Hypurin Porcine Isophane

[Brendan Hyland]

Hello Friends!

I am hoping someone would be able to help me. I am a 41 year old type 1 who has had a really bad reaction to analogue insulins and for this reason I switched to porcine neutral 2 years ago. I started to feel much better but still suffer from unusual symptoms which I surmise is due to my long acting analogue insulin. I really want to move to porcine isophane but I am worried about a loss of blood sugar control and the impact on my personal and working life. Would anyone be happy to speak to speak about their experience? Please can you start a private message if you are able to help.

Thank you in advance for your help.

 

[everydayupsanddowns]

Hello Brendan

Welcome to the forum.

Sorry to hear that you;ve had a tricky time with analogues. Have you tried other 'human' rDNA insulins or only the analogue versions? (eg Insulatard / Protaphane / NPH / Humulin I etc). They all have shorter and spikier profiles than long-acting analogues, but may be suitable for you with a bit of work.

We had a member here for many years who used bovine insulin until it was discontinued, but she no longer visits so much, and managed to switch to an analogue without too many major issues when Wockhardt stopped making bovine (though I think human insulins had been problematic before).

I would suggest you remove your email address from plain view and request people to start a 'Conversation' with you (the forum's private message system).

ETA: You can also 'watch' any thread on which you post, which means that the forum software will email you when you get a response. 🙂

 

[Brendan Hyland]

Yes I have Mike. I have struggled with all analogue insulins for over 20 years. I had the same problem with mealtime insulin. I switched numerous times between Novorapid and Humalog U100 and Humalog U200. I felt really unwell with sweats, exhaustion, pains and aches and brain fog in 2010 so much so that I had to give up my teaching job. All my issues went away on switching to Porcine Neutral in or around 2016 It was such a relief. However as the insulin hangs around for so long I was getting hypos and ended up in hospital a number of times. I'm not sure if I should mention this but I don't want to complicate the situation but I switched to Afrezza inhalable insulin for my mealtime insulin in 2015 and my diabetes control is absolutely amazing and no major hypo incidents or hospitalisations. I don't get spikes and I will upload my freestyle data and attach it at the end of this email to show what I have achieved with Afrezza. My HbA1c is 5.8% having come down from 6.5% since starting Afrezza within 4 months. I am therefore an amazingly well controlled insulin-dependent diabetic! As Afrezza is the fastest insulin available and peaks within 15 minutes of inhalation and clears within 90 minutes, I need more basal between meals. As I upped my Tresiba the brain fogs and weaknesses came back. I have tested this by waiting 34 hours between injections of Tresiba and I feel better as I approach the 34 hours and then within 4-5 hours of injection I feel poorly again. I am aware that Tresiba is a fantastic insulin in terms of glycemic control but I cannot manage the side effects I experience. I put this down to analogue insulin. I expect that porcine isophane will make me feel much better but I am aware that glycemic control may be much more difficult especially in the first 6 weeks of a switch. I know Afrezza is amazing and will aggressively destroy high blood sugars and clear fast without a huge hypo risk and with Afrezza it is very easy to know which insulin is affecting the blood sugar as it does not stack and confuse the situation.. I am just not sure how much more I can mentally take with diabetes. I am also aware that an NHS 15 minute appointment will not suffice to discuss these issues! I am really looking for reassurance that it is possible to get good glycemic control with porcine isophane. Thanks for your help and speedy response. It is great to have received a response so quickly. I am happy to help anyone too if I can.

 

[everydayupsanddowns]

We've discussed Affrezza here before (eg https://forum.diabetes.org.uk/boards/threads/whats-everyones-take-on-afrezza.51782/), and it's unfortunate that as a company they seem to have used rather questionable marketing and social media strategies in the past - so much so that I get slightly uneasy when it is mentioned at all - to be honest I wasn't even sure that it was still in production after it hit the rocky patch and Sanofi pulled the plug in 2016. Having said all that if you say that it's working well for you then that's great.

2015 must make you one of the first users - I wasn't even sure it was available in the UK in 2015, expect on a trial basis - and still in phase 3 clinical trials for the UK as of 2017 https://www.sps.nhs.uk/medicines/insulin-inhaled/

I'm a bit confused, because you say you are using Tresiba as a long acting analogue, and Porcine Isophane since 2016 as a successful meal replacement, but that you also switched to Afrezza in 2015 for mealtime insulin.

I am assuming you are paying for Afrezza, since it's not readily available on the NHS?

 

[trophywench]

I used porcine UltraLente until I built up antibodies to it - and I understand the human body can do this with both animal ones - the old remedy was to change to the other animal - before there were any manufactured alternatives.

I understand the animal ones have more peaks and troughs than the manufactured ones (well they all have to be manufactured but you know what I mean) so you might find you need to have a more regular lifestyle - as we all did when we had no choice.

I thought Hypurin Isophane was described as 'Intermediate' rather than 'long acting' but I'm not sure how long it actually ever was 'active? Did one ever only have one jab a day of it, or split doses? Or was it more usual to have the 70/30 mixed variety and no separate 'bolus' ?

 

[Brendan Hyland]

Hi Mike,

Thanks for your reply and for sharing the Afrezza link. To touch on this I have been using Afrezza since September 2015. I don't carb count and eat what I want when I want as Afrezza allows for real-time control of blood sugars. Mannkind did enlist the help of Sanofi with Afrezza in the early days but it was then decided that they wanted to have full control over it and all Afrezza from then on was branded by Mannkind. Prescriptions I understand continue to grow and they are working on new technologies to help Afrezza users which is confidence-inspiring. I just inhale and eat whenever I need to and my levels stay completely in range. Pretty good I would say since my body is not producing any insulin! Mannkind are a small company who have transformed the lives of many people with diabetes in the USA and around the world and they intend on being around for some time I understand. Afrezza is as yet unlicensed in the UK but has been through the rigour in terms of FDA approval in the USA. In terms of the NHS, it is possible to be prescribed unlicensed drugs on what's called a named patient basis where a patient has a special clinical need. This is assessed by the MHRA who can assign a license and this is the route I went down.

You made a mistake. I mentioned using Porcine Neutral since 2016 not Porcine Isophane for a brief period of time in 2016 until I was sure that my Afrezza supply would continue. Porcine Neutral is a mealtime insulin. Anyhow I started this post to discuss Hypurin Porcine Isophane and not Afrezza so it would be really good to hear about this. My NHS doctor has agreed today that I need to use Porcine Isophane going forward but understandably he has little experience with it apart from advising the split dose. A basal insulin is required between meals to be used in conjunction with Afrezza. Most Afrezza users find Tresiba works well but it doesn't for me. This is to do with my inability to tolerate analogue insulin. Therefore my query about Hypurin Porcine Isophane.

Jenny, you are right Hypurin Porcine Isophane is an intermediate-acting insulin and you have to take a split dose AM/PM. I believe it lasts for up to 12-14 hours. I am sorry to hear of your experience and of course bovine insulins are not being manufactured anymore! What are you currently using? I am very worried about the switch but I hope that it will work ok for me. I would love to speak to someone who has experience with Hypurin Porcine Isophane!

I look forward to any help with Hypurin Porcine Isophane!

 

[trophywench]

I'm fine thanks Brendan - I used twice daily Levemir and bolused Novorapid (Lantus at first but since my body doesn't peak its BG ever 5 hours later than any time I could have a jab, I was far better off taking two jabs of Levemir in tandem with the mealtime Novo) but that didn't match 'me' that well either but since I've been pumping Novorapid only - I find it a lot better.

I honestly don't recall anyone on this forum over the years ever saying they were using that type of insulin I'm afraid, even years ago. It hasn't been a choice really for at least 25 years, so a lot of more newly diagnosed folk won't ever have even heard of it. However - it's a good thing it does still exist cos you can't be the only one that needs it.

I had a look on the DSF website where the profiles of various insulins are shown - and even when we wrote that - because it wasn't in normal use it was never mentioned - the 'oldest' type on there is NPH.

However - the profile graphs were all obtained from the manufacturers when the info was put on the website - at least 20 years ago - so maybe if you contact the manufacturers, you can still get it from them? If you know when the peaks and troughs are, you can hopefully base the timing of the daily jab/jabs on that?