Well…this is always in the back of my mind whether it’s said or not. Why? Because treatment in this county depends on your ability to have insurance. IF you don’t have the right job / insurance, you will have all of these things, and die. So I still fear for my son.
There are a lot of dirt poor unemployed people with diabetes out there and they manage to make it work… there’s always a way to get insulin. It may become increasingly more hassle without a good income and good insurance, but it’s no less possible…
There are R and NpH, there are free and sliding scale clinics, there’s Obamacare subsidies, there’s Medicaid, we are fortunate to live in a first world country…
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I think nobody here would consider R and NPH unless it is the only thing they can do to survive, though. It is a survival option.
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Many people who aren’t on this forum chose them every day… just because they aren’t popular on web forums doesn’t mean they aren’t options that work. My cousin is a highly compensated stock broker (and well insured), has been on R and NPH since he was 3 years old. Switched to Lantus and novolog, hated them and went back
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Because that is their only choice.
That is patently false in many, many cases. It’s not like we’re talking about home made pork insulin. R and NPH are still widely used and even prescribed in the USA and other first world countries…
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I’ve been on R and NPH before. As far as I’m concerned, that’s not living, that’s surviving.
The average A1c in most first world countries isn’t very good either. Just because that insulin is available and I could survive on it, doesn’t make it a good way of treating diabetes. I’m glad it works for your cousin, but he’d have to completely structure his eating and exercise around his insulin in order to maintain good control. For me, that’d be a serious decrease in my quality of life.
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Have you personally tried R and NPH? As well as the type of restricted diet plan that goes with them? If you do it for a couple of months and can get to your current level of control and are fine with it, I will take your point seriously. It could be a great thread…
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Just the other day on a Facebook group someone mentioned using openAPS and closed-looping with the Walmart brand of insulin, due to cost issues. He said his A1C was creeping up and he did not like it as much, but that intrigued me because I personally expected it to perform much worse than simply causing A1C to “creep up,” and would have imagined pumping with it to be virtually impossible.
I’d really love to see a thread from people who do use it and don’t hate it describing their best use-cases, because this is an intriguing question.
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I would imagine pumping with R to be considerably different than using R and NPH—I doubt it would be great, but the NPH as basal is the worst part of that combo IMO. If I had to do either R and Tresiba (my current basal) or Humalog (my current bolus) and NPH, and I’d chose R and Tresiba and just eat super low carb and prebolus more. And I’m saying this as someone who did R and NPH for many years.
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Also, in case it wasn’t clear, I thought using R and NPH was pretty awful, and I remember the huge relief and freedom that came with both moves to Humalog and Lantus.
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My mother says NPH stands for “Non-Productive Help.” 
I think she said she heard this from my sister’s medical team.
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R and NPH wouldn’t be my first choice either… they would not be ideal… I would certainly opt to use them long before opting to die though,
I suspect my control would be appreciably worse…
However my point is that thousands of people who have other options are still choosing to use them… just ask a pharmacy tech how much of it they are still selling, in a time where virtually everyone is covered by some sort of rx plan that covers analogs
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NPH = Not Particularly Helpful
I started on R/NPH 2/day + a restrictive meal plan. There were 3 moments of great excitement in my diabetes life.
1 - Going on MDI with R/NPH - Freedom from having to eat NOW
2 - Levemir - A basal that actually worked an did not create random lows at night
3 - CGM - ability to micromanage.
From that you get - I would be ok with R/Levemir but not NPH.
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Since we have gone off topic…
Why is there a price difference between R and Rapid Acting Analogs or NPH and Levemir/Lantus?
Is the manufacturing different or is it just a patent thing?
Humalog has been around since ~1996ish so I think so you would think 20 years of sales has covered the development costs.
I’d probably attribute the continued use of R/NPH to these three things:
- This person has had diabetes for a long time and is used to using these insulins to control their diabetes. Starting a new insulin and getting used to the nuances and methodology of that insulin may be more of a hassle than it’s worth to them. They’ve likely been on restricted diets for so long that it’s not as big of a deal. These people may be resistant to change. They’ve found something that works relatively well and don’t see any point in switching. Switching may or may not improve their control… it would depend on how well they learned how to adapt to the new insulins
- This person cannot afford other insulins.
- This person doesn’t have a skilled endo to give them suggestions on new/other treatment methods. They may even be getting their insulin prescriptions from their GP. This type of doctor would be unlikely to suggest new insulins if R/NPH is working relatively well for them. Relatively well could mean an A1c in the 7s though.
I think the original tangent 
on this thread was the concern of being able to adequately control your diabetes if you lost insurance. It’s valid to be concerned about losing insurance in the U.S. when you would likely have to go on a substandard insulin if you did.
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I agree that resistance to change is probably a factor…
In the brief periods of time when one might find themselves without insurance (since everyone is required to have it, right?) there are discount cards available for virtually every insulin… i also think people with diabetes have an additional responsibility to have an emergency fund of savings that they can use to purchase the medications they need… also doctors generally are pretty good about giving free samples to people who tell them that they can’t afford their insulins, at least the docs I’ve dealt with…
I also personally recommend keeping at least a couple years worth of the insulin you prefer on hand… accumulate a stockpile while times are good just in case one ever falls on hard times
Then of course there’s Medicaid…
But “literally dying” because you lose your employer based coverage isn’t really realistic…
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I think Humalog’s patent only ran out in the last 4-5 years. They let these patents go for way too long IMO. Maybe in the next five years we’ll see some generics of Humalog that are cheaper. I know there’s a generic of Lantus out now that’s a lot cheaper. I don’t know how much though.
This isn’t really true. If one loses their employer based insurance, then this means they’ve probably also lost their employment. If you lose your employment, the options are very limited. If you have no money, no savings, no family to ask for money and help support you, then you can’t buy what you need and you can literally die. Like…literally. So your comment assumes that the person doesn’t also lose their income stream. Everything takes money…Big pharma doesn’t care if you die or not.
Getting on Medicaid if you have completely exhausted all your savings does not require an income stream…
Getting on an exchange plan with large subsidies if you have no wealth also doesn’t require an income steam
You can purchase enough R and NPH to get by for a long long time for very little money. If my running out of money was imminent, this would be highly prioritized above other expenditures
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