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Should I ask for an Insulin change?

Or maybe they’re waiting for a possible biosimilar of Levemir? I posted that link with the reference to legal cases but Levemir’s patent must run out soon. I’m still annoyed at Novo Nordisk for discontinuing it even though I don’t use it.
 
rebrascora said:
I think that the problem lies in the fact that some of us only get an appointment once in a blue moon and now we are down to near enough a year to stocks running out, I think you need to at least have a discussion and a plan in place about what options you have and what might be most appropriate. They will not suddenly be able to give everyone appointments next summer to swap them over.
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I’m sure diabetes uk will have considered that before giving the advice not to switch and that there will be a recomendation of what to switch to in advance.
 
Lucyr said:
I’m sure diabetes uk will have considered that before giving the advice not to switch and that there will be a recomendation of what to switch to in advance.
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You have more faith in DUK than me! Do you really think that they fully appreciate how overrun some clinics are or that one particular insulin will suit everyone currently using Levemir. This is a conversation that needs to be started now and planned for. Not suggesting anyone necessarily changes insulins now but in my opinion it is important to have a discussion about it with your consultant or nurse now and have a plan in place. We might be lucky and a biosimilar produced by another company but my consultant felt it was pretty unlikely.
 
NovoNordisk will no doubt recommend Tresiba but Tresiba doesn’t suit those who need the flexibility of twice daily basal. What they should have done is sell the Lev patent or allow biosimilars earlier.
 
This has been an incredibly helpful discussion.

I was interested in a Levemir switch because, as pointed out, it’s not clear I’ll have an appointment near a time when I need to switch. The DUK advice is identical to that from the Department for Health and Social Care and so I suspect is in part driven by existing stocks.

However what this discussion has made me think is that I should have sat up more quickly when the diabetes nurse said I could have a pump of if I wanted. Her message to me was: “we give them to pretty much any T1 who asks”. However I realise (a) this isn’t in line with NICE guidelines and (b) things may have changed since she said it four or five months ago. The kinds of things I find frustrating about my current regime are: I can’t exercise easily after breakfast (yoga sends me plummeting, I’ve not tried anything else after breakfast because when I was first diagnosed I was told it would be easier if I didn’t), at weekends I can’t go hiking without having to eat a lot of carbs to keep me going unless I skip breakfast which then has me stable, small walks can send me downwards (I work in three different buildings and it is a giant pain going between them - they are all 15 mins apart - and after an evening out I have to wait up for a bit to see if the journey pushed me down). These all sound as though they might be made easier by a pump.
 
Inka said:
Or maybe they’re waiting for a possible biosimilar of Levemir? I posted that link with the reference to legal cases but Levemir’s patent must run out soon. I’m still annoyed at Novo Nordisk for discontinuing it even though I don’t use it.
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By the looks of it the patent has expired already; I am surprised a replacement hasn’t been developed.
 
MollyBolt said:
By the looks of it the patent has expired already; I am surprised a replacement hasn’t been developed.
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I’m hoping the reason isn’t the same reason NN have - money to be made elsewhere. When I was first diagnosed, there was a large choice of insulins. I don’t remember how many, but lots. This made it easier to swap and experiment until you found a regime that worked best.
 
MollyBolt said:
This has been an incredibly helpful discussion.

I was interested in a Levemir switch because, as pointed out, it’s not clear I’ll have an appointment near a time when I need to switch. The DUK advice is identical to that from the Department for Health and Social Care and so I suspect is in part driven by existing stocks.

However what this discussion has made me think is that I should have sat up more quickly when the diabetes nurse said I could have a pump of if I wanted. Her message to me was: “we give them to pretty much any T1 who asks”. However I realise (a) this isn’t in line with NICE guidelines and (b) things may have changed since she said it four or five months ago. The kinds of things I find frustrating about my current regime are: I can’t exercise easily after breakfast (yoga sends me plummeting, I’ve not tried anything else after breakfast because when I was first diagnosed I was told it would be easier if I didn’t), at weekends I can’t go hiking without having to eat a lot of carbs to keep me going unless I skip breakfast which then has me stable, small walks can send me downwards (I work in three different buildings and it is a giant pain going between them - they are all 15 mins apart - and after an evening out I have to wait up for a bit to see if the journey pushed me down). These all sound as though they might be made easier by a pump.
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For exercise after breakfast, I’d simply reduce my breakfast bolus @MollyBolt You can do that on MDI. I wonder if part of the problem is simply that you’re taking more insulin than you need? If you’re going out on a hike at the weekend, reduce your morning Levemir and probably your boluses too. If small walks at work are sending you low, then I really do think you’re having more insulin than you need. You’d be surprised how much effect a few targeted tweaks can have.

I already mentioned pregnancy targets above but what I didn’t mention is that in order to achieve those, the amount of hypos can increase a lot. Trying to keep too tight control can mean you can’t live a normal life. Again, a tiny easing of the throttle can have a big effect.
 
rebrascora said:
You have more faith in DUK than me! Do you really think that they fully appreciate how overrun some clinics are or that one particular insulin will suit everyone currently using Levemir. This is a conversation that needs to be started now and planned for.
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Of course I trust Diabetes UK to communicate this advice accurately. They aren’t just making the advice up, they’re repeating what clinicians have been advised to do. It explains this in the article “DHSC is working with NHS England and clinical experts to plan for this discontinuation”
 
rebrascora said:
This is a conversation that needs to be started now and planned for.
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As I understand it the DSN Forum is discussing this but hasn't offered any advice yet, so waiting until they've produced their advice seems like a reasonable option. (I presume the DHSC and NHS England (or what used to be NHS England) advice will in fact be coming from the DSN group, but I may be mistaken. I'll bet they offer the same advice, anyway.)
 
MollyBolt said:
This has been an incredibly helpful discussion.

I was interested in a Levemir switch because, as pointed out, it’s not clear I’ll have an appointment near a time when I need to switch. The DUK advice is identical to that from the Department for Health and Social Care and so I suspect is in part driven by existing stocks.

However what this discussion has made me think is that I should have sat up more quickly when the diabetes nurse said I could have a pump of if I wanted. Her message to me was: “we give them to pretty much any T1 who asks”. However I realise (a) this isn’t in line with NICE guidelines and (b) things may have changed since she said it four or five months ago. The kinds of things I find frustrating about my current regime are: I can’t exercise easily after breakfast (yoga sends me plummeting, I’ve not tried anything else after breakfast because when I was first diagnosed I was told it would be easier if I didn’t), at weekends I can’t go hiking without having to eat a lot of carbs to keep me going unless I skip breakfast which then has me stable, small walks can send me downwards (I work in three different buildings and it is a giant pain going between them - they are all 15 mins apart - and after an evening out I have to wait up for a bit to see if the journey pushed me down). These all sound as though they might be made easier by a pump.
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Your list of frustrations match those that I had when I was on MDI. For me these issues were solved by got on a pump.

Having said that tweaks to your insulin regime can make a big difference.
Are you using a half unit pen? These certainly helped me as I was able to make smaller changes to a dose (a pump does this by 0.1 units).
On MDI I found it easier to exercise after a meal. This was because I could adjust my bolus just before. On a full day of walking at the weekends I would also adjust my basal for that day (and the evening if the walk was strenuous). I would still find that I needed to have Wurther’s Originals through the day to keep my levels topped up, and I still do that even when looping with a pump.

Our Diabetes keeps us on our toes.
 
MollyBolt said:
The kinds of things I find frustrating about my current regime are: I can’t exercise easily after breakfast (yoga sends me plummeting, I’ve not tried anything else after breakfast because when I was first diagnosed I was told it would be easier if I didn’t), at weekends I can’t go hiking without having to eat a lot of carbs to keep me going unless I skip breakfast which then has me stable, small walks can send me downwards (I work in three different buildings and it is a giant pain going between them - they are all 15 mins apart - and after an evening out I have to wait up for a bit to see if the journey pushed me down). These all sound as though they might be made easier
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Yep, these all sound like they’d be made a little easier (or at least you’d have other options) with a pump.

The ability to fully suspend (or just partially reduce) basal is such a huge help. Plus, of course, your basal profile can be tweaked to give you more when. You need it and less when you don’t, unlike the pharma companies obsession with ever longer-acting basals!

Plus you could also have the option of a hybrid closed loop, where the pump helps smooth things out a little even while you aren’t watching. You still need to prep for activity / carb count etc… but those little algorithmic tweaks can add 10-20% to your TIR
 
So I had such a nice appointment with the doctor today. I am really glad I had thought about it all with your help in advance.

He agreed to put me on the waiting list for a pump. I will have a choice between an Omnipod (but this is 1 year + waiting time) or Ypsopump (3 or so months waiting time). Once I've opted for Ypsopump it sounds like I can't change to the other because there's a four year contract or some such. Grateful for views on this? I had rather hoped for an Omnipod but also know from the Pumping and Technology thread that there is no "best pump" and so maybe the timing should be the deciding factor (though four years is a long time to be locked into something). They said that I could go for an Omnipod and self-fund for 3 - 4 months and then switch to the NHS which would seemingly cost around £1500 or maybe a bit more. What do you think?

He's given me some Fiasp cartridges to try with no obligation to stick to them. I am mildly alarmed because everyone seemed to find it took a while to get used to. But let's see. Regardless this now means I have a smart pen which I have yearned for ever since someone talked about getting a 1/2 unit.

He also raised the fact that I am looking at my sensor too much (which obviously I also know) and is worried about burnout. We talked through why I look so much (basically hypo unawareness, control freakery and finding it alarming to suddenly find I am high or low without realising). He's suggested switching me to Dexcom because of their multiplicity of alarms. He's given me one to try and, though I feel a bit anxious about getting it to sync with my watch etc, I feel from a quick read as though this could be a good move for me.

Thanks all for your help - and any views on any of this would be welcome.
 
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Great to hear you had such a good and positive discussion with your consultant and some options to try. Sounds like you have a NovoPen Echo for your Fiasp. They are really great pens! All you can do is try the Fiasp and see
how you get on. I wouldn't go back to NR now and I can eventually say that I like Fiasp, but I didn't find it an easy transition. That may be partly to do with me following a low carb way of eating. Some people find the transition easy and straightforward and I hope you are one of them but if you have problems, shout up and we should be able to give you suggestions as to what to try, that worked for us, which should mean you can overcome any difficulties quicker than I did.

Can't really offer you any advice on your pump choice as I am happy with MDI but we do have one or two experienced members who found the Omnipod 5 was not as good as they had hoped particularly looped with Libre and swapped to the Ypsomed. The swap to Dexcom might be a good idea if you do go for the Omnipod as I believe the HCL works more reliably with Dexcom sensors.
 
Brilliant that you had a good appointment @MollyBolt and great that they open to you trying new things - I much prefer Fiasp to Novorapid but everyone is different and the half unit pen is great (I wouldn't be without one!) as it enables you to make minor tweaks to doses safely (and particularly if you are changing insulins) - I'm not allowed a pump :( so can't give any advice on that I'm afraid but there are many people here who can give sound advice on that front
 
I have been using Fiasp for a few years now and would hate to revert back to NovoRapid.
Most of the time, it is faster but that speed is very dependent upon my current BG. I would suggest it is not a great insulin to use to make corrections. It can be pretty slow if my BG is above 10 mmol/l.

With regards to which pump, only you can decide. There is no such thing as a bad pump.
It is common for new pumpers to set their hearts on OmniPod because they think the tubes will be a problem.
As someone who has used both tubed and tubeless pumps (but not either of the ones you have on offer), the tubes are not an issue.
The main reason I prefer my tubeless one is because it is smaller than the tubed one I have on offer. But the Yposmed is much smaller than the Medtronic so I would not be as concerned.

This page looks as if it is from the US but it still looks like a good starting point for comparisons: https://type1better.com/wp-content/uploads/2022/12/Insulin-pump-comparison-table.pdf

Personally, I would prefer to have something confirmed in 3 months than a maybe in 12 months. I know 4 years sounds along time but it has certainly gone quickly with my pumps.
 
MollyBolt said:
Ooo say more? Both on Dexcom and also on Ypsopump!
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@MollyBolt I have the Dexcom G7 and it’s absolutely brilliant. It sticks like a super-limpet and is far more accurate for me than the Libre 2. It also has a great range of alarms.

I’ve not used the Ypsopump but I’d never use the Omnipod because it’s a lump of a thing, doesn’t have a good reputation at my clinic, and I prefer tubed pumps plus I think they’re better quality. The Ypsopump is offered by my clinic and quite popular. If you’re going to loop with it, then it uses CamAps, which is a very good loop.
 
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