# Losing job/insurance and the options that follow **URL:** \ **Category:** Insurance\ **Created:** [January 25, 2018, 1:32am UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330 "2018-01-25T01:32:06Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [January 26, 2018, 6:30pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/61 "2018-01-26T18:30:40Z")
I didn’t post it to support NPH I posted it to offer some actual research on the subject… I don’t use NPH I’m just saying it shouldn’t be dismissed as unrealistic or unreasonable ---
**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\ **Post date:** [January 26, 2018, 6:31pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/62 "2018-01-26T18:31:25Z")
> [@Sam](#): > > Can’t help but notice no clicks on the article ;). A right click does not register a hit 🙂 ---
**Author:** ![ClaudnDaye](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/claudndaye/32/5_2.png) [@ClaudnDaye](https://forum.fudiabetes.org/u/ClaudnDaye)\ **Post date:** [January 26, 2018, 6:33pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/63 "2018-01-26T18:33:26Z")
> [@Sam](#): > > But my point is, that thousands patients are on them Because they have no choice because they’ve been priced out of the market by the sheer greed of big-pharma. Just because they’re on it doesn’t mean they like it or they wouldn’t prefer to not be. > [@Sam](#): > > Can’t help but notice no clicks on the article 😉 Right click + open in new window or new tab = you won’t see clicks. However, the direct quote referenced from the article by @Katers87, indicates she read it (as did I.) ---
**Author:** ![Katers87](https://avatars.discourse-cdn.com/v4/letter/k/a9adbd/32.png) [@Katers87](https://forum.fudiabetes.org/u/Katers87)\ **Post date:** [January 26, 2018, 6:33pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/64 "2018-01-26T18:33:27Z")
There are lots of articles on the subject with the alternate perspective. "For type 1 diabetes, insulin aspart was more effective and less costly than regular human insulin. " > > > Insulin analogues may be associated with fewer episodes of hypoglycemia than conventional insulins. However, they are costly alternatives. We compared the cost-effectiveness of insulin analogues and conventional insulins used to treat type 1 and type 2 diabetes mellitus in adults.We conducted a cost-effectiveness evaluation of insulin analogues versus conventional insulins using the Center for Outcomes Research Diabetes Model. We compared rapid-acting analogues (insulin aspart and insulin lispro) with regular human insulin, and long-acting analogues (insulin glargine and insulin detemir) with neutral protamine Hagedorn insulin. We derived clinical information for the comparisons from meta-analyses of randomized controlled trials. We obtained cost and utility estimates from published sources. We performed sensitivity analyses to test the robustness of our results.For type 1 diabetes, insulin aspart was more effective and less costly than regular human insulin. Insulin lispro was associated with an incremental cost of Can$28,996 per quality-adjusted life-year. The incremental cost per quality-adjusted life-year was Can$87,932 for insulin glargine and Can$387,729 for insulin detemir, compared with neutral protamine Hagedorn insulin. For type 2 diabetes, insulin aspart was associated with an incremental cost of Can$22,488 per quality-adjusted life-year compared with regular human insulin. For insulin lispro, the incremental cost was Can$130,865. Compared with neutral protamine Hagedorn insulin, insulin detemir was less effective and more costly. Insulin glargine was associated with an incremental cost of Can$642,994 per quality-adjusted life-year. The model was sensitive to changes in the effect size of hemoglobin A(1c) and to decrements applied to utility scores when fear of hypoglycemia was included as a factor.The cost-effectiveness of insulin analogues depends on the type of insulin analogue and whether the patient receiving the treatment has type 1 or type 2 diabetes. With the exception of rapid-acting insulin analogues in type 1 diabetes, routine use of insulin analogues, especially long-acting analogues in type 2 diabetes, is unlikely to represent an efficient use of finite health care resources. ---
**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\ **Post date:** [January 26, 2018, 6:35pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/65 "2018-01-26T18:35:30Z")
> [@Sam](#): > > I posted it to offer some actual research on the subject Here is the full conclusion quote, in case someone is misled by what you imply about this article: > analog insulins are not preferred with two important exceptions. Type 1 diabetic patients require basal analog insulin because they produce no endogenous insulin and need 24-h coverage. In the unusual occurrence of overnight hypoglycemia in type 2 diabetic patients who ingest a bedtime snack, it may be helpful to prescribe an analog rapid-acting insulin before supper (and presumably before the other meals to simplify the regimen) if the hypoglycemia occurs early overnight, and a basal analog insulin if it occurs toward morning. With these two exceptions, analog insulins provide no clinical benefit compared with human insulins, but cost much more. Translation: this article’s conclusions does not apply to any Type 1. I think it is an important clarification 🙂 ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [January 26, 2018, 6:35pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/66 "2018-01-26T18:35:48Z")
> [@Katers87](#): > > insulin aspart was more effective and less costly than regular human insulin. " How can something that costs $380 per vial be less costly than something that costs $25? ---
**Author:** ![Katers87](https://avatars.discourse-cdn.com/v4/letter/k/a9adbd/32.png) [@Katers87](https://forum.fudiabetes.org/u/Katers87)\ **Post date:** [January 26, 2018, 6:38pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/67 "2018-01-26T18:38:27Z")
Probably because of fewer complications resulting from better controlled diabetes. I’ll have to read the whole article and get back to you. Complications are expensive. ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [January 26, 2018, 6:42pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/68 "2018-01-26T18:42:57Z")
I’m not saying they’re ideal options… but they aren’t a death sentence either. They work. Lots of people use them… some because they prefer them. I’d switch to R and NPH before I’d cancel cable TV, personally. Personally I’d rather use them than a pump… To each their own. ---
**Author:** ![ClaudnDaye](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/claudndaye/32/5_2.png) [@ClaudnDaye](https://forum.fudiabetes.org/u/ClaudnDaye)\ **Post date:** [January 26, 2018, 6:45pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/69 "2018-01-26T18:45:26Z")
> [@Sam](#): > > but they aren’t a death sentence either Not immediate death sentences perhaps, but proven to be so bad that long-term health issues are virtually inevitable. ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [January 26, 2018, 6:46pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/70 "2018-01-26T18:46:30Z")
You do realize that every single Joslin medalist was on them for decades? Analogs have nowhere near the proven long term success rate that they do… granted that’s is likely just a matter of time, but still ---
**Author:** ![Katers87](https://avatars.discourse-cdn.com/v4/letter/k/a9adbd/32.png) [@Katers87](https://forum.fudiabetes.org/u/Katers87)\ **Post date:** [January 26, 2018, 6:52pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/71 "2018-01-26T18:52:35Z")
Just because people are still alive that used them for a lifetime doesn’t mean that they have a high success rate. What is success? How many people have developed complications while using them? How many have died? How the insulin affects A1c is a better way of measuring the effectiveness of insulin. How that insulin impacts your quality of life is also a factor. ---
**Author:** ![ClaudnDaye](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/claudndaye/32/5_2.png) [@ClaudnDaye](https://forum.fudiabetes.org/u/ClaudnDaye)\ **Post date:** [January 26, 2018, 6:54pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/72 "2018-01-26T18:54:07Z")
> [@Katers87](#): > > How the insulin affects A1c is a better way of measuring the effectiveness of insulin. How that insulin impacts your quality of life is also a factor. Along with the associated lack in short and long-term health complications associated with each treatment option. ---
**Author:** ![Scotteric](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@Scotteric](https://forum.fudiabetes.org/u/Scotteric)\ **Post date:** [January 26, 2018, 7:20pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/73 "2018-01-26T19:20:27Z")
> [@Sam](#): > > Personally I’d rather use them than a pump… I really doubt you’d be saying that if you actually tried a pump! It is not outdated technology, there are disadvantages to it as with every treatment regimen but Tresiba hasn’t replaced pumping. It’s merely an alternative that works very well for some people, and not as well or well at all for others. Only a smart insulin that could actually react to the body’s varying needs and food by itself could actually render the pump obsolete. ---
**Author:** ![TiaG](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/tiag/32/594_2.png) [@TiaG](https://forum.fudiabetes.org/u/TiaG)\ **Post date:** [January 26, 2018, 7:22pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/74 "2018-01-26T19:22:03Z")
> I’d switch to R and NPH before I’d cancel cable TV, personally. Wow!!! ---
**Author:** ![Katers87](https://avatars.discourse-cdn.com/v4/letter/k/a9adbd/32.png) [@Katers87](https://forum.fudiabetes.org/u/Katers87)\ **Post date:** [January 26, 2018, 7:38pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/75 "2018-01-26T19:38:06Z")
I suppose it’s probably better that you (@Sam) prefer R/NPH since it would be less expensive than a pump should you ever lose your job or insurance. I think my main reservations on this topic of R/NPH is that when discussing the effectiveness of an insulin, quality of life must be considered. > [@Sam](#): > > But my point is, that thousands patients are on them, and it’s an increasingly more valid debate every year (and one that’s gaining traction amongst researchers and practitioners) if the increasingly absurd costs of analogs can really be justified. This particular portion of this discussion is very concerning to me. I really can’t communicate how upset I would be if the medical community determined that analogs weren’t worth the cost so some insurance companies stopped covering them. I was completely unaware that there were any discussions of this kind occurring, and I find it very disturbing. I don’t particularly care what you or anyone else wants to use as insulin, but there are distinct, substantial, measurable benefits to analog insulins. While quality of life may be hard to measure, I truly believe that if any effort were made, it would be very clear that there are substantial benefits to using analog insulin in that regard as well. ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [January 26, 2018, 8:03pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/76 "2018-01-26T20:03:31Z")
It’s also relevant to note that most people were using R and NPH back before most were even doing home bg monitorong, let alone using cgm… given all the additional tools available to an insulin user now, I really don’t think it could possibly be that bad ---
**Author:** ![Katers87](https://avatars.discourse-cdn.com/v4/letter/k/a9adbd/32.png) [@Katers87](https://forum.fudiabetes.org/u/Katers87)\ **Post date:** [January 26, 2018, 8:04pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/77 "2018-01-26T20:04:53Z")
My A1c was much worse on R and NPH. I couldn’t stick to the eating schedule. It was impossible. I hated it. Granted I was a child then, but my A1c was better as an adolescent (going through all those hormones) on Humalog and Lantus than it was when I was on R and NPH as a 6th grader. ---
**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\ **Post date:** [January 26, 2018, 8:12pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/78 "2018-01-26T20:12:28Z")
As a side note - There is a very easy way to make R better than any of the current rapids. Much faster and much less duration. Super easy, 5 minutes to start working, peaks in about 15 minutes, and completely done in about 45-50 minutes. Nobody else wants to do it that way, but I don’t think it’s a big deal. If I had to, I’d just IV dose the R without any worries. They use R in hospital ER’s that way. Not ideal, but it’s doable. ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [January 26, 2018, 8:43pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/79 "2018-01-26T20:43:26Z")
Somebody out there could be out of insulin going into dka and reading this then thinking “well it’s not really that bad I can just wait until Monday to call my doctor to get a new script, maybe I can call them on my lunch break… or, well I can just wait until payday because R sounds so awful… Instead of just going and getting the slightly inferior insulin… ---
**Author:** ![TiaG](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/tiag/32/594_2.png) [@TiaG](https://forum.fudiabetes.org/u/TiaG)\ **Post date:** [January 26, 2018, 8:44pm UTC](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330/80 "2018-01-26T20:44:07Z")
I dont think that’s a viable long-term strategy. Even in the hosptial they don’t want to have IV’s in you forever or you’re prone to infections. At home the risk is even greater. As a one-off I think the risk may be acceptable; as a long-term strategy, nope. But that’s just, like, my opinion, man. [Previous page](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330.md?page=3) [Next page](https://forum.fudiabetes.org/t/losing-job-insurance-and-the-options-that-follow/3330.md?page=5)