Question for porcine isophane users

[FionaR]

Hi all,
I was just wondering if those on porcince isophane could post how much they take and what times of day you take it?
The reason I ask is because I changed onto porcine isophane and neutral in June, but cannot for the life of me get a decent BG reading. I am either way to high (especially in the morning) or to low.
My only normal readings are between 11am (after a correction dose at breakfast (8am)) and 3pm, after which I start going low (on average 3+ hypo's a day after 3pm)
I take my isophane at 8am and 10:30pm, which is the times I took levimir when I was on that.
If I take my isophane before 10:30pm I am sky high all night, if I up my dose and keep it at 10:30pm I am hypo through the night
The reason for my change to porcine:
My first insulin was pork mixtard when I was diagnosed (23yrs ago) which changed to hypurin 30/70 when novo stopped making pork. Changed to levimir and novorapid in August last year and subsequently suffered extreme tiredness, feeling sick constantly, loss of appetite (ate 2 slices of toast at bedtime and "occasionally" my dinner for 10 months) to the point my daughter and my mum were convinced I was anorexic and various other silly things I would never have put down to being the insulin until they all disapeered after changing back to pork.

I do have an appointment to see my DSN next week, but am not expecting much as she seems to have become anti-pork (she has been my DSN for 15 years, but now thinks porcine is useless and offered no advice whatsoever when I changed back to pork, hence I "assumed" everything would be pretty much the same as it was on levimir without the side effects)

Anyway, just curious as to what everyone elses routine for the isophane is

Many Thanks
Fiona x

p.s I probably should mention my BG's when on levimir and novorapid were pretty much steady and as near perfect as I could ever have hoped for despite not eating and feeling like poop everyday, now I feel a whole lot better but have **** control! Sods law lol

 

[janabelle]

Hi Fiona
firstly don't let your DSN's attutude deter you from persevering with Porcine insulin. Chances are her nursing post is funded by a one of the analogue insulin producing pharmas :evil:
It's great that you're feeling better, so many people suffer probs on analogues, and they keep coming out of the woodwork-well done for recognising it , many people don't unfortunately.
I started taking Hypurin Porcine Isophane & Neutral just over 2 yrs ago, following 4 years of ill health on Lantus. I'd previously been on synthetic hman insulins, Insulatard & actrapid for years.
I've been lucky and my control has been good since changing to porcine. I split my dose of Isophane, an unequal split- 22 units at 8 am and 12 units at 10pm. I take approx 3-4 units of Neutral before meals. What doses are you on?
Jus

 

[jopar]

Chances are Janabelle that the DSN is funded by the NHS, and it's more likely she doesn't understand the difference in control with animal insulin...

Fiona

Have you allowed for the difference in peaking times with your insulins? You might have to change the timing of your background insulin to suit your liver action better..

I would google or e-mail the manufactuers see if you can get hold of the insulin profile, so that you can compare peak time and fall off with what you BG data it might give you some indication to where you may need to make changes..

 

[badmedisin]

Hi,
I switched from lantus to porcine isophane in May cos I was constantly tired and had headaches and felt horrible all the time. I had been taking 30iu lantus and got pretty good control following dafne principles. After switching to isophane I had really awful blood sugars. My dose had gone up to 20iu in the morning and 34 at night. I wasn't having night hypos but I woke up every morning with blood sugars around 19. I started off doing my injections at 9am & 9pm. Couldn't manage doing them earlier as I usually get up at 9 (my entire timetable is a couple of hours behind normal people's!). That wasn't working so I moved them to 1.30am & 1.30pm to time the peak to coincide with my rise in blood sugar. That didn't help either. My blood sugars were all over the place and I still felt tired all the time and had lots of headaches. Last night I switched back to lantus in desperation. My sugar levels have been 7ish al day.

Don't really know if there's anything else to try. Maybe isophane just doesn't work for everyone?

 

[FionaR]

Hi Jus,
thanks for replying.
I definately didn't let my DSN put me off changing. The one I had most problems with was the "new Diabetes specialist Dr" We had agreed when I switched to levimir and novorapid that it was only a trial basis and if I wasn't happy he will let me switch back to pork.
I have to say He did not stick to his word and kept fobbing me off until the last visit where I got so frustrated with him I became quite angry and cheeky towards him. Made a point of mentioning the fact it is my body, my medication choices are, at the end of the day, MINE and no-one elses. So after he blatently and noisly dissed me to his collegue saying there was not much he could do about the matter, I was passed to the DSN, given my new prescription and told nothing about the differences between isophane/neutral and levimir/novorapid. Good job there is the internet! lol Fist time in a long time I have stood up and disagreed instead of the usual head nodding, say nothing agree and leave lol (I am proud of myself )
My regular GP on the other hand, is absolutely brilliant with my diabetes care, I wish it was him rather than the hospital all the time

Thank you also for posting what/when you take.
Isophane, I take 6 units at 8am and last night increased my pm dose to 8 (was on 6, but having problems with morning high BG's)
I take my pm one at 10:30pm, so I am glad to see you take yours about the same time as elsewhere I was made to feel I was doing everything wrong because I was not taking them exactly 12 hours apart! Even after explaining if I take the pm one earlier I go hypo through the night and still excrutiatingly high in the morning :roll:

All my insulin doses are "under review" because none of them are correct ATM, although I did have better results through the night and this morning on 8u (BG's were pretty much steady all night and only 2u higher this morning from when I went to bed)

My neutral varies through the day. For breakfast I am taking 3.5u for 10g of carbs, lunch and dinner 1.5u for 10g carbs. That will probably all change again once I get my basal correct though

Many Thanks
Fiona x

 

[FionaR]

Hi Jopar,
Thanks for the reply.
Yes I have the profiles of the insulins.
I think once I manage to get my doses correct I should be alright.
I did try changing the times which I took the isophane, but it didn't work.
Of course, I am going to take everything with me to my DSN next week so she can have a look, and maybe see something I can't (i've looked so much it is all just a blur now :lol: )
I have also recently discovered dawn phenomenon and liver dumps. 23 years of diabetes and I'd never heard of such things! Amazing what you still learn after so many years. Anyway, no idea if either of those plays a part. It's all trial and error atm

Thanks
Fiona x

 

[FionaR]

Hi Badmedisin,
Thanks for replying.
I am sorry to hear you are having problems too. sucks doesn't it
You may be like me and 12 hour splits just don't work?
Maybe you could try a 14 hour split and see if that works? 9am and 12am?
I know when I done the 12 hour split I was waking with bg's in the high teens and low 20's, some nights I was also going low at 1am. Regardless what I done I was high in the morning. (even after a perfect BG at bed time and "almost" perfect at 3am ... 5o'clock came and I rocketed up)

You are right of course, not every insulin suits every person.
However I would not have gone back to lantus making you feel like **** (the same reason I came off levimir) I would rather a high BG and feel alive than have perfect BG's with very bad side effects (in my case, I felt sick, lost my appetite, could hardly stay awake I was so tired all the time, lost a stone in weight, and I was already underweight, plus a few other "minor" things)

I hope you find the insulin regime that works for you very soon

Take Care
Fiona x

 

[iHs]

Hi

Was just wondering why none of you have switched to bovine insulin? It doesn't have such a high peak to it like porcine.

 

[FionaR]

mmmmm :? I've never thought of bovine tbh and it's never been mentioned at my clinic (surprise surprise :lol: )
I went back to pork because that is what I had always used and know it works for me.

Fiona x

 

[iHs]

Hi

CarbsRok uses bovine insulin I think and has been for many years. I used porcine insulin years ago but found that I went hypo too quick so switched to using a mix porcine/bovine and was quite a fair bit better.

Look on the Workhardt website for the bovine stuff. I'm sure that they must do a bovine isophane that could be used.

 

[kewgirl]

Hi Fiona

Welcome to the forum and sorry to hear you have had a “cack” time using analogue insulin and are trying to get control of your blood glucose (BG’s) using the piggy insulin.

Hi badmedisan

Sorry to hear you are struggling with animal insulin but don’t throw the baby out with the bath water just yet and return to using Lantus until you have tried the other options.
:idea: Have you tried Levemir :?: Some folk get on with it and others like Fiona do not but it is worth having a trial of it.
Levemir does have however 30% less action than other insulin’s (and some research for example Hermansen 2001) has shown that some users require 3.5 times more of Levemir than NPH (Isophane) or Lantus but that’s not reflective of everyone.
:idea: Have you tried Hypurin Bovine Isophane :?:
:idea: Have you tried Hypurin Bovine Lente :?:

Not sure if any of the following will/can help.

1. :idea: Be realistic in that the time it takes to get control of your BGs may be a lot longer than you anticipate. If you think you can get this cracked in say 1 month then you might be disappointed.
Changing insulin’s is not as straightforward as many Health Care Professionals (HCP’s) and the literature would make us believe. Your body has go to get used to a new insulin and the time that takes will vary considerably in everyone.
Also it is impossible to get the entire day of insulin use completely cracked in say a week. It will just not happen.

2. :idea: If you change both bolus and basal together it is sometimes more difficult to get control – hence might want/need to stay on a shorting acting analogue until you have sorted the basal regime.

3. :idea: Regarding dosages of insulin – you really cannot compare them at all – so don’t get fixated on what dose you were on of a previous insulin or what doses anyone else is on – you are now trying a different insulin - & you are you not anyone else.

4. :idea: Hypurin Bovine Isophane is more gentle and has a slightly longer lasting action profile than the Porcine. Having used both Porcine & Bovine Isophane I can definitely feel the difference in the action profile of these insulin’s.

5. :idea: Hypurin Bovine Lente is the nearest animal insulin to have an action profile similar to Levemir – injected twice a day as a basal its onset is approx 2 – 4 hours, it has a peak action between 6 –16 hours and it can be beneficial to help deal with the dawn phenomenon (Walsh 2009) It has zinc added to enable it to last longer.
The only slight problem with Lente is that it only comes in a vial so you do have to use insulin syringes.

6. The Dawn Phenomenon is a right proverbial pain in the rear end :roll: :roll: :roll: for Type 1 diabetics – 75-80% & of diabetics suffer from it.(Bolli et al 1993).

7. :idea: Taking a lower dose of Hypurin Porcine Isophane say around 9-9.30am and then take a small amount of Lente at bedtime 10-10.30pm – this is my regime and now I have cracked it I have good BG levels in the morning. (I have been back on animal insulin a year now).

8. One of the real problems for many users on Isophane whether its animal or human synthetic variety is the absorption rate can be a little more variable hence why many users find BG’s somewhat erratic which is why Levemir and to a lesser degree Lantus was hailed as so much better.
:idea: You might need to experiment with where you inject – as in bodily not as in the environment :lol: :lol: – I have found the Isophane & Lente work much better for me injected into my arms.

The NICE Guidelines suggest injecting Isophane in the thighs can give longer duration of insulin with slower onset. Walsh (2009) advises injecting in abdomen increases the speed of insulin but again we are all so different – so you might need/want to experiment with injection sites. Just don't chop & change injection sites too quickly :shock: :shock: as it is difficult to evaluate then which is he most effective part of the body to use.

9. :idea: You really have to make sure the Isophane vial/cartridge is mixed – one of the many reasons that the long acting synthetic analogues like Lantus & Levemir were hailed as great because they required less “preparation” as such i.e. no gentle rolling to mix the insulin.
The potency of Isophane can vary greatly from injection to injection if it is not mixed well. One study by Jehle et al (1999) showed that only out of 12 users only rolled the pen cartridge effectively as in the recommended 20 times. :shock:

10. :idea: If you are using pen injectors the Humapen Luxura HD (which accommodates the Hypurin Porcine & Bovine Cartridges) is good as it gives ½ units – I’m aware that there is some school of thought that it does not matter with adult insulin dosages as to whether you give a 1 or 2 unit injection but actually the addition or subtraction of ½ a unit of insulin can make a significant difference.

11. :idea: Animal insulin can be used in an insulin pump.

12. It may be a case of trying a variety of insulin’s be it animal, and/or human synthetic and/or analogue insulin until you get the right combination for you – its not an exact science – sorry.

The most important thing is that you should not be feeling unwell on insulin – insulin must provide you with a quality of life as well as optimising blood glucose levels.

Jopar – many nurse specialists post within the NHS are actually funded by pharmaceutical companies – the nurse will be employed by the respective NHS Trust be it a hospital (acute) setting or a PCT (community setting) but the funding is provided by the pharmaceutical company or a company supplied the peripherals ie. blood glucose monitors for example.
Realistically it’s the only way many NHS Trusts can employ nurse specialists and its not just in diabetes care but asthma, respiratory, stoma, incontinence etc etc etc. It’s not an uncommon practice.

Hope you both get things sorted.

best wishes

Txx

 

[Cazz]

Hi Fiona. I can understand the frustration because when I switched to porcine I just couldn't solve the overnight bs rise. I too used to inject at 8am and then 10.30pm. When I switched to isophane, no matter how much I injected, my bs would rise overnight. I finally worked out that the 8am dose was running out at around 10.30pm. I currently inject 4 units of isophane at 8am and 11 units at 8.45pm. Have you tried fasting to see what's happening? On day one, skip breakfast and just inject isophane and then test every hour until lunchtime. On day two, skip lunch and test test test. On another day, have a late tea and test test test. It's a pain in the neck fasting and testing but it does give you a good idea of what effect isophane has on your system. I also tested overnight at different hours and it was then that I found my blood sugar was rising within an hour of me going to bed. Good luck with getting it sorted x

 

[Gjimmy]

Hi Jopar,
Thanks for the reply.
Yes I have the profiles of the insulins.
I think once I manage to get my doses correct I should be alright.
I did try changing the times which I took the isophane, but it didn't work.
Of course, I am going to take everything with me to my DSN next week so she can have a look, and maybe see something I can't (i've looked so much it is all just a blur now :lol: )
I have also recently discovered dawn phenomenon and liver dumps. 23 years of diabetes and I'd never heard of such things! Amazing what you still learn after so many years. Anyway, no idea if either of those plays a part. It's all trial and error atm

Thanks
Fiona x

I have been diabetic for 22 years and I'd never heard of dawn phenomenon and liver dumps either.
Doctors don't tell you anything ! It's like they run a secret society or something.

 

[Gjimmy]

Absorption rate is definitely the key to managing diabetes with the porcine isophane insulin.
I too am having problems controlling my BG with isophane compared to the excellent control on both Lantus and Levemir.
Because of variable absorption rates on different injection sites , I am thinking of averaging out an injection by using multiple sites with the same jab.
By using multiple sites the absorption rate may be "smoothed out" compared with just using a single site injection.
This may work I haven't tried it yet, because of poor control using the isophane I got fed up and am back on the levemir, which makes diabetic control easy (forgetting the side effects, of course).
I think people shouldn't lose sight of the ball controlling their diabetes.
aldose reductase the real baddy in diabetes, causes more problems than the side effects of the analogue insulins. Keeping BG levels balanced is the MOST important consideration.
Don't forget the awful diabetic complications of kidney disease , neuropathy and retinopathy.
Diabetes is the Number one cause of blindness in the UK. Don't' forget to keep your diabetes under control . Don't let it control you.
If I can't get used to using Isophane with MDI, then I might consider using a pump with the porcine neutral. At least I can fall back on the Levemir in the short term.

 

[nigelho]

Hi,
I've been on porcine neutral and isophane for about 3 weeks having switched fron novorapid and lantus which made my life hell....tiredness/fatigue, drugged up feelings etc..My control during the day has been good, having had a short spell on humulin S and I when my control went out the window. However my night control is up and down. Due to my tiredness and work etc with lantus I was going to bed by 7.00pm. I usually have my tea between 4.30-5.00pm as my sugars DROP rapidly after my shift at work..It's physical so I need my tea early. I've been checking my isophane control by testing up to twice nightly and have found that between 1.00 to 5.00am my readings are around 5.00 which I'm happy with, but sometimes it starts to rise after 5.00am and can reach up to 15.0 by 6.15am.

It seems that my isophane is running out between 8-9hours. It hasn't mattered if I inject my isophane at 5.00pm or 7.00pm it seems to only last around 8-9hours. the last few nights I injected around 9.00pm and had readings around 5.5 around 6.15am..GREAT. I'm thinking of injecting isphoane 3 times a day around 9.00pm, 6.00am and around 1.00pm, as sometimes my 'tea time' readings when NOT AT WORK has been high. I've noticed that the couple of times I've injected ispohane 3 times I need to reduce the neutral. By accident I didn't have enough neutral at work so I gave myself some isophane when I had my lunch and had GOOD figures for the rest of the day and night.

All good except this morning, it was ****..could have been my fault as when I took lantus if I went to bed with readings of 6-8ish I needed to eat something for fear of night hypo. It might be that FOR ME..we're all different..I don't need to snack for reading around 6-8ish. IT's such a learning curve....it's much better feeling better after lantus. I can put up with the odd high readings as I see how isophane works for me. I know it's said that porcine isophane works for 12 hours ish but test yourself at night and see how the readings go for you.