(Our) survey results indicate that for some people, changing insulins has a negative impact on their health, well-being and quality of life. People need more information as to the reasons for changing their insulin and they need to have the choice. They need the support of their physicians and their diabetes health care teams during this time of change-over. The (Canadian) National Advocacy Committee is committed to advocating for the continuation of beef/pork insulins for those whose health, well-being or quality of life will be affected by the change.
Diabetes Dialogue, Fall 1997, Canadian Diabetes Association
The following is the summary of a position statement that originally appeared in the June 1995 edition of Canadian Diabetes, a publication of the Canadian Diabetes Association’s Clinical & Scientific Section.
After reviewing the evidence, the ad hoc committee came up with a list of recommendations and a protocol for switching insulins, which the Association du Diab_te du Qu_bec and the Canadian Diabetes Asso-ciation’s Clinical & Scientific Section endorsed.
The key recommendations include:
- Patients who can control their diabetes well with beef/pork insulin should continue on it.
- Sometimes, switching to human insulin means increased injections. If patients are under control with beef/pork insulin and don’t want more injections, that’s another reason for staying with animal insulin.
- Patients who believe they can feel low blood sugar better on animal insulin can try returning to it.
- The small percentage of patients on animal insulin who have the problems mentioned earlier (allergies, losing fatty tissue at injection sites, resistance to insulin’s effects) should switch to human insulin.
- In cases where insulin is needed only intermittently, human insulin is better.
Who can decide on changing the type of insulin? That should be left to the endocrinologist or the treating physician. Except in emergencies, pharmacists are not authorized to exchange human insulins for beef/pork insulins. Unless their reasons are justified, medical professionals also shouldn’t pressure patients to switch from animal to human insulins.
With that in mind, the ad hoc committee suggested that when switching insulins:
- All transfers should be medically supervised.
- Patients must receive detailed information about how the change will occur.
- To effectively adjust the doses of insulin, patients must temporarily do more self blood sugar testing more often. If not, closer medical follow-up is required.
- Patients who were previously on animal insulin should lower the initial dose of human insulin by 10 to 20 percent.
- Patients can use the same dosage schedule if switching from Novo Nordisk’s animal insulin to Eli Lilly’s animal brand of insulin.
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Adapted from the Report of the Ad Hoc Committee on Beef-Pork Insulins by Nahla Aris-Jilwan, MD; Pierre Malheux, MD; Tina Kader, MD; Alain Boisvert, B.Pharm, DPH, MSc; and Sara Meltzer, MD. Adapted by Stuart Foxman.
From the CDA web page: diabetes.ca, added June 6, 1996.