That’s not what we’re talking about though… No one here has said that zero insulin is preferrable to using R/NPH. We’ve simply said that an R/NPH regimen is not equivalent to a regimen with analogs. One is simply better than the other for a variety of reasons (whether you’re using a pump or on MDI). You may not agree with that, but none of us are advocating for someone going without insulin instead of using R & NPH.
Hopefully that person, if they exist, is able to recognize that.
Disagree there.
None of them cares about my life as much as I do. In hospitals there are a lot of mistakes and they do stupid things.
Last time at the lab when I had to have a blood-draw, the technician dropped the needle, picked it up off the floor (with her gloves on), disposed of the dropped needle and reached for a new needle…without replacing the gloves that had just picked something up off the floor. I stopped her and told her, “New gloves, please.”
Anyway, I think I do it better than they do it.
I wish I could draw my own blood. I get so nervous letting a phlebotomist do it- especially if they don’t get it the first time! If they poke around for too long, then I’ll literally pass out 
I agree with Sam that there are definitely a lot of people out there still using NPH and Regular insulin, and not solely because of the cost. I’ve read posts from some of them on the online forums. I used these insulins for many years. I switched to the modern analogs, and I’m glad I did - so I’m not saying I want to go back to those insulins. But I haven’t, for example, started using a pump or CGM, even though I have good medical coverage and could have gotten these decades ago. My control is good enough without them, and I consider the downsides to be greater than the upsides for me personally, so I am still injecting. Yet for some people, not using a pump/CGM is just as backwards as using NPH/R - so be it.
There is a fundamental truth for many people that the devil you know is better than the devil you don’t know. So if you get good control by some means, then why should you change it? If your control is good enough for you with NPH/R insulin, or injections, or anything else, then why change it?
Bernstein is a good example of this - he figured out how to get good control several decades ago using the technology that was available to him at the time, and he has persisted in preaching that to anyone who will listen (and even some who don’t want to listen). For him, besides his radical diet change that means Regular insulin (he considers Humalog too fast acting), and Ultralente insulin (he is still pissed that they took that off the market) and he preaches against pumps for various reasons too.
Finally, bear in mind that Regular insulin was the fastest insulin we had for many years (decades) of pumping - and in fact I remember when Humalog first came out it took some time before it was approved for pumps. So I’m not surprised that it works in pumps now, simply because it worked in pumps back then too. I suspect it doesn’t work as well in some ways for some people, but on the other hand it, it might just work even better in some ways for other people.
@sam I enjoyed the R/NPH vs. Analog Insulin paper. It was like a trip back down memory lane.
First off, I have to agree that you can get an ok A1C with R/NPH. If you can’t afford anything else it will give you an ok A1C and keep you alive. The cost savings on the insulin are given up on the loss of quality of life.
To me it is like washing your dirty clothes for a family of 6 by hand vs. using washing machine. You can get clean clothes doing the washing by hand and you avoid the high cost of buying a washing machine, but… washing clothes by hand takes a hell of a lot of time that you could be doing something else - like looking for a new job or applying for medicaid.
A couple of highlights:
Insulin Analogs—Is There a Compelling Case to Use Them? No!
…but only if you are a smug paternalistic doctor who does not have Type 1 diabetes and only uses A1C as a measure of success and thinks his patients should walk uphill both ways to school and be beaten every morning and every evening just in case the patient was doing something wrong.
“we insist that patients taking insulin eat a small bedtime snack and very few experience nocturnal hypoglycemia.”
The good doctor insists that his patients EAT NOW OR DIE. What you didn’t eat your bedtime snack? - You will sleep on the floor without a pillow, or blankets, and have a severe beating at 3am.
At least six studies have evaluated treatment satisfaction.
…but the paper was written in 2014 and most of the the treatment satisfaction surveys were done in the mid 1990’s before people had a chance to use the new insulin and figured out what the real benefits are and how it can be best used.
This would be like saying to someone - use afrezza the same way like you use humalog and see if you like afrezza better. I think you would argue that new technology should be used differently.
The only recent paper was…
Hsia SH. Insulin glargine compared to NPH among insulin-naïve, U.S. inner city, ethnic minority type 2 diabetic patients. Diabetes Res Clin Pract 2011
Which is probably relevant to the discussion.
Like others have said the conclusion of the paper was Type 1 patients do benefit from the newer analog basals. I would somewhat agree - I can use R just fine (although the long prebolus is a bit if a pain) but to me NPH is a pain compared to levemir.
I feel like I’m not being well understood here. I’m not saying R and NPH are as good as analogs. I don’t think they are, or I’d currently be using them. What I am saying, is that I think that the statements that have been repeated here over and over again that they are only an option to be considered when the only alternative is certain death, is absolutely ridiculous. I am also stating that many people are still using them, even when they readily have access to newer analogs insulins. I know this to be factually accurate.
Thanks for clarifying.
I agree that some people still use R/NPH because they like them.
Really not helpful…
https://youtu.be/0RpmwqaxrwA4
That is very demeaning
But funny. 
Intended to be funny. Lighten up.
Imo if you have the means to use analog and you choose R and NPH it’s very applicable. But to each their own…I get it. If you can get good control with it… Who am I to knock it.
I’m not sure I would want to give up my Novolog. I started with analogs, R and NPH sound foreign to me
I guess I should not knock it till I’ve tried it.
I am like Sam, I have really good insurance but I have wondered how a T2 like me would fair using R and NPH.
He’s wrong about pumps though and from what I’ve heard him say his criticisms of them are based on minimal anecdotal evidence without having real experience with them. I don’t entirely disagree with him - I think absorbtion can be erratic and scar tissue/infusion site issues are a legitimate problem with them (which led me to try MDI for the past few months). But he is denying a treatment option to his patients that may benefit some of them and help them with problems that can’t easily be solved with injections alone and this I don’t like. I think the real problem is that people are being forced to use R + NPH which are objectively outdated insulins (whether some people prefer them or not) simply because they can’t afford current treatment options and that is disgusting. There is no reason why analogs shouldn’t be cheaply available for everyone who needs them.
These are not meaningful statements whatsoever unless you have personal experience with what being on R and NPH actually is like. You have no way of knowing right now if that’s actually true or if you’d end up deciding (like most of us who actually know what R/NPH is like) that it would suck so much that cable tv would in no way be worth that trade-off. There’s perhaps a reason why everyone who actually did this for years and values tight control enough to be on a diabetes forum like this is on the opposite side of this debate…
And again, R is not as big of an issue—it would fit ok with a LCHF diet (although it’s worth noting that if you’re strapped for cash, that’s generally not a cheap diet, and R is much less compatible with cheap carbs), which I assume is why Bernstein likes it, since it matches well with rises from only protein/fat. It’s the NPH that makes the whole thing an absolute mess.
How would that be any different than me saying because you don’t use afrezza you aren’t entitled to an opinion on it?
I fully understand that with the way it was used 50 years ago it wasn’t a lot of fun. People weren’t checking their blood sugars at home then… they certainly weren’t using cgm… they were taking their basal 1x daily in most cases. we have different tools available that would make it tremendously easier…
If I said Afrezza would never work for me and couldn’t possibly be worth trying, well, that would indeed be silly since I’ve never tried it. Or if I said it would definitely work for me, either way.