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Monday, February 4, 2013

Frustrations...

These days I seem to be becoming more and more frustrated with myself. The Humulin R and N regimen I am on has been kicking my ass and leaving my BG high and leaving me pissed of. I am unable refuse to CONSISTENTLY pre-bolus by 30-40 minutes, and the NPH peak leaves me in a constant fear of nocturnal lows, resulting in keeping BG values higher than they should be, followed by a 50-80 point climb into the 200s by 5:30 AM, every day, like clock-work.

Why am I on R and N? I started on R and N in 2008 after diagnosis, and a couple of years ago was switched to Lantus and Humalog (for a period of 6 months). There was no significant change in my A1C going from R & N to Lantus & Humalog (7.8, 7.6), but I did see better AM numbers (I blame the lack of better control with analogs on not having a CGM at the time). After looking more into it, I found it highly concerning that Lantus has an extremely high affinity (like 18-fold higher than regular insulin) for the IGF-1 (insulin-like growth factor) receptor (mitogenic potential), and that at least two independent studies have shown an association between Lantus usage and cancer. So I went back to the old and trusty R and N (something about how old they are combined with the fact that they are structurally identical with human insulin, unlike analogs, makes me feel good as a cell [cancer] biologist). However, my experience with Humalog for those 6 month got me used to the convenience of a  later bolus, and I found it harder and harder to wait the amount of time required for the R to work properly. The N pisses me off even more. The morning injection kicks in and I am dropping like crazy by 1 PM. The nightly injection (regardless of whether I shoot up at 7 or 10 PM) always drops me at 2 AM and never covers my early morning dawn effect... So I find myself constantly shooting up, having snacks, and constantly frustrated.

Having gotten that off my chest, I have an appointment Endo in 2 weeks and I am requesting  (read: demanding) a change to Levimir and Humalog (or Novolog). Having looked into Levimir, I feel much better about it than Lantus and (psychologically) I can't stand the NPH anymore. The fast-acting analogs like Humalog are only structurally disrupted to prevent hexamerization (thus resulting in faster release than R), and these changes do not affect it's affinity for other (non-insulin) receptors, making me feel pretty good about them... At the end of the day, there might me some risk to analogs, which (if any) will become apparent as more time goes by, but the evidence of the complications of long-term high BG are clearly evident today. And I conclude that it would be stupid not to change up my regimen when I know it will likely: 1. Give me better BG control, thus preventing complication and 2) (dare I say more importantly) give me some freedom...

Question: any T1s out ther on Levimir? Do you use 1x or 2x daily??

Thanks #doc for listening <3

2 comments:

  1. I know that NPH is your big complaint, but there's no reason you can't switch from Humulin R to Humalog while keeping on the N - for at least awhile. That's what I dd, and stuck with for several years, before giving up N and going to a "flat" basal (in my case, Lantus).

    I'm pretty sure that Kelly at the Trials & Tribulations Blog (kellywpa.com) uses Levemir - you may want get in touch with her with some of your questions.

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