tag:blogger.com,1999:blog-16774010.post8480750744244289531..comments2024-01-25T17:58:34.297-05:00Comments on Scott's Web Log: What Do You Know About Regular Insulin?Scott Shttp://www.blogger.com/profile/03286529314567223617noreply@blogger.comBlogger15125tag:blogger.com,1999:blog-16774010.post-12649139935597190602010-10-03T14:35:09.956-04:002010-10-03T14:35:09.956-04:00Hi Aimee, the best way to answer your question is ...Hi Aimee, the best way to answer your question is to note that most people cannot use a single insulin variety alone unless they use an insulin pump. This is because basal insulin can be replicated with tiny deliveries of sub-unit increments each hour. Without that, unless your basal insulin requirements are next to nothing, you will probably require some type of long-acting insulin such as NPH (or you can use the Levemir or Lantus analogs for this purpose). For most people, a pump is probably the best option, and there are newer pumps that cost less than the traditional pumps, such as Insulet's Omnipod which may cost less if cost is an issue.Scott Shttps://www.blogger.com/profile/03286529314567223617noreply@blogger.comtag:blogger.com,1999:blog-16774010.post-24072512522338942472010-10-03T08:58:50.707-04:002010-10-03T08:58:50.707-04:00I am curious, how could I take just Regular insuli...I am curious, how could I take just Regular insulin only. I ordered NPH in Pork insulin from a Canadian company, but I will run out of mine before it gets to me. I am hoping to use just my regular until it gets here. Now after reading your post I wonder I could manage on Regular alone.<br />AimeeUnknownhttps://www.blogger.com/profile/06529320462952710120noreply@blogger.comtag:blogger.com,1999:blog-16774010.post-77058597172055562782008-08-14T08:02:00.000-04:002008-08-14T08:02:00.000-04:00Thanks for the info ... since I don't personally u...Thanks for the info ... since I don't personally use Novolog, I don't regularly read the package inserts, and they are often updated without much publicity. I can tell you, however, that rivals Humalog and Apidra are not currently approved for IV administration.<BR/><BR/>Still, the necessity seems lost for me. Regular works just fine (actually Schering Plough dominates the bags intended for IV administration) for IV administration and is far cheaper. But I can tell you that Novo has been very forthcoming about its desire to stop making regular and other original biosynthetic insulin formulations because they are no longer covered by U.S. patent law. In many markets around the world, all they'd have to do is stop marketing the product, but in the U.S. Lilly still controls a large share of old formulations (and they are growing that business on a worldwide basis) thus Lilly is the thorn in Novo's worldwide desire to "migrate" patients completely. Personally, I have an ethical problem, and commented to the FDA that regardless of what the drug companies think, the "standard" for clinical trials should never be against insulin receptor ligands (analogues) but against regular.Scott Shttps://www.blogger.com/profile/03286529314567223617noreply@blogger.comtag:blogger.com,1999:blog-16774010.post-20436441709501908122008-08-12T10:58:00.000-04:002008-08-12T10:58:00.000-04:00Novolog's IV use is clearly stated in the prescrib...Novolog's IV use is clearly stated in the prescribing information.<BR/>http://www.novolog.com/NovoLog_Prescribing_Info.pdf<BR/><BR/>See section 2.4 in dosage and administration.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16774010.post-38526420560754951322008-08-12T08:18:00.000-04:002008-08-12T08:18:00.000-04:00To my last "Anonymous" responder:Thanks for your c...To my last "Anonymous" responder:<BR/><BR/>Thanks for your comments! A few responses. First, you note that "Novolog is available for IV administration". I do not find anything on file with the Food and Drug Administration (FDA) to verify the accuracy of this statement. It's 'possible that Novo Nordisk manufactures Novolog (insulin aspart rDNA origin) for IV administration and it may actually be approved in some countries, but to the best of my knowledge, it is not approved for IV admin in the U.S. Many people confuse the brand names Novolog and Novolin, as Novolin R is FDA approved for that use, but I see no evidence that Novolog is. Perhaps you can share some documents on file with the FDA to back that statement up, that would be appreciated!<BR/><BR/><BR/>As a follow-up to your last point, you stated "The different analogues are attempts at altering the speed (slower-basal's, faster-bolus's) of administration through subQ to better mimic what the pancreas does. RHI will never do that via SubQ."<BR/><BR/>With all due respect, you are incorrect, there is a Connecticut-based company called <A HREF="http://www.biodel.com/" REL="nofollow">Biodel, Inc.</A> which is now completing Phase III Human Clinical Trials for its FDA submission of VIAject, which is actually a version of RHI with already FDA-approved "additives" which alter the ADME (absorption, distribution, metabolism, and excretion) characteristics of RHI to work (at least according to the clinical trial results) <I>faster</I> than a rapid-acting insulin analogue such as Humalog (insulin lispro rDNA origin). Others have also doe similar things with RHI to prolong its ADME characteristics, although so far, only in a trial setting. It is entirely possible to alter the ADME characteristics without altering the genetic structure of the molecule itself.<BR/><BR/>I will spare you a diatribe about how numerous meta-analyses (conducted in the UK, Canada and Germany) of the the trials undertaken for insulin analogues have failed to demonstrate superiority over older-generations of insulin preparation in a clinical setting, but I assure you, the analyses have demonstrated that the trials in virtually all cases failed to demonstrate scientific proof of superiority.Scott Shttps://www.blogger.com/profile/03286529314567223617noreply@blogger.comtag:blogger.com,1999:blog-16774010.post-11117254590816531472008-08-12T01:47:00.000-04:002008-08-12T01:47:00.000-04:00RHI is fantastic in IV form. But by subQ it's dir...RHI is fantastic in IV form. But by subQ it's dirt slow. The analogues speed this up. Who wants to be on IV insulin all day? I don't, I'll take the analogue any day.<BR/><BR/>As an aside, Novolog is available for IV administration, although it makes little sense to use it that way, because insulin via IV is all the same. Just wanted to point out the factual error there.<BR/><BR/>The different analogues are attempts at altering the speed (slower-basal's, faster-bolus's) of administration through subQ to better mimic what the pancreas does. RHI will never do that via SubQ.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16774010.post-20493396852046202062008-03-31T07:45:00.000-04:002008-03-31T07:45:00.000-04:00Response to Anonymous: Fundamentally, it means th...Response to Anonymous: Fundamentally, it means that all of these so-called "improvements" have done virtually nothing to improve glycemic control, but they have done wonders for the drugmakers' bottom lines!Scott Shttps://www.blogger.com/profile/03286529314567223617noreply@blogger.comtag:blogger.com,1999:blog-16774010.post-42877968879903546062008-03-31T02:55:00.000-04:002008-03-31T02:55:00.000-04:00The more I read the less I know. Does all this mea...The more I read the less I know. Does all this mean that the profiles given with lantas and nova rapid don't make life easier? Have all these "improvements" meant nothing?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16774010.post-10373145333889807042008-03-28T13:19:00.000-04:002008-03-28T13:19:00.000-04:00Great post SS.Great post SS.Scott K. Johnsonhttps://www.blogger.com/profile/06601851114190791084noreply@blogger.comtag:blogger.com,1999:blog-16774010.post-33917679732251340912008-03-28T13:00:00.000-04:002008-03-28T13:00:00.000-04:00I live in Hungary and the standard here used to be...I live in Hungary and the standard here used to be U-40, but with January 1, 2008, they switched to U-100. Perhaps there is an attempt to standardize outside of the USA as well?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16774010.post-12585010462100857522008-03-28T11:27:00.000-04:002008-03-28T11:27:00.000-04:00Insulin is the most dangerous drug in America, esp...Insulin is the most dangerous drug in America, especially in the forms now being proffered. Hormones are highly bioactive and even a small error in miniscule a PPM dose can result in seizure, coma, or even death. What the insulin cartel doesn’t want you to know is that synthetic insulins are NOT just like what Mother Nature makes. If accurate adverse events reports were submitted for meta-analysis, I feel quite certain that synthetic insulins would be used sparingly, and only for those individuals who exhibited allergic reactions to natural insulins.<BR/><BR/>The theory proposed by our caregivers is that “faster is better” in order to cover post-prandial glucose elevation. Another way to say this is, “you can eat all the garbage (carbohydrates, empty calories) you want to; we have produced “insulins” that act quickly enough to offset the quick rise. The down-side to this sentiment is that the rise in insulin levels far outweighs the human body’s safety mechanism, which is telling the liver, “give me a burst of glucagon to solubilizes some stored carbohydrate so I can survive the excess insulin in the bloodstream.” The only reason natural insulins weren’t made by rDNA technology was that the natural hormone molecule was UNPATENTABLE. No one ever compared the beef/pork hormone molecule as a “standard” of insulin function and safety against the new synthetic molecules. <BR/><BR/>An analogous situation, folks, would be if automakers and oil companies decided that all vehicles with fuel efficiency exceeding 10 MPHG must be withdrawn from our roadways. Who would benefit from some a move? <BR/><BR/>Does anyone out there have connections or influence in the right places to have natural insulins made available—non-prescription, as they were in the past—as a human supplement in the manner of many enzymes sold by the nutraceutical industry? BTW, oxygen is sold as a drug because people CAN overdose; but there was another reason for this classification: it’s highly dangerous because of its explosive nature. Of course, you also know there are oxygen bars in some metropolitan areas where a regulated, safe form is available in the same manner we seek natural insulins.<BR/><BR/>--BrentAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-16774010.post-75258671748481142852008-03-27T23:30:00.000-04:002008-03-27T23:30:00.000-04:00It depends on your definition of "drug" ... if one...It depends on your definition of "drug" ... if one uses the definition of drug to mean a chemical substance used in treating disease, then it is technically not even a "drug" but a biopharmaceutical because of the manner in which it is made. But I think this is more a debate over semantics; the fact is that it is essentially a replacement hormone normally found in the human body, and on that basis, there is not really a comparison to drugs like metaformin used in treating type 2 diabetes -- that's a chemical creation that exists nowhere in nature.Scott Shttps://www.blogger.com/profile/03286529314567223617noreply@blogger.comtag:blogger.com,1999:blog-16774010.post-64555627313890825732008-03-27T23:11:00.000-04:002008-03-27T23:11:00.000-04:00Hormones ARE drugs, at least the ones you put in t...Hormones ARE drugs, at least the ones you put in that your body doesn't make. Oxygen is considered a drug by med-pros.Christinehttps://www.blogger.com/profile/13564731989568599206noreply@blogger.comtag:blogger.com,1999:blog-16774010.post-82772333727595280682008-03-27T19:19:00.000-04:002008-03-27T19:19:00.000-04:00Scott, when I was dx'd in '74 I always had to ask ...Scott, when I was dx'd in '74 I always had to ask for "U100" - I'd forgotten about that.<BR/><BR/>I think I'm one of the few people who takes 3 insulins. In addition to my basal and meal coverage, I also take R to cover my dawn phenomenon. I get up at abou 2:30 a.m. to test and the R is timed just perfectly to cover the rise that I sometimes have.<BR/><BR/>My insurance will only pay for 2, so I pay for the R out of pocket - , and in the vial lifespan of a month usually only use about 40 units so I end up throwing a lot away.<BR/><BR/>It does its job, though, and I'm very thankful I discovered the trick.Minnesota Nicehttps://www.blogger.com/profile/02170043587010711783noreply@blogger.comtag:blogger.com,1999:blog-16774010.post-29716553200226620452008-03-27T12:49:00.000-04:002008-03-27T12:49:00.000-04:00Scott, thanks for mentioning the benefits of Regul...Scott, thanks for mentioning the benefits of Regular. Endos today think a patient is crazy to use it when so are "better" alternatives available. I find my control is so much more smooth when adding Regular to my mealtime dosing.Anonymousnoreply@blogger.com