Insulin ..... A postcode lottery?

Cost will undoubtedly be the biggest factor I would imagine, but some diabetes teams do seem to favour some insulins over others, and this is replicated up and down the country.

noblehead said:

Cost will undoubtedly be the biggest factor I would imagine, but some diabetes teams do seem to favour some insulins over others, and this is replicated up and down the country.

Click to expand...

I'm not sure it's about cost Nigel... my consultant was happy to put me on Tresiba - my GP had a whinge about the cost but had to comply.

The scientific method that my insulin regimen was decided five years ago was thus:

Having considered that basal/bolus was a good way to go I was presented with some basal pens to choose from. The same with the bolus. Some more pens to choose from. My husband actually chose the pens based on the mechanical design of the pens. I am still on the same insulin regimen. I have recently asked whether I am on the most suitable insulin regimen and received a curt affirmation.

logindetails said:

Yes, I agree, but what for what reason do they favour one over another? Surely they would have documented the research used to come to their decision and if so those documents should be made available to the public.

Click to expand...

Agreed, but I would imagine they'll also rely on patient feedback within the clinics, this (in some ways) would influence their decision making when starting people on insulin for the very first time.

robert72 said:

I'm not sure it's about cost Nigel... my consultant was happy to put me on Tresiba - my GP had a whinge about the cost but had to comply.

Click to expand...

It's good that your gp seen sense and started you on Trisiba Robert, but I do think cost is a consideration in their decision making when prescribing drugs as much as it is with any other illnesses and conditions.

If you look at people with high cholesterol, up until last year Simvastatin was mainly the first drug that gp's prescribed when starting patients on statins as it was the cheapest available, although the drug Artovastatin is a much better drug as it works as effectively in a lower dose than Sim does at a higher dose, plus it's reported to have fewer side-effects, but up until 2013 Artovastatin was still under license and was much expensive to prescribe than Sim, now that there are generic versions of Artovastatin some gp's are using this first when prescribing statins.

Oddly enough I actually asked this question when I was diagnosed 5 years ago.
I was started on Lantus and Novorapid. I was told that Lantus was the preferred basal insulin since it gave the most predictable release profile and the novorapid was simply what they all tended to prescribe unless someone had problems with it. (First made sense and I let the second slide)

A couple of years down the road and it was clear that Lantus did not work for me as my numbers indicated that it was only lasting around 18 hours and not the full 24. I was moved onto Levemir at that point and we started to split the dose. At the same time I also did a DAFNE course and was told by the DAFNE educator that they generally preferred Levemir + (Insert Bolus Insulin) as making changes to the basal rates was much easier with Levemir than it was with Lantus since the latter often took a few days to settle down after a change while Levemir was pretty much straight away.

My overall opinion is that it seems to more or less come down to the preferences of your practitioner at the time of diagnosis and whatever is "in fashion" at the time. My own feeling is I am on a much better regimen now so I think it kind of falls to us in some respects to not only record our logs accurately (even when the numbers suck) but actually read them and see if there are patterns that indicate we may need to have our Dr's re-assess what we are on.

Sometimes I think we end up taking stuff long term purely because no one has actually sat down and had a good look at what we are on.

Least, that's how I see it

noblehead said:

....up until last year Simvastatin was mainly the first drug that gp's prescribed when starting patients on statins as it was the cheapest available, although the drug Artovastatin is a much better drug as it works as effectively in a lower dose than Sim does at a higher dose, plus it's reported to have fewer side-effects, but up until 2013 Artovastatin was still under license and was much expensive to prescribe than Sim, now that there are generic versions of Artovastatin some gp's are using this first when prescribing statins.

Click to expand...

I can attest to this one. I held out on going on statins for as long as I could. Once the patent lapsed last year I finally relented but told them I thought I should go on Atorvastatin, at first Dr resisted until I told them the patent had lapsed the previous month. My own digging into the interaction and side effects also indicated it would have been better than Sim since Sim would have messed with Levothyroxine absorption. Since I was on the max dose at the time I figured that would be a bad thing.

Still comes back to what I was saying in previous post, we are also part of the treatment team so we really should at least try and do some homework or at least ask the Dr's "why are you choosing that drug over some alternate?" Everyone needs a sanity check, even Dr's and us making them think a little more can only help us in the long term

I think a lot of it is personal preference by the diabetes nurse/team and not based on exact science. Whilst there are differences between Lantus and Levemir they are small and looking at posts it seems it's around 50/50 usage for the two Basals. NovoRapid seems to be the most prescribed Bolus. I think my DN wanted me on Levemir and said she was using my gym visits as a 'reason' for prescribing it rather than Lantus (perhaps it costs more). She said Levemir had a flat daily profile, which it doesn't, and showed me NovoDisk's chart to prove it. If you Google the web you can find a 3D chart which isn't flat. At least most insulins work very well for most people.

The type of insulin a person is prescribed may be changed from that originally prescribed - the question here is - on what basis are the original insulins prescribed?[comic]

Click to expand...

Just to educate you before you are ruined by a lawsuit for slander - neither Lantus nor Levemir are "original insulins" (that term would only really apply to NPH and human insulin). Implying that the NHS is giving you old, ineffective drugs when prescribing Levemir (or Lantus?) is slanderous nonsense.

I think he meant, well at least I read it to mean, what was the original/first insulin you were given at diagnosis, so I was put on Humulin M3, - that was my originial insulin, then I moved to Humulin I. When I went to basl/bolus I started on lantus/humalog, then I went to levemir/humalog then levemir/humalog/humulin S.

type1 lantus & novarapid

Im on apridra and bolus, what's your question?