changing to animal insulin

[avi]

Hi
Went to see my consultant this morning with a view to get her to change my insulin. Was expecting some resistance from her at least. However, she couldn't have been any better and wrote me a prescription for porcine insuling, long acting one. I am to try it alongside novo rapid and see how I get on. My question is this, she asked me why I wanted to change to animal rather than try the human insulin and I said I felt it was more natural. She said that it was also manufactured nowadays and not derived from the animals themselves? She also wants to put me on Metaformin as she says this should reduce my insulin requirement, not that I take that big a dosage anyway, and that it should help me to shed some weight. I,m type 1.5. I get the new insulin tomorrow and hopefully they are going to send me out a pen for it as well. I'm to try this for a month and see how I get on. She also said that the dosage should be the same amount as I take of Lantus only difference being I will have to split the dose as it only works for 18 hours.

Avi

 

[fergus]

Good luck with the smokey bacon flavour insulin Avi!
Please let us know how you get on with it. It's an issue for lots of us T1's, whether to opt for natural or synthetic insulins and the more feedback we get from people who have tried both, the better informed we'll all be.

All the best,

fergus

 

[kewgirl]

Hi Avi

Congratulations on getting Porcine Insulin prescribed and welcome to the approximate 30,000 other animal insulin users in the UK.

Not entirely sure why your consultant informed you animal insulin is not actually from animals because it is. :shock:
Animal insulin’s are extracted from the pancreases of slaughtered pigs and cattle. Porcine Insulin is natural animal insulin not synthetic. However in fairness to the consultant she may have been getting confused with the early human (not extracted from dead people!) synthetic insulin, which was actually made from pork. Or alternatively she is just.......... :!:

A couple of useful points but please remember everyone is individual and I can only share with you my own personal experiences.

Metformin can help with increasing insulin sensitivity in diabetics using insulin & it can also help with weight management but you might find coming off the Lantus helps with your weight.

Lantus is notorious for causing water retention so do not be alarmed if you pee gallons :shock: when first changing to the Porcine as it can happen. Keep testing blood glucose levels.

I also remained on Novorapid for a short while then went the whole hog :lol: – excuse the pun - and changed to Neutral as well but there is absolutely no reason why diabetics cannot mix and match the types of insulin they use.

As Lantus has a very flat profile you will need to keep a close eye on your blood glucose levels and take into account & get used to when the Porcine Isophane peaks.
Isophane starts working approximately 2 hours after injecting.
Peaking effect between 4 and 6 hours.
Duration up to approximately 14 hours.

Use the peaking effect to your advantage. By checking blood glucose levels regularly you will get a feel for how long the Isophane lasts in you.

When you split your dose you may not necessarily have the same dosage for each Isophane Injection - for example I take less in the morning dose than my evening dose.

Make sure the pens they send you/prescribe you are the Autopen Classic Pens (available in 1 unit pen: 1 - 21 units and 2 unit pen: 2 - 42 units) as the cartridges will not fit the Autopen 24. Alternatively phials and syringe are also availiable.

The prescription must read Hypurin Porcine Isophane & check the box before you leave the pharmacy – this might sound like overkill but one slight problem with the porcine insulin is the boxes of both Neutral (Short Acting) and the Isophane (Long Acting) are identical save the names Neutral & Isophane & unfortunately my local pharmacy have inadvertently given me the wrong boxes in the past.

Where to inject the Isophane (as in bodily not as in where you are physically :roll: :!: ).
The NICE Guidelines recommend thighs when using Isophane as it reportedly has a longer duration when injecting there.
John Walsh’s book "Using Insulin" advises that injecting in the thigh may be useful if you experience nocturnal hypos as injecting Isophane in thighs slows the action time. If however you need it to act a bit quicker then injecting in the abdomen increases the speed of absorption and action time but as we are all different it is a case of trail & error.
I have experimented on both and I have to say that personally abdomen works better for me.

Keep testing blood glucose levels.

Don’t worry if you suddenly get cravings for apple sauce and sage & onion stuffing its quite a normal reaction to using Porcine Insulin :lol: :lol: :lol: :lol: :lol: and you will become the brunt of many jokes from family and well meaning friends :lol: :lol: :lol: !

All the best

Txx

 

[avi]

Hi Kewgirl,

Thanks, that clears up a few points, I was wondering what dosage are you on and at what times do you take it, did you have to reduce your dosage compared to when you where on analogues?

Avril

 

[kewgirl]

Hi Avi

My regime is at follows:

Neutral Insulin - pre breakfast time – dose varies with carb counting, oral medication aka Thyroxin, pre menstrual & any other factors

Isophane @ 10am (I inject where ever I am out & about or at work - however I am a little(!) flexible in that sometimes I may be inconvenient work & it might not be possible to inject exactly at 10am so I allow myself an hours window for this injection).

Generally I have a low carb lunch – if I have been swimming for example and really active I can consume 30grams of Carbs without it having any adverse effect on my blood glucose levels & I wouldn’t have any bolus insulin to cover that.

Neutral Insulin pre supper dose varies

If I have been really active like yesterday I had a low carb supper and actually didn’t take any bolus Neutral but I am very fastidious about checking BG levels!

Isophane @ 10pm

I usually set alarm clock for once or twice a night just to monitor what BG’s are doing.

A resounding yes to a reduction in my overall insulin dosage since returning to porcine insulin – I was on a shockingly huge amount of Lantus (dam thing never worked & those awful debilitating side effects which I am still reminded about all too frequently) & Novorapid, even though my HBA1C’s were always very good.

I have reduced my insulin dosage by 2/3rds!! But everyone is different & it does depend on how insulin sensitive you are. If you are concerned its always better to reduce dose to begin with and then increase as necessary - Isophane can be fairly responsive to changes but again we are all different.

In total I would say it took me about a 1-2 months of tinkering with the times and the doses and where bodily I injected before I was completely happy with things (I am rather a perfectionist!!)

The IDDT (Insulin Dependent Diabetes Trust) are also very helpful & supportive when diabetics are changing over to animal insulin's. Their website has full contact details & telephone numbers.
http://www.iddtinternational.org/

I should also mention in case you have not been made aware - Porcine Isophane is a cloudy insulin which needs to be adequately shaken prior to each use - Isophane is visibly different from the long acting Lantus which is clear.

Best wishes

Txx

Footnote: The reason why I have a lower carb diet than that recommended by dieticians, DUK et al is because in 1970 when I was diagnosed we only had Porcine Insulin & Low Carb Diet to manage diabetes and Clinitest Tablets to monitor our diabetes. Oh how times have changed!
I remember as a child being so excited when the docs informed my mum I could increase my lunch time carb allowance from 10 grams to 15 grams of carbs cos it meant you were well controlled!!
I am so used to eating small quantities of carbohydrates that it is normal for me and I have never known anything different.

 

[noblehead]

Avi

I am in the process of changing back to animal insulin too. At the moment I am on lantus, which I believe is detrimental to my health, hence why I am making the change.

The more I learn about lantus, the more convenced I am that it is the cause of many health issues. I did not know that it could also cause water retention, which Kewgirl states in her post. I like Kewgirl, may change from lantus to Porcine Isophane, but stay on Novorapid for the time being. Novorapid, being a fast acting insulin, suits my mealtime routine, injecting just before eating, as oppose to Porcine Neutral which has to be given 30 minutes before food and has a much slower profile. My concern is that I may start to get post-meal highs, as the Neutral takes much longer to kick in. At the moment my pre/post meal bg's are the best I have ever had, so I am reluctant to upset this control for now.

Therefore, I need to ask some questions, and would be thankful should anybody be obliging!

Can you mix both synthetic and animal insulin together without complications?

Or alternatively, would I be better changing over completely, and adjust my meals to suit?

Many thanks

Nigel

 

[avi]

Hi

I'm like you the more I read about Lantus the more concerned I get, my health wasn't too great to start with but really deterioated when I started Lantus. I had about nine months of good control on it then things changed rapidly with very varying bg results. My Hba1c has been alright, 6.8 at the moment but that is because of the amount of hypos I get. I am going to try one change at a time, and if I get on alright, I might consider changing from the Novo rapid as well. My biggest concern at the moment is getting the right dosage.
Avril

 

[iHs]

Footnote: The reason why I have a lower carb diet than that recommended by dieticians, DUK et al is because in 1970 when I was diagnosed we only had Porcine Insulin & Low Carb Diet to manage diabetes and Clinitest Tablets to monitor our diabetes. Oh how times have changed!
I remember as a child being so excited when the docs informed my mum I could increase my lunch time carb allowance from 10 grams to 15 grams of carbs cos it meant you were well controlled!!
I am so used to eating small quantities of carbohydrates that it is normal for me and I have never known anything different.

Kewgirl

Beef insulin was also about in the 60's and 70's. I found it much nicer to use than pork insulin. Could not get on at all with pork based Monotard MC so switched from beef Lente to Lentard MC. Pork insulin made me go hypo too quickly :cry:

Sadly animal insulins have their problems. Beef Lente insulin caused me to develop a dent like appearance in the top of my leg. The problem was due to the depot effect of injecting 32 units to last me over a 24hr period. Over a period of just 5 years, a small dent started to appear so I wasn't too happy. Because of this, the consultant decided to put me on Monotard pork and told me to inject into the dent with the hope that the pork insulin would make the dent swell up. All it did though was to cause me to have a painful lump where the dent once was and gave me fairly bad hypos with little warning so was glad to come off the stuff. Lentard MC though was all ok and I stayed on that until the late 70's.

 

[kewgirl]

Hi iHs

As I have previously stated I can only reflect on my own personal experiences of using a particular insulin.
Living on an offshore island in 1970 I only had pork insulin available so in some respects you were lucky (or not!! :lol: ) to have the option of both pork and beef insulin.

I don’t deny that the early animal insulin's were not as purified as they are today which is why there were problems with lipodystrophy – craters in limbs where you injected insulin – yep been there, done that, got the t-shirt. I too remember the docs suggesting I injected into the hollow crater in one of my thighs – eugh – but that was then and this is now.

All types of insulin cause some problems for some diabetics but that doesn’t exclude the fact we need a choice of insulin’s to try and that a one size fits all approach is not necessarily in the best interest of people living with diabetes.

What I have stressed time and time again on this forum is that we are all individual and we are all so different.
There is a choice available in the UK of animal insulin, human synthetic insulin and GM synthetic analogues – as diabetics we need that choice and the availability of all of them to try and find which type of insulin suits/works best for us.


Hi Noblehead

Sorry to hear you are also experiencing possible side effects/ill health from Lantus.

If you change from a rapid acting analogue Novorapid to the animal short acting Neutral you will possibly notice a big difference in its action but it will also depend on how sensitive you are to a particular insulin. If you are happy with the Novorapid then choose to stick with it until you have tried/evaluated the Porcine Isophane and then take it from there.

In theory you should be able to mix and match the types of insulin you use be it animal insulin, human synthetic insulin or GM analogue. However whether complications are going to occur by mixing and matching different types of insulin I cannot answer – again we are all very different in terms of how our bodies react. In addition I am unsure if any research has been carried out on diabetics who use more than one different type of insulin. from my own experince I have mixed & matched in the past with insulin's and I believe I will possibly do so in the future.

From the lived experiences and anecdotal accounts from diabetics who have experienced side effects debilitating or otherwise from Lantus, once coming off this analogue you are generally able to evaluate in a relatively short period of time if it was the Lantus causing the problems.

Water retention from Lantus does affect some individuals using this analogue and is not entirely well understood why this happens.
Whilst water retention may be visible externally i.e. puffy ankles is a classic symptom and weight gain it is not clearly appreciated what internal damage may be being caused to internal organs such as kidneys and heart for example.

Just as why a significant number of diabetics suffer debilitating side effects from Lantus and others do not remains somewhat of a mystery at present.

I believe we are still learning new things about insulin all the time - its not yet an exact science!

Txx