Would love some opinions on using the cheaper insulins while doing the Dr Bernstein low carb diet. I’m having pretty good results, very few hypos, but looking to dial it in a bit better (i.e. still running ~25 points higher in the morning than I want).
After being diagnosed during dka March 2018 at age 39 - I was given almost zero training on what I needed to do to manage this. 10 months later, 8 week “diabetes class”, Dr B’s book, and many hours online researching - I convinced my clinic at the time to put me on a cheaper insulin Humulin 70/30 (basal NPH / regular R) to try out after the usual Lantus/Novolog regiment (of which the out of pocket was still too high and the Lantus made me retain water). I am forever grateful to the nurse teaching the diabetes class informing me that there are other, cheaper, older insulins that you can buy OTC and without a prescription affordably as I had no idea that existed. Being a frugalist, and putting much emphasis on financial sustainability as I can and calculating the costs of doing the 90 day insulin delivery - I did go on the Humulin 70/30 with pretty good results and an A1C of 6.0. The reason I am doing Humulin over Novolin (Walmart) is that I prefer the kwikpen since I have inexperience with the vials - of which I need to get over eventually.
My questions:
Anyone else on the 70/30 regiment?
I am planning a future scenario of where I will not have prescription coverage for a few months - anyone here go from Humulin 70/30 to Novolin 70/30 (or even just the R or NPH separately)? Did it work the same?
I see threads on buying from Canada. I currently live in south TX - I would like some opinions/experience buying insulin/other supplies in Mexico?
Is there anywhere I can buy out of pocket/no prescription needed for any cgm in Canada or Mexico? I have zero interest in a pump but do see the value of the cgm even it it’s an older model.
Lots of great content on this board! Thanks for listening.
Hope you luck on 70/30, didn’t work 4 me hopefully it will for me. You have to have script for cgm. Freestyle libre flash cgm is reasonable and avaible at wslmart/local parmacies. If you but some 15 day sensors you can get free reader from freestyle, but you have to have sensors first, you have to enter serial number to get. If memory serves me right there about 45$ apeice. There are some good threads here on them with more info.
Any reason you are on 70/30 rather than separate R and NPH? I’d think 70/30 would be very hard to adjust, since you cannot adjust intermediate- and short-acting insulin independently like you can when using R and NPH separately.
I have used R and NPH when younger (before analogues were available) and have followed a very low-carb diet for about a year, but never both at the same time. Hope you get some useful input!
When I tell people I’m on 70/30 - they think I’m unemployed, destitute and/or living in a cardboard box! I actually have a good finance job and insurance but prefer to do this in a sustainable way. I am freaked out by the cost of all this stuff, the amount of waste and dr appts (of which causes the most stress because half the time they tell me things that are not helpful and downright inaccurate), and feel like there HAS to be an easier way than agreeing to the usual protocol. I am completely happy with the R insulin - I do wish I could try a “better” basal and get off the NPH but for now it seems to work good enough. I love the fact I only have 2 shots/day and while I need to be strict with what I eat and when - that’s the easy stuff for me. I have started implementing correcting shots (like 1-2 units of rapid) if I’m running higher than I want or overdue my lunch which seems to be working although I just started that. Once my rapid acting pen runs out - I am going to buy Novolin R OTC.
I love only having 2 shots/day doing the 70/30. I keep my lunch very light/low carb and use walking strategically 3x/day to give a boost to the efficiency of my R while it’s in my system and then help the basal with another quick walk a couple hours after lunch. Going for a walk mid-morning and again at 4pm also gives me an excuse to leave the office!
I have seriously considered splitting the R and NPH but with my current eating and walking plan - it seems to work.
So the interesting thing here is that you can buy a more modern basal from Canada or Mexico and stick with your Regular insulin which matches the way you are currently eating. There are members here that are using R for particular meals where the digestion matches that insulin action curve.
If it were me, I would get a more modern basal, and if you are going to stick with the low carb, you can probably do just fine with the regular insulin.
As far as strategies to deal with a morning high, I think that will be somewhat difficult on your current regimen. With that said, your A1c is great, so you may not need to change. Finally, on the Dr. front, if you can, find one that you mesh with better. Someone telling you useless stuff isn’t really great.
Can you tell me which basal is available in Canada or, much closer to me, Mexico? Do you need a prescription? Can I have it shipped? I tried finding info on people going to Mexico for their prescriptions/cheaper costs but didn’t get enough detail to have the guts to drive the 3 hours to Mexico myself and show up at a pharmacy. I would be crossing over at Brownsville or Mission/McAllen area as I currently live in Corpus Christi.
You can mail order any basal available in the US via prescription. Just search out the threads on this site. You can also go to Canada and purchase over the counter with no prescription at all. It is quite inexpensive and easy to do.
We are not using 70/30 but do use R for very specific types of corrections when on MDI (sick days). Without any experience, I would, from theory, prefer using NPH and R.
We bought local insulin without prescription while in Costa Rica. I would have no problem trusting Mexican insulin. I am not sure if you need a prescription. I suspect that it is possible to buy insulin without prescription there (I have been able to do that all over Europe) but I can’t guarantee that is true.
I believe that Dexcom supplies are no cheaper in Canada? Hopefully some of our Canadian members can help us there. In your case, I also suggest you check out the Freestyle Libre + third party reader such as Miao-miao.
Like Chris, I would expect that purchasing modern insulin in Canada/Mexico might work better for you. Even if you need to spend a day to get a prescription with a Mexican doctor it would not be hard.
As for Canada, I have experience with Mark’s Pharmacy and I like them a lot.
No savings on Dexcom in Canada that I am aware of.
I used to do one shot of R/NPH twice a day on a fixed diet but I found both the fixed times of eating and the fixed meals a bit restrictive. I think you can probably get better control with ajusting your NPH/R ratio than being stuck at 70/30.
Also on 70/30 if you get sick and cannot eat then you are stuck. Basically it is IV deteose time.
With that said, if you can afford it using R and Levemir would be my choice if eating low carb and is the recommendation of Dr. B. If you want a really.low A1C and lots of adjusability that is the way to go. It also lets you miss meals if you are sick.
I go through periods of low carb eating but I use a pump to get good basal coverage with extended bolusea for the protien.
@MNTexan, do you speak Spanish? If the area is reasonably safe I would not have any qualms trying. I am a guy though, maybe drive over with a friend?
My understanding, btw, is that you will find the big 4 available, but not always in stock: Lantus, Levemir, Humalog, Novolog/Novorapid. In Costa Rica, we could sometimes find only one penfill in stock in one rural pharmacy.
Y’all are awesome sharing this information. I am going to do some research and a “scouting trip” to the southern border in the next few months and report back. I also have a former neighbor who winters in Donna, next door to McAllen in a retirement community to see if I can find folks that buy prescriptions across the border and where.
As far as moving from NPH to Lantus or Levemir - I’m certainly not opposed to that however that kills off the need of mine to be financially sustainable. I actually have a full box of Lantus pens in my fridge now from the hospital that I could switch to and would have enough time to test it out to see if my A1C improves - although it would have to be significant for me to move to Lantus permanently to take on the extra cost/dr hassle/more shots. I also hear about the early morning lows from Lantus users, including my mom who had the issue. I would have to do split dosing and go through the section of the Dr B book again.
I think I finally know enough and have enough confidence to test out a few different regiments.
I think @Chris’s thought was that it might work for you if it was 1/3 the price it costs in the US, which is, I think, roughly what it costs in Canada. There is a thread on the forum, about a year old, that gives precise numbers.
I’d love to know what you find out about prices and purchasing in Mexico. Hopefully you can share all you find with us, I am sure many would like to know!
Honetly, if you aren’t looking for a better A1c, then you don’t have to change anything. With that said, I think the modern basals offer a better quality of life than NPH. i.e. skipping meals and not having to be so regimented in everything.
And what Michel said is what I was thinking. I am guessing you can get a modern basal in Mexico for $75 a vial. More expensive than NPH, but not crazy either.
Hi @MNTexan, Mexican here In Mexico you do not require a prescription to buy insulin and you can buy almost in all big pharmacies across all cities. (example. Farmacias Benavides, Farmacias del ahorro, Farmacias Guadalajara, Farmacias San Pablo, Walmart pharmacy, etc) you just need to ask the pharmacist for what you need. About quality, it is exactly as in the US.
I have bought Tresiba, Novorapid (same as novolog, just different name) and Ryzodeg which is 70/30 degludec (tresiba)/(aspart)novolog .
Thank you @Israel, this is fantastic information. My thought was just a hunch, but glad it proved correct. $56 for 15 ml of Lantus is a great price. We have much more information about purchasing in Canada, but Mexico is certainly an option for people that live in the southwestern US.
Israel - You are awesome- thanks for the information.
That is a great price on Lantus pens - I paid $90 just for the copay.
What concerns, if any, are there getting back over the border into the US and dealing with the customs / border patrol agents? I would only be buying the insulin and not the needles probably if that helps.
In Mexico you do not require a prescription to buy insulin and you can buy almost in all big pharmacies across all cities. (example. Farmacias Benavides, Farmacias del ahorro, Farmacias Guadalajara, Farmacias San Pablo, Walmart pharmacy, etc) you just need to ask the pharmacist for what you need. About quality, it is exactly as in the US.