Problems with Trurapi insulin

[JonHutch75]

I have recently changed insulin from Novarapid to Trurapi insulin and have felt increasingly anxious. Anxious to a possibility life threatening extent. Does anyone know if the insulin change, or anything in it, could be causing this? Have felt like this since changing insulin in November.

 

[RBZ5416]

For what it's worth, I made the switch the other way & had no issues with either.

 

[mikeyB]

Hi @JonHutch75, welcome to the forum.

Trurapi insulin is Insulin Aspart, so identical with Insulin Fiasp, which I use. It is a faster acting insulin than Novorapid, so you may have to shorten the time when you pre-bolus for a meal, and is faster acting when doing corrections for that extra spud. I haven't experienced any psychiatric symptoms.

Insulin does pass through the blood brain barrier, and there are receptors throughout the brain. These are all related to food and appetite, none would cause anxiety. It may be due to using the same pre-bolus time you give your insulin, and your BG dropping while eating, or running lower through the day than you are used to. Do you use any CGM like the Libre or Dexcom? That may give you the answer.

 

[JonHutch75]

Thank you for your replies. The anxiety I get at the moment may not be connected but due to its intensity I’m trying to explore all avenues as I did change insulins back in 2006/7 and had similar issues. I just wondered if there’s any ingredients in the insulin that may cause extreme anxiety or if anyone else had suffered extreme anxiety after an insulin change. It’s greater than general anxiety disorder and “normal” anxiety in that it’s all pervasive and irrational to a very high extent and I’m not sure how long I can cope with it.

 

[rebrascora]

Oh wow! That sounds awful! I wonder if you could still get NR on prescription so that you have it to fall back on like a safety net, so that the change feels less drastic/permanent.
What I am trying to say is that we place a lot of trust and reliance on our insulin because it keeps us alive day by day and night by night. You might not consciously be thinking of that, but it may well be ingrained into (y)our self conscious. Perhaps if you are feeling overwhelmed with this anxiety, then going back to NR for a while would be helpful and then trying again. Hopefully you will find the second attempt a little less fraught.

I only suffered frustration when I transferred from NR to Fiasp. I had 3 months of tearing my hair out before I asked to go back to NR, then I tried again about 9 months later and promised myself I would stick at it for a whole year and had the same 3 months of frustration, when it just didn't behave as I wanted it to, but eventually I made a break through with it just as I was cursing my promise to stick at it for 12 months and I still use it now, but I don't love it like I love my Levemir. I still find it frustrating but then NR was frustrating too, just in different ways.

Also worth considering why you have changed to Trurapi in the first place and if the potential benefits longer term will outweigh this period of turmoil and anxiety. If there has been no good reason to change, then change back.... You do have the right to request a named insulin, so your GP or consultant should not just be changing it to save money or on a whim.

Hope you manage to resolve the problem, even if it means going back to old trusty NR.

 

[Piglet]

You could ask to try Humalog to replace NR, just a thought.
Piglet

 

[helli]

Trurapi insulin is Insulin Aspart, so identical with Insulin Fiasp,

Fiasp stands for Fast Insulin Aspart.
NovoRapid is Aspart (without the fast part).

I am not familiar with Trurapi and wonder if it is a biosimilar insulin to NovoRapid.
If that is the case (and I am just speculating), I can only assume the switch was made on cost and it would be worth @JonHutch75 going back to whoever made the change and asking to return to NovoRapid.

 

[Bruce Stephens]

If that is the case (and I am just speculating), I can only assume the switch was made on cost and it would be worth @JonHutch75 going back to whoever made the change and asking to return to NovoRapid.

I think it's a biosimilar, yes, so it wouldn't be unreasonable to ask to be switched back. I'm less sure that would resolve the anxiety, etc.

(I think I'd want to be switched back just because I have useful features on my smart pens, and I'd be a bit annoyed to lose those.)

 

[Inka]

Thank you for your replies. The anxiety I get at the moment may not be connected but due to its intensity I’m trying to explore all avenues as I did change insulins back in 2006/7 and had similar issues. I just wondered if there’s any ingredients in the insulin that may cause extreme anxiety or if anyone else had suffered extreme anxiety after an insulin change. It’s greater than general anxiety disorder and “normal” anxiety in that it’s all pervasive and irrational to a very high extent and I’m not sure how long I can cope with it.

Some insulins just don’t suit certain people. That’s why it’s crucial we retain a broad range so we have the choice.

If this new insulin isn’t suiting you, ask to change back. It’s not worth feeling off and having the stress and worry.

 

[JonHutch75]

I think it’s a cost issue. NHS Cornwall website says the following (blue circle shows 2nd line drugs, green circle shows 1st line drugs).

Insulin Aspart (Novorapid) 3 ml prefilled pen (Flexpen) Pack of 5

£30.60​

Short-Acting Insulins

Insulin Aspart (Trurapi) 100 units/ml solution for injection 3ml pre-filled Solostar pens Pack of 5

£21.42​

Short-Acting Insulins

https://www.eclipsesolutions.org/cornwall/info.aspx?paraid=261

 

[Inka]

So are you using pre-filled pens @JonHutch75 ? If so, you could swap to a re-useable pen and then just get the Novorapid cartridges to put in it (like a fountain pen).

It’s possible, the cartridges might not be graded in the same way.

Anyway, if it’s making you feel bad, then you should ask to change back. Some people might be fine with it, but others not. It’s not like you’re purposely flicking through and going for the most expensive insulin. You simply want to keep on using the one that’s worked for you.

 

[Inka]

Just to add that my surgery tried something similar but with my test strips. They removed my normal strips and put cheap ones on, giving me a new meter ‘because it was policy and the meter was just as good’. This was rubbish. It was a poor meter and I refused to use it. My consultant also wrote to them and told them to stop messing round with my prescription.

 

[Lucyr]

If this happened last time you switched insulin too, then it’s probably psychological. What did you do about it last time? Did it settle down over time?

 

[nonethewiser]

Thank you for your replies. The anxiety I get at the moment may not be connected but due to its intensity I’m trying to explore all avenues as I did change insulins back in 2006/7 and had similar issues. I just wondered if there’s any ingredients in the insulin that may cause extreme anxiety or if anyone else had suffered extreme anxiety after an insulin change. It’s greater than general anxiety disorder and “normal” anxiety in that it’s all pervasive and irrational to a very high extent and I’m not sure how long I can cope with it.

Think it's just case that changing insulin has heightened your anxiety, which is understandable as you experienced same in 2006/7.

Been using insulin for last 40 years & get bit edgy myself when changing over, especially having been using one type for long time, bit like stepping into the unknown.

 

[everydayupsanddowns]

If this happened last time you switched insulin too, then it’s probably psychological. What did you do about it last time? Did it settle down over time?

I wondered this too @Lucyr

It would certainly be worth asking to switch back to try to resolve things, but the fact that this happened before with another insulin switch (can you remember from which to what in that instance @JonHutch75 ?) might suggest that it’s the switch itself rather than any minor difference in formulation between branded and biosimilar.

Certainly needs to be addressed, as it’s obviously really distressing for you, and asking to switch back to NR seems an obvious and easy first step 🙂

Hope that resolves things for you Jon, but it might be worth exploring counselling or psychotherapeutic options too in case this crops up elsewhere in life?

 

[JonHutch75]

I managed to get my insulin changed back to Novorapid last Saturday (14/01/23) and my anxiety, if that’s the best thing to call it, has been improving daily. I didn’t think this would work out and it felt like a last shake of the dice for me so I don’t believe it is a case of a psychosomatic response (physical disorder that is caused by or notably influenced by emotional factors). This is the second insulin I have had this with and I have been on at least seven different types. There must be something in the medication that caused this, or the medication was making bodily changes that led to me not sleeping/very very high anxiety/problems eating/feeling like everything in my body was in a constantly over anxious state. I do have mental health issues but this insulin turned everything up tenfold and I was genuinely thinking about suicide as I felt a physical mess. I can’t find anything definitive on line to explain this, although it does seem that there has been a lack of research on anxiety and insulin. I really need to know what was in it that was causing this. I lived for over two months on the edge and wish to pinpoint the cause. Does anyone have any suggestions?

 

[rebrascora]

Good to hear you got it changed back and are starting to feel better now, but afraid I can't help or even point you in the right direction for where to look regarding the cause Thankfully NovoRapid is very widely available so there shouldn't be any supply issues. I hope you asked your GP to make a note on your records for it not to be changed again. Your reaction sounds horrid.

 

[nonethewiser]

Good to know you got insulin changed, no suggestions on cause but wish you well for future.

 

[Inka]

Good news @JonHutch75 It doesn’t matter what the reason was really, we’re all entitled to insulins that suit us as individuals.

 

[EmmaL76]

I’ve had issues with insulin that doctors say simply don’t exist but would appear every time I trialled it. We are all different and insulin is a hormone so who know how each individual will react. Was this insulin behaving differently with regards to your blood sugars ? Maybe swinging more? Faster acting ? Dropping suddenly? It’s just I know these things can provoke a kind of fight or flight response which can feel very much like anxiety.