Changing Insulin type - benefits or pitfalls?

[NoodleDoodle]

Hi all, hope you’re all fit and well, or as well as can be. In these somewhat challenging circumstances. I’ve had a bit of a search of the forum. Trying to gain some insight on moving from an existing insulin treatment. To using another, different type of insulin.

I’ve been injecting Humulin S and Humulin I, since around 1994. Other than the usual ups and downs over the last 26 years. My management of my condition has been pretty good. My HbA1c has been between 54 - 48 for a long time.

My specialist and hospital clinic have mentioned again, about moving me from Humulin to Lantus and Humalog. They seem to do this every year! Now I’ll be honest, I’m up for giving anything a try. But I don’t want to change insulin for the sake of changing it.

My specialist seem to think I might achieve better control / more consistent control by moving insulin’s. I do find I have to make the odd correction every other day or so. I’ve been trying to get an explanation from my specialist and clinic as to what distinct advantages/ disadvantages there might be in moving insulin types.

What I don’t want to have to do. Is learn everything all over again. Has anyone got any input in moving from one insulin type to another? And insights, challenges to look out for? Any advantages to taking Lantus / Humalog over Humulin?

Any thoughts, comments or advice much appreciated

: )

 

[everydayupsanddowns]

Welcome to the forum @NoodleDoodle

Well... on the one hand, what have you go to lose? You could always switch back if you give them a few months and can’t get them to work...

On the other hand, I’m slightly unsure about change for change’s sake, and without the replacement insulins supposedly offering something that you are looking for (faster action... more stable background... more responsive background... shorter ‘tail‘... or whatever)

In my experience, switching insulins is never a straight swap, so you need to be up for quite a bit of relearning, experimentation, and probably a fair bit of frustration.

Your current results seem pretty good. Is there anything that you would like to improve? Anything you find particularly challenging with your current insulins?

 

[Inka]

Hi @NoodleDoodle I’ve tried various insulins and swapped insulins a few years ago. However, this was for a reason (suspected intolerance to the insulin I was using). It was my choice.

At varying intervals before and after that, people have tried to persuade me to swap insulins and I’ve refused. Usually there was no reason given for the suggested swap other than the offered insulin was “more modern”. That very term irritates me now.

If you don’t want to swap and you have good control with minimal issues, then personally I’d ignore them. I’ve now had a note put in my file asking them to stop offering me new insulins because the one I’m using might be older but it’s a much better fit for me.

 

[NoodleDoodle]

Hi everydayupsanddowns, thanks for the response. I was kind of thinking the same. In the current circumstances, under lockdown. It’s almost an ideal opportunity to try out the new insulin’s. And do so at a time of relative safety (I’m homeworking, no real need to drive anywhere etc).

My work life is a bit manic, I’m running at maximum pretty much all the time. Which can make consistent meal times difficult. As I’m often on a conference call, going from one meeting to another etc (exciting stuff, I know! lol ). Meaning a do find, during the working week, that I have a few ‘wobbles’ (highs and lows, or ‘ups and downs’ : ) ). Might be nice to reduce that fluctuation a little bit.

But I think that’s more a circumstance of my working / home life pattern. Which makes me wonder whether changing insulin types will make any significant difference? Or allow me any increased stability over what I have now? I guess nothing ventured, nothing gained. In knowledge and experience, if nothing else!

I think I’ll ask some more questions of my specialist / consultant. Then consider what I’m going to do. Thanks so much for the welcome, also!

 

[NoodleDoodle]

Hi Inka, thanks for such a helpful post, much appreciated. It’s nice to get a view from someone. Who’s gone through a somewhat similar set of circumstances. Thank you!

 

[trophywench]

I used to use exactly the same insulins. However - after going mega hypo on the motorway twice with absolutely NO warning - wrote off two company cars, wasn't popular LOL - I went on to Lantus and Novorapid!

That was well over 20 years ago and I'm still here now, plus no more wrecked vehicles. (Though I now have an insulin pump, in which I still use Novorapid.)

 

[NoodleDoodle]

I used to use exactly the same insulins. However - after going mega hypo on the motorway twice with absolutely NO warning - wrote off two company cars, wasn't popular LOL - I went on to Lantus and Novorapid!

That was well over 20 years ago and I'm still here now, plus no more wrecked vehicles. (Though I now have an insulin pump, in which I still use Novorapid.)

Hi trophywench, sorry for the slow reply. I appreciate your adding some more info and further detail for me to consider, that’s fab. I guess I have to understand that the recommendation is being made, with the best interest of my health at heart.

Perhaps adapting to a new insulin regime, which might be tough for a few months. Is less worrying or indeed damaging. Than having less accurate control over my condition. I’m going to make a positive change, and see how things go.

I can be mindful of how the new regime is working. And actually, in circumstances where my life is pretty stable (under lockdown). In some respects, it’s the safest set of conditions under which to learn a new approach.

Many thanks all, for your helpful input. It’s been very much appreciated!

 

[Abi]

It sounds as if you are doing very well with you HbA1c range and managing erratic meal times. Moving to the more modern insulins might help with the fluctuations. How do you manage with the older insulins- are you using them in a basal bolus regimen with carb counting?

 

[rebrascora]

I guess I have to understand that the recommendation is being made, with the best interest of my health at heart.

I am always a little sceptical that these decisions are made solelywith the patient's best interests at heart. I think there may also be a financial element and perhaps the older insulins are used by a lot less people and therefore not purchased in bulk, so may be more expensive as a result. Moving as many people as possible onto the same insulins will probably be beneficial to the NHS Trust. I would therefore want some explanation of why that new insulin might be more beneficial than the one I was already using, particularly if I had such great control with the existing one.

 

[Bruce Stephens]

Moving as many people as possible onto the same insulins will probably be beneficial to the NHS Trust.

It's also presumably helpful to all the healthcare staff. That is, it's similar to other medications, only probably more so: doctors get used to particular ones and so next time they need to prescribe a statin they'll choose the one they usually prescribe. With a statin (or an antihistamine, or whatever) the differences probably aren't that significant, but with insulin there's an obvious advantage in being familiar with its idiosyncrasies.

 

[NoodleDoodle]

It sounds as if you are doing very well with you HbA1c range and managing erratic meal times. Moving to the more modern insulins might help with the fluctuations. How do you manage with the older insulins- are you using them in a basal bolus regimen with carb counting?

Hi Abi, I’m on a basal bolus regime. And to be honest, when I was diagnosed. The support from my GP and local hospital was, looking back on it, shocking. I think I got a book on Carb counting followed by a cheery “......right, off you go...”. And to be honest, that was about it.

I’ve learned by experience, instinct, blood glucose readings etc. To ‘manage’ my condition over the last 25 years. I couldn’t for the life of me tell you how much carb / sugars there are in something. But my meal regime is relatively consistent, and I know how much insulin I should take based on the meal being prepared, or that is in front of me.

Not very scientific or best practice, I know!

 

[NoodleDoodle]

I am always a little sceptical that these decisions are made solelywith the patient's best interests at heart. I think there may also be a financial element and perhaps the older insulins are used by a lot less people and therefore not purchased in bulk, so may be more expensive as a result. Moving as many people as possible onto the same insulins will probably be beneficial to the NHS Trust. I would therefore want some explanation of why that new insulin might be more beneficial than the one I was already using, particularly if I had such great control with the existing one.

Hi rebrascora, yes, I understand your point, totally do. I’ll be the first to admit that, for a number of reasons. My capability to manage my condition has developed on a rather ‘agricultural’ basis.

I’ve certainly noticed my awareness of hypo’s is less acute. And that’s something I’d like to improve. I guess I have concerns about the longer term impact on my brain health. If I find that I’m spending more time in a hypoglycaemic ‘state’. As my awareness is perhaps not so good. That being said, I don’t often find myself in an uncontrollable state. But perhaps surprisingly still in quite good control even if my glucose levels are low, which is a bit of a concern