Blog Entries With Tag: lente


Posted: Jul 6, 2009

This is not the first time there has been a study (or two) indicating a possible connection between an analog insulin and cancer.  The question is, as with any study, is it true?  How do we, as layman, determine if the study(ies) were manipulated in any one direction?  If the hypothesis is true, how do we determine if the group of patients studied includes us? 

 

This particular study published in Diabetologia was conducted on 127,031 patients with diabetes.  The study was conducted from data accumulated in an insurance database.  According to the press release, “the research identified a statistically significant link between patients who had used Lantus insulin and those who had been diagnosed with cancer.”

 

Of particular note according to Endocrine Today is the fact that there were “several important differences in baseline characteristics between the treatment groups. The insulin glargine group was older (68 vs. 41 years), more overweight and hypertensive and more likely to be on oral antidiabetic therapies and have a diagnosis of type 2 diabetes (97% vs. 37%) compared with the insulin glargine plus other insulins group. Of note, differences in cancer risk may be attributed to the different between-group baseline characteristics rather than the treatment itself, according to Gale and Smith.”

 

There was, of course, concern that patients would stop taking Lantus.  For the record Lantus users, as an overall concept (of stop taking insulin out of fear) bad idea.  I stopped taking Lantus several years ago because I do not like the product and found a better solution.  However, I did it with great research, thought, testing, and effort.  I did not just stop taking insulin.

 

In fact, one of the solutions according to the articles, was my original solution … go back to legacy insulin products (humulin).  Well, geniuses, I would love to!  Anyone willing to put Lente and UltraLente back on the market?  Eli Lilly are you listening?  It is cheaper and obviously known to pose no cancer risks.  I know how to use the products individually and in tandem.  I achieved the same 5.1 A1C with Lente that I do with Levemir at ¼ the cost to me and the insurance company.  (I realize the articles meant NPH (N) by the way but that doesn’t cut it – just ask Dr. Bernstein why NPH isn’t the best solution.  Regular (R) is a good product I still use but not for long acting purposes.)

 

I still have to take 3 small shots a day with Levemir that I did with Lente.  Lantus was worse (than Levemir or Lente) since there were bigger peaks and gaps that had to be filled with “gap fillers” to get 24 hour coverage.  Overlapping long acting insulin or OD’ing on it to force 24-hour coverage is not on my top ten list.  I know and can do better now.  Hmm … feels better too.

 

In the “old days,” I used one shot of Lente and one shot of Ultra Lente to get 24-hour coverage but I could better afford to do that at $30 per bottle with an insulin that didn’t have an ineffectiveness time bomb after just 30 days post opening.

 

I promised Dr. Hudson I would not inflict fear in patients.  She is concerned about the quality of this study data and that reluctant insulin users might just stop taking Lantus.  So, please people, do not stop taking your insulin.  Do, however, use the links provided and do some research.  Speak to your doctor.  Ask questions.  Follow the research.  Do good due diligence before making any changes.  It’s your body; it’s your diabetes; it’s your life. You don't get a redo!

Doris J. Dickson

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Posted: Aug 4, 2008

Here's the thing.  You need long-acting insulin.  You are uninsured.  You have limited funds.  You can’t afford Lantus or Levemir.  What can you do?

 

Well, I’m happy to say, from experience, you can safely use NPH insulin which you can buy from Walmart for $22 without a prescription.  It wouldn’t be my first choice but it can be done and it can be done safely.  So your next question is, how?

 

  • Use small doses
  • Use three injections approximately eight hours apart
  • NPH has a peak so carefully work the peak into your eating schedule.   

What Doesn’t Work?

 NPH insulin used to be given in large doses once or twice a day which coincided with meals.  But then you had to eat the same amount of food at the same time every day without variance or you had some dramatic high or low blood sugar effects.  From years of experience, most of us NPH veterans can tell you the technique doesn’t work very well, isn’t very flexible and does not lead to good blood sugar control. 

What Can Work?

 Use NPH only as a background insulin as a substitute for Lantus or Levemir.  

 

What can safely work is to take the total amount of insulin you need (figuring that out I’ll save for another day) and divide it by three.  Determine when NPH peaks for you; in small doses that is likely to be four to six hours.  Position the peaks to coincide with your normal meal times or when you need a bit more insulin working, such as first thing in the morning to counter dawn phenomenon.  Subtract to figure out when you should inject to properly coincide with your needs. 

 

Example:        For you NPH peaks in six hours.  You eat at 5:00 p.m.  Take your insulin around 12 p.m. so the NPH will peak around 6 p.m. when your food is digesting.  You’ll offset the NPH with Regular and/or a rapid-acting insulin (again another story) but you won’t have a huge low when the NPH peaks because you’ve used a much smaller dose and it crosses a need for more insulin anyway. 

 

One note … many insulin products tend to last longer in larger doses.  Thus, the smaller the dose the sooner it tends to peak.  This can apply to any long, intermediate or rapid acting insulin product. 

What Do I Do? 

 I was using Lente (a bit longer acting than NPH) up until last year.  I switched to Levemir because they discontinued Lente.  Turns out for $116 per bottle, Levemir only gets me about 8 hours of solid working time and it still has a peak!  I get no more duration than Lente did for $30 a bottle but has a slightly delayed peak. 

 

So, using two shots a day, I either had to supplement the approximately four hour gaps or go to three doses a day.  I chose to experiment with three doses a day.  I didn’t want to take, nor did I think I needed, more total insulin; I just needed more coverage time.  So I took the 8 units I was taking and divided it by 3.  That got me 3, 2 ½ and 2 ½ units.  That works well.  I take 3 units at 7 a.m., 2 ½ units at 3 p.m. and 2 ½ units at 11 p.m.  I take the extra ½ unit in the morning to cover any insulin resistance from dawn phenomenon.   

Another Tip

Most practitioners tend to tell patients to inject in their stomachs.  For a variety of reasons, I have never used my stomach.  I use my arms and my behind.  I use my arms when I want a speedier absorption or when I'm in public and my behind when I want to slow it down, it doesn't matter or I'm at home.  So, normally, I use my behind for my long-acting insulin.  No reason to speed up long-acting insulin as I see it.  And after more than 31 years, I have no scar tissue on my behind to hinder absorption.  No lumps, no bumps, no scar tissue – seems like a win-win to me. 

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