So how bad is Novolin R really?

Give me the good and bad of your experiences, please! Particularly because I’m not on basal insulin as my fasting blood sugars are fine, the extended DIA is scaring me a bit with the potential for lots of lows (I already sometimes get borderline/mild lows with Novolog if I don’t eat between meals).

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I wouldn’t think it would be too terrible on its own, you just have to get used to its action. I think the people that talk about problems with it, talk about when the Novolin R and the Novolin N both overlap. But someone with direct experience will have a better answer in a bit.

If I already sometimes see borderline/mild lows at the 3-4hr mark after Novolog if I don’t eat between meals, should I expect to see similar/worse lows with the Novolin R?

Do you really have to pre-bolus 30mins-1hr before eating?

Curious why you are asking. Are you considering using it?

For some people the cheaper cost is helpful, if they don’t have insurance. But I’m not sure how useful it is compared to NovoLog or Humalog or Apidra.

It can keep someone alive. But it would not be my first choice.

I don’t feel competent to talk about Novolog R when we have people who have lived it for many years time, such as @drbbennett !

But we pre-bolus all the time! I thought this was a great question, so I made a wiki for you.

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She is asking because her insurance is making her fail on it before approving afrezza.


What @Chris said. Can’t even think straight, I’m so frustrated right now! Just got off the phone with insurance, being sent in circles AGAIN, about covering a Dexcom (I’m not comfortable doing the Novolin until I can keep a closer eye on things, particularly at night). I finally talked to someone who’s going to look deeper into things to figure out why I keep being told it’s not covered when it should be, so a step in the right direction.

So yeah. I’m not looking for info on how it compares, really, except for tips on how it differs to be prepared and survive the month I have to be on it. :roll_eyes:


The fact that you would just be using R without a basal simplifies things a bit. I think someone mentioned that the hardest thing on the old R/NPH regimen was that the rising N curve could hit while you still had R aboard and the intersection could be unpredictable and lead to severe hypos. With just the R curve to deal with, you’re in a better position not only in terms of avoiding that problem but also in terms of figuring out how to use it: fewer variables involved. You can look at the effect curve charts to get the general idea, but those kinds of things always have to be evaluated in light of your own experience, so there’s going to be some trial-and-error involved. The longer arc may mean it’s harder to fit the doses to your meal times, particularly breakfast. I’d start out by using the official effect chart as a general guideline, but test a lot so you can see when your BG is starting to drop, then next time adjust accordingly. You have the advantage of much better testing gear than we had back in the day, which should help a lot. If you can get a CGM approved, so much the better.

The big difference is that you’re going to find you have to eat to the schedule set by the insulin, not the other way around. Though that’s less of a severe problem with R than with N.


I saw your post on Facebook— is this so that your prescription coverage will cover afrezza only because you’ve had poor results on other options? You realize you could just get the rx for it and not use it and then tell your doc it was not a good fit for you and you had hypos. It’s called jumping through the hoops… of just ask your doctor to work with you on the PA (prior authorization). Most docs are so fed up with insurers that they’re more than happy to just pencil whip and PA and make it work by whatever means necessary


I knew she had to try an injectable before getting approved for Afrezza. What I am wondering about is why R instead of NovoLog.

I could understand them wanting you to try an injectable before trying Afrezza, since injectables are part of their formulary. (not sauying I agree with it, just saying I understand their rational).

And I can understand how they may have a preferred drug, like Humalog over NovoLog, or vice-versa.

But what I am confused about is why R over a rapid insulin like NovoLog or Humalog. Nobody uses R anymore.

Is this just an endo mistake? Saying R instead of NovoLog?

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Thank you for the input! I had heard stories of the severe lows, which is what I’m most afraid of, so I’m glad to know it won’t be as bad with no basal.

That’s what I’m assuming - I got a letter from my prescription coverage provider basically saying it was denied because there are other options, so I’m guessing I have to show those don’t work.

I’m definitely considering that - I kinda exaggerated things a bit the last time I was supposed to prove something worked (when I knew it wouldn’t). But if she runs an A1c after that time (not sure when I get my next one drawn), and it’s ok, would they say it’s obviously working well enough?

I have NO idea why they are saying R instead of Novolog, but I don’t think it’s the doc’s mistake as I just saw her and got a new script for Novolog. My guess is they want me to try all options first (since I’m already on Novolog, they know that isn’t working like Afrezza would)?

Ok, just replied to the other thread.

I didn’t understand why the R. If NovoLog is not fast enough, what idiot thinks R is going to be better?!? That’s what was so confusing to me!

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Well, there aren’t that many options that are (a) not a fast-acting insulin and (b) not a basal insulin.

Besides, he may be thinking there is no way you can be successful with Novolin R :slight_smile:

I wouldn’t assume that your insurance is requiring you to try and fail with R in order to approve afrezza… they just want you to use whatever is in their formulary instead-- Have your doc fight the cause for you, they’ll have to deal with a PA… and some runaround… unfortunately its a hassle to go off-formulary.

I’m going to call her office tomorrow and make sure I understand what exactly is going on.

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It’s unfortunate they play games like that. If you adjust your meal choices and pre bolus, you might get same results on Novolog that you could do on Afrezza. You can certainly sway the results by what you choose to eat and timing.

I would make many different food choices if my insurance covered Afrezza and would have similar A1C results. But Afrezza makes many situation so much easier that I am willing to pay out of pocket, and use it based on the situation.


I have a lot (understatement) of food issues - celiac, intolerances, diet reqs for a muscle disorder, plus my breastfeeding babe has intolerances, too! - that make changing my diet up more challenging. And now that I’ve gotten a taste of what life is like with Afrezza…haha. I use Novolog probably 80-90% of the time, but use Afrezza when eating out or for those high carb meals that are harder to manage with Novolog.

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If using it only 10% of doses might as well just get discount card and pay cash probably cheaper than copay (speculating) certainly less headaches. @mpg54, @livingandlearning201, @Cynthia_Rogers, @DuckFiabetes what can you tell us about available discounts ?

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@Sam might be right, and people who avoid headaches are probably smarter than me.

But man, it burns my biscuits when a PWD (or any health issues for that matter) cannot get what they NEED because of their doctor’s insistence on buddying up with the insurance company.

And if you can afford it and pay out of pocket, it’s okay, but to me, you’re paying for insurance, and that should cover the medications and medical devices that have been proven to work and increase your long term health. So sometimes I want to fight the fight to prove what is right and what is fair. Not that I have a great track record of winning that fight. But I am ready for it presently. And maybe it’ll help someone else in the future.

And, for the record, I’m sitting in the endos office for the third time in a week, this time to meet the Afrezza rep.