How do they decide which insulin?

[lauraw1983]

Just curious I guess....

I saw the DSN yesterday for my lessons in how things work....

At the moment, my levels are behaving better than they have been - I even saw a couple of 4's the past few days! However, as I had read here and she also said, it will be the "honeymoon phase" probably at play, though she said I'm obviously doing well on the metformin still too. My c-peptide test still wasn't back yet, grrr.

I've not to start on the insulin immediately apparently, but just to keep testing etc and if i see them start to rise then I get in touch with them and we go from there with starting MDI. She did tell me what to do though over the Xmas break time too though, if I find things rising - to use basal insulin at night and see how that affects things.

I have read conflicting things about LADA patients starting insulin earlier is said to help prevent killing more beta cells, but the nurse said this wasn't the case?

Anyhoo I got given Humulin and Humalog - how do they decide what to give people, how much do they all differ? Do they all do the same thing anyway or do some behave differently?!

 

[Marc]

I think it is kinda trial and error added with Doctor's/DSN's preferrence. At my hospital they like Apidra and Lantus as insulin of choice so that is what they gave me. But that may not suit people so they then try other insulins till they get one that suits. It's a bit like blood pressure tablets and insulin ratios, trial and error. I've been lucky and suited the insulins I have been on first time.

Now someone will give the proper answer.

Marc

Remember we are all even the Consultants and DSNs still practicing.

For what I don't know 😎

 

[Copepod]

You probably mean Humalin I, which has been my long acting since starting MDI a few months after starting bimodal insulin in 1997 (as a 30 year old) - only found out about MDI when I went to Belgium for a few days with a student midwife friend, who must have told her mother, a pharmacist in Tasmania, who sent me a photocopied journal page by post (didn't have an email address in those days). The hopsital consultant seemed pleased when I approached him and asked to change - still don't know why he / DSN didn't tell me about MDI right at the beginning, but it doesn't really matter now.

Later, I was advised by a DSN to try splitting dose into 2 per 24 hours, which I find even more flexible, as timings for each dose can be an hour or so either way, so that copes with different times getting up or going to bed (or working through the night).

I also really like the fact that Humalin I costs the NHS half what Lantus or Levemir does - it seems to me to make much more sense to start with the cheapest option and only go to more expensive if the cheaper one doesn't suit.

 

[trophywench]

I lost hypo warnings on Humalin which I went to after building up antibodies to my original porcine in about 1984 - MDI using Humalin I basal and S bolus.

I'm afraid the events that ensued directly from this left me with an ongoing pathological fear of Humalin - but clearly, QED by Copepod's example - we are just not all the same at all, are we! LOL

 

[Ellie Jones]

It must be Humilin S, as this is the background insulin, I'm sure that Humilin I is the one I dropped for humalog..

I've been on several different types, started out on animal insulin in 89, then moved the humilin s&I moved onto humalog when it came out, as I started to obtain an eating disorder (gagging on food) and to make life easier at work with being able to inject and eat pretty quickly..

Then my background was moved to Levimer and now have the pump so only use humalog in that..

But a lot is down to preference of Consultant/DSN, with a dash of experience with other diabetes the rest is then a case of seeing how it pans out for the individual

 

[Copepod]

There are several types of Humalin, which is why the letter afterwards is a vital part of the name. Current edition of BNF (British National Formulary) lists:
Humalin I (intermediate / long acting / background insulin)
Humalin M3 (biphasic / bimodal insulin)
Humalin S (short acting insulin)

These insulins have different names in USA, for example, but to avoid confusion, I have omitted US names.

So, Humalin I the only one of the three in UK that is used as a background insulin.