FUDiabetes

Newbie here and this T1D thing - anyone use Humulin 70/30 or the Walmart Novolin 70/30 with VLCD?


#21

Sorry for taking this long in my reply. No prescription is needed in Mexico for diabetes supplies. (insulins, meters, oral meds, pumps, CGM’s). However we do not have Dexcom. We have FreeStyle Libre (flash monitoring) and Enlite (medtronic).


#22

Watch this video, I don’t know if it applies the same for all stated in the US. But you’re allowed to cross with a certain amount of supplies (like several months worth of supplies)
https://m.facebook.com/story.php?story_fbid=597705377356646&id=1723663281205105

If by any reason you cannot see the video please let me know, I’ll figure out how to copy and post it somewhere else

According to the lady in the video, you do need a prescription for crossing back to the US only if you decide to declare that you are carrying medical supplies with you. But as said before, you are allowed to carry a certain amount without any issues. (no prescription)


#23

Thank you!!!

Israel - can you send the link to a price on a box of Novorapid or (preferrably) regular insulin pens? Are those available at a pharmacy?

Beth / MN Texan


#24

Sure
Humulin R and Novorapid are available physically at pharmacies… my favorite is Farmacias del Ahorro. (it’s usually cheaper than many others)
Here is a photo of the storefront just so you can identify it.
farmacia-del-ahorro-1

These are for novorapid
$257 MX Pesos
Novorapid Flexpen 100 U.I 3ml

$860 MX Pesos
Novorapid Vial 100 U.I 10ml

$1,422 MX Pesos
Novorapid Penfill 100 U.I. 5X3ml

$536 MX Pesos
Novolin R 100 U.I 10 Ml Vial

This is from Walmart… not sure about what type of insulin is this
$1008 MX Pesos. Currently on discount

Insulina lispro / insulina lispro protamina Humalog Mix 25 100 UI/mL 10 ml

Edit… again:
Found it
$499 MX Pesos
Humulin R 100 U.I. 10ml 1 vial
@MNTexan

There is another pharmacy (farmalisto.com.mx) which I’ve never bought from because there is no physical store in my city, but seems many people buy from there online
Also https://www.farmaciasanpablo.com.mx/ is not in my city either but it is in center and south of Mexico… I’m north near TX


#25

The prices on the pens are amazingly cheap.

I do see that the Novorapid vial$860 mx is about the same as Walmart here. That’s interesting.

That Walmart one $1008 mx looks like a 75/25 NPH/rapid acting. The “protamina” I believe is NPH. Is that just 1 vial?


#26

Yes, it’s just one vial.

Im gonna keep on looking. Im just learning about insulin types… I’ve only used tresiba, ryzodeg and novorapid so please apologize that I might be missing some types/brands.

And yes, for some reason I’ve seen that buying several pens is almost always better than buying a vial.


#27

You are allowed to cross with almost a year supply. Been there, done that.


#28

@Israel, @Mariana, you are treasure troves of information! Thanks so much!


#29

I’d like to stick with Walmart so I’ve been researching their site the most.

Can someone confirm what this is - is this like novolin 70/30? Although it says “aspart” so it’s 70% NPH and 30% rapid acting? And 5 pens in this box?: So 1,500 units total?

https://super.walmart.com.mx/medicamentos-de-patente/novomix-flexpen-ampolletas-5-pzas-de-3-ml-c-u/00750300782222


#30

Yes it’s protamine and aspart (ultra rapid acting if I’m not mistaking)

And yes 1,500 units total


#31

Looks like this one is the Novolin, non rapid, mix with NPH, but in vial.

https://super.walmart.com.mx/medicamentos-de-patente/novolin-70-30-solucion-inyectable-10-ml/00750300782203


#32

NO, no need to thank , this is what we’re all here for: SUPPORT :slight_smile:


#33

@MNTexan, after some reflection, I would like to add one more comment on your purpose. I have been hesitant to mention it because we all make many personal choices with D—but, at the same time, some of these choices can be dangerous. If you have already considered these issues, then, of course, don’t worry about these caveats.

In our country, the patient cost of treating diabetes is a high penalty and a great worry to many (something I do not think is right, btw). It is natural that almost all of us try to optimize costs for this treatment. But there is also a point beyond which one should not go. A recent survey showed that almost a quarter a PWDs in the US have shorted themselves of insulin at one time or another: this is deadly. I am somewhat concerned that your choice of 70/30 may, in some circumstances, carry dangerous consequences: choosing 70/30 for treatment reasons is one thing, for cost reasons another.

We have no experience of 70/30, so I write without direct knowledge. But what I have read of it makes me somewhat concerned, as its requirements of use are so rigid. You absolutely need your carbs on schedule come what may. You can’t afford to be sick and throw up, or miss a meal etc. Being too high for a while is one thing—but we all know what the price is if we go too low. There are circumstances where 70/30 may have deadly consequences, particularly if you have to make difficult treatment decisions while you are very low and therefore less able to make the right choice.

If I had to make treatment choices driven by cost:

  • I would be very careful about using 70/30. This is not a choice I would make for cost alone, because I think that there would be little additional cost to NPH and R used separately.

  • I would carefully consider what likely costs I am going to run due to complications. A worse A1c or Time-In-Range for 20 years is likely to lead to much worse odds of complications, some of which may be immensely costly (kidney transplant…). There is a treatment reason why most have moved to modern insulin.

  • I would try very hard to use a modern basal through buying supplies abroad, as you are doing now. I would prioritize modern basal over modern bolus insulin with limited resources.

  • I would carefully analyze the short- and long-term cost of using imported modern insulin, and see if I can make other life choices that allow me that option.

  • For sure, knowing that modern insulins can last much longer than advertised, I would always keep modern insulins at home in case of sick days etc.

  • I would develop, over years, a large stash of insulin, so as to be less vulnerable to momentary money problems.


#34

I hear ya on the concerns for 70/30 and well aware in the lack of flexibility, particularly with a “sick” day. I can assure you that the amount of insulin I take a day is well optimized to my eating and exercise/walking schedule with as much flexibility as I can do. I’ve also started doing correcting shots (1-2 units at the most) when I run high, which is usually a Saturday or Sunday afternoon due to just generally eating more - and that’s been a great piece of flexibility in not having to skips meals (which I never did before except for maybe cutting back the protein a bit) if my sugars were higher. I also can assure you I don’t skip meals generally or ration and I eat more and better doing the low carb diet than at any other time in my life. And I’m finally at an ideal weight - ~20lbs less than before I went into the hospital. I can thank Dr Bernstein’s book and youtube videos for that. I was able to actually take control not only of what I ate but also the effects of it. As far as moving to a “modern” basal - I’m contemplating that and would only do it if I felt I could truly get closer to a 5.0 A1C more easily, while having decent access to the prescription at a cost that is bearable. People can talk all day long about how they need to be on the most modern medicine and cost is no object - I disagree - and I believe that the fact that health care consumers don’t really have any idea what medical services cost or their regulation thereof - making them needing to rely on an employer and expensive health insurance - is part of the piece of why medical care and insurance is so brutally expensive in the U.S. - the lack of transparency which inhibits knowledge and then better control via more options. Locking myself into an expensive regiment without fully understanding my options is not what I’m going to do. I’m going to keep optimizing what I have now, institute a bit more exercise now that I’m stronger months out from my dka experience, and find out insulin and pharmacy options - with or without prescription insurance coverage.

I typed this on my phone so pardon any grammatical or context issues!

Beth


#35

Hi Beth. Glad you joined FUD!!

I’m also glad that you’ve been able to find a lot of resources in your first year with D. I was diagnosed as a child and had a week-long training, but I’ve read that adults aren’t often given as much info as they should be. It’s too bad that you experienced this as well, but it’s great that you’ve sought out the information you need to take care of yourself.

I’ve noticed more willingness to adopt the very low carb diets among people who were diagnosed as adults. I sometimes wonder if having to adhere to a strict regimen as a child has greatly biased me against adopting a similar way of eating as an adult. I cannot picture myself ever being willing to use 70/30 unless it was the only option available. I like trying new foods and not adhering to a specific eating and exercising schedule too much. I’ve had diabetes for 23 years. If I’d kept the exact same schedule day-in and day-out for that long, my life would be so incredibly different (and very boring comparatively in my mind). I can see why being diagnosed as an adult may influence that perception though because we’re a bit more set in our ways at that point.

I’m all for using whatever method optimizes your quality of life. I’ve had difficulty understanding why people would want to use these insulins, but eventually I’ve realized that I don’t really need to understand why. I just need to be happy that it’s working for you.

I will say that I haven’t met a single diabetic who has said that “cost is no object.” Most type 1 diabetics I’ve met are very aware of the costs of modern insulin and are very upset by them, but they feel trapped because those insulins give them the best quality of life. It’s okay that their definition of quality of life is not the same as yours.

As a newly diagnosed person, you may find that your insulin needs change over time. It’s very common for people who are newly diagnosed to still produce some insulin and some glucagon, and management may become more challenging over time as this production decreases. Obviously I have no idea if that’s the case for you, but it’s a fairly common experience so I just thought I’d mention it.


#36

I’m new to everything and the doctor had me on tresiba for the first month, now he switched me to 70/30 (Ryzodeg) don’t know if the name is the same in the US. and I absolutely need to have all my meals… specially breakfast which is when I inject myself (25 units). sometimes I forget to eat breakfast and have lows around de 40s… quite scary TBH so I try to get a sandwich at least before that happens

He said he might split it in 2 doses but even though my basal (around 18 of those 25) might not be enough.
In the meantime my insurance is delivering a 3 month supply of Ryzodeg… funny thing is that doc could change the type of insulin later so… if that happens, I’ll have a complete box of 5 tresiba pens and some pens of Ryzodeg lying in the fridge.


#37

I understand your concern. but I must say I have not yet met a PWD who feels that cost is no object.

These are small corrections. Are you still in honeymoon? Since you were diagnosed as a adult, honeymoon, for you, will last longer than for kids. As @Katers87 mentioned, as you accumulate years of D, you may see worsening symptoms. Most if us try to do the best we can to maintain as normal an A1c and Time-in-range as possible, to minimize as much as possible the odds of complications.


#38

I believe Ryzodeg is a 70/30 split of modern insulins - Tresiba and Novolog (aka Novorapid). I also use Tresiba as my basal insulin, but I do not use it in a 70/30 split form. I believe that Beth is referring to a 70/30 split of the much older insulins, NPH and R.

I’ve never heard of Ryzodeg, and I’m not sure what the advantage would be of taking that versus using each insulin, Tresiba and Novlog, separately.

My preference would always be to use each insulin separately so that I can measure the amount I want of each insulin rather than be required to increase my bolus insulin in proportion to any needed increase in basal. That would mean increasing my food intake so that I can match the increase in bolus without dropping low. It would require that I structure my life around my insulins rather than structuring my insulin around my life.

I’m not sure how you would dose for lunch or dinner with Ryzodeg. Do you have a Novorapid prescription for those meals?


#39

Hi, yes, I only use Ryzodeg in the morning before breakfast, for lunch and dinner I bolus with Novolog (novorapid) separately.


#40

That makes sense. Thanks for clarifying :slightly_smiling_face: