More Readers Respond to Insulin Articles

Eli Lilly responded to Ressmeyer with a letter informing him that “The rising costs of continued production of some formulations, in view of decreasing therapeutic use of them here and abroad, forced us to reevaluate our strategy. The result was that we substantially narrowed our insulin product line by discontinuing some lesser used products, such as animal Ultralente insulin.”

The letter also said part of the reason for the discontinuation of the insulin was to free up more funding for research on various insulin analogs.

Bernard P. Shagan – an M.D., FACP at Monmouth Medical Center in Long Branch, N.J. – sent us a particularly detailed letter.

“It’s great to know I am not alone… ” he said. “I have a small, select practice in which many patients have been successfully placed on a combination of twice a day beef U insulin and pre-meal regular insulin. These patients, many of whom had never previously been adequately controlled, were able to control both their diabetes and their lives through this regimen. Human U insulin is not a substitute. As noted in your article, it is too short-acting and it peaks too much, even in small doses. Indeed, I have used it to replace animal source NPH insulin in some patients who go to bed early and need overnight control and in whom human NPH peaks too soon after injection.

“Again, as noted in your article, I agree that an insulin pump is the only reasonable substitute, but for many patients it is an unacceptable one. It requires far more resources to run a pump program properly, and without the resources it is far more dangerous to the patients. I am very upset by the action taken by the insulin manufactures.

“I also believe that either a long acting substitute for beef U insulin should be found and made available, or that it should be treated as an orphan drug and its production sponsored. Should we form a group to protest and try to get beef U back? I need it for my patients. My patients need it for their lives.”

Insulin user Steve Davis reported from his own use that “human U is similar (in duration) to Beef/Pork NPH, with human U maybe a little longer, but not much.

“I found Humulin NPH worked like regular – I have a pretty high metabolism,” he said. “I’ve actually taken a shot of Humulin NPH, eaten after one hour, and had stable BGs! U does a much better job of lasting through the night. I’m at least one person who finds all the insulins last maybe half the time of duration listed for them.”

Two of the aforementioned doctors sent in their own advice for making the switch from beef U to human U. Striebel asked “Have you tried human U in the same way that you use the beef U? (Taking U at lunch and at bedtime.) My guess is that it should work just as well.”

Shagan sent us the same instructions he mailed to his patients when beef U was pulled form the market last September. His instructions follow:

“When you switch from two doses of beef U per day to Humulin Ultralente (human U) from Lilly, remember that this is not an equivalent insulin. Reduce your dose by two units per injection if you are on more than eight units. This may cause problems, but it is the best we can do for now. If this does not work, you may take your total current dose of beef U, divide it by three and take that dose at breakfast, between 3 and 4 p.m. (with no other insulin), and at bedtime.

“I know this requires one additional dose of insulin, but it may give the best baseline with as little a peak as possible. Please continue taking your regular insulin as you are now doing. Please contact your primary care physician for any problems that may occur.”

Mezitis said some his patients using U have had to move the U dinner shot to a bedtime shot to get a suitable overnight coverage. He also mentioned that patients might try the standard animal lente (which maybe longer acting than the human U in some patients).

Since each person responds to insulin in a different way, it is impossible to make blanket statements about the benefits and hazards of a certain type of insulin. There is also no way of knowing how many people have made the switch from animal to human without a hitch.

However, respondents claim that many lives have been disrupted by the discontinuation of animal U, and many people have become disillusioned by companies’ claims to care about people with diabetes.

Striebel went on to say “I was told by a Lilly representative at the ADA meetings in June that Novo Nordisk was developing a flat insulin, an insulin which would have no peaks. I have not come across that information from anyone else, but I know that Novo is developing the insulin analogs just as Lilly is. Perhaps they are not at the point where they want to make this public information.”

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