote:
> > i'm not closed minded about using different insulins
> > and/or dosing strategies. my 46 year diabetic "career"
> > shows that in spades
> First, happy Thanksgiving.
thanks. :) you too
> Next, since my immune system seems to be over-active, (I suffer from rosacea
> so my immune system is attacking my skin for some reason),
if you get a yearly flu shot, you might want to rethink that
> I do not plan to
> make unnecessary changes that could cause a chain reaction with my touchy
> immune system. (Period.)
you already use "human"-U
why would "human"-L cause yer touchy immune system
to go ballistic?
if anything it's more likely for the "human"-NPH
that you use to do that
which is why i see you using L (or a L/U combo)
at bedtime as a win/win in that you'd have a flatter
basal routine with a morning peak from the SL and
no protamine in your routine
> This means I will not change to the newer insulin
> molecules that could push my immune system into uncharted waters for my
> metabolism. (Period.)
you know, in some ways you are laughable
your recent switching back and forth between
pisspro and aspart being a good example
and no, this is NOT a put down, but rather
pointing that what you say and what you do
are not the same
>
> As an aside, lets say I find an MD that I train on this Glucose Transform
> method. (S)He provides an independent observation of my change in insulin
> action as I change to these new insulin molecules. But when I changed, my
> insulin therapy became unstable. Now I have a potential lawsuit to clobber
> big pharma
groves must be rubbing off on you. :-\
> as they provoked my immune system reaction that destroyed my
> stable insulin therapy.
>
> More food for thought,
right. the last one was that i should get married. :)
bill
Jim Dumas
>> As an aside, lets say I find an MD that I train on this Glucose Transform
>> method. (S)He provides an independent observation of my change in
>> insulin
>> action as I change to these new insulin molecules. But when I changed,
>> my
>> insulin therapy became unstable. Now I have a potential lawsuit to
>> clobber big pharma
>
> groves must be rubbing off on you. :-\
Unfortunately, the US system runs on money, lawsuits and _then_ Government.
So you nail the bottom line with a lawsuit. It gets attention fast, as I
won't buy a stock with pending lawsuits, as an example.
So don't change my insulin therapy or I'll whip a lawsuit out and push back
on the system. The objective is bad press for the company pushing me into
insulin therapy I don't want.
What other recourse do you have? Just look at your problems now,