Background- I use MDI with Humalog and Basaglar with a Dexcom G6.
My doc said to just message him if I ever needed an Rx renewed, but then when I did this we ended up having a multi-day back-and-forth message exchange delaying the order. Partly my fault for waiting until I had two pens left instead of 3 or 4 I guess, but here I am where I’ve never been before. So I figure I have two options and would like anyone’s experience or advice on them:
Steal one (or possibly more) of my son’s Tresiba pens. This would be easiest, but I use way more than he does and don’t want to mess up his prescription. Also, Tresiba is not a one-to-one substitution on units for Basaglar, so I’m not sure how much I would need to take.
Take extra fast-acting insulin every few hours. I’ve got plenty of my own Humalog, so this one isn’t a problem on the supply side, but it would be PITA especially overnight where fast-acting insulin just doesn’t seem to work for me. Also, I’m not even sure if Humalog is a one-to-one alternate for Basaglar.
Any ideas, suggestions, recommendations, or conversion factors between insulins would be appreciated.
I am really hesitant to try to get insulin from my local pharmacy. 90 days via mail order for me is only $40. Last time I tried to get any from the local pharmacy (Rx sent there by mistake) they were going to charge me ~$175 for a single box of pens. Thankfully then I had enough in reserve to say no thank you and get the Rx fixed. Hopefully I can manage a few days now.
@bwschulz are you also using a short acting insulin? If so, can you manage with that in the short term? If not, ask your Dr about using either R or NPH for a few days. $25 per 10ml vial @ Walmart in US. Not Basaglar, but it works in a pinch. It’s also not a 1:1 substitute and you need to be cautious of stacking. Speak to your Dr before going down this path unless you have previously travelled it.
The pharmacy would need to contact him, and I have done that before, but this time I needed to up the dosage. So not a one-for-one renewal, but he did know that my dosage had gone up lately because I told him so at our last appt. in September.
If I were in your situation, I’d go to Walmart and pay $25 for a vial of their generic long-acting insulin that is available without prescription. This is type-N also called NPH insulin. It is not like Lantus that releases about the same amount every hour. Instead, it is like a Humalog that peaks in 6-8 hours instead of 1-2, and that lasts many hours after that. The slow peak can send you hypo, so dosing can be a bit tricky. Some here have used this kind of insulin and can suggest dosing strategies.
Of course I’d try to get the usual insulin the way others have suggested, but the type-N can tide you over without having to wake every 2 hours all night.
Normally a pharmacy will supply insulin for an emergency. If you don’t want to do that because of the cost of the analogs buy NPH OTC.
No conversion is necessary - NPH is available in 100IU/mL and I think that matches Tresiba. Units convert directly; that’s the point. What doesn’t convert is the time over which a delayed action insulin delivers units. If you are relying on the basal dose to cover some of your bolus requirements differences in delay will result in apparent differences.
The trick I use is to simply half the basal and deliver it twice as often; then I get a pretty much flat basal and I can use correction boluses to deal with any rising blood glucose. I would expect to deliver the other half of the basal as a bolus (or increase in bolus) during the day. This is particularly easy with a CGM though if you have all the alerts switched off like I do you may want to turn them back on.
Let me respectfully hazard to disagree. NPH has a peak, not a flat delivery. If you take the same number of basal units per day, there will be periods about 6-8 hours after each dose where you will be getting significantly too much basal. Of course I’m just stating this based on what I think I’ve read; I have no personal experience with this.
All the analogs have a peak too, they’re just different. Pumps don’t have a peak - they inject every five minutes or so - and what I do is go from a pump with a totally flat basal of 0.5IU/hour to Lantus with a peak. I do Lantus twice a day at 6IU each dose (so I do not halve it) but I do not use my basal to cover any food intake, so that works for me - Lantus is flat enough at twice a day for me to not notice the peak.
Bear in mind that injecting NPH four or so times a day is a whole lot easier than injecting humalog every five minutes, or even every hour
Since I was already taking Basaglar 2x a day to flatten out the peak in that one, I’m going to try for NPH 4x/day to keep the peaks flatter. I picked up the vial (and some bigger syringes) this afternoon and just took my first dose. Thanks for the advice everyone!
It’s still a little crazy to me that you can get insulin pretty much OTC now when CVS wouldn’t even let me get syringes without an Rx for them.
In most states in the US, you don’t need a Rx for Syringes. There is a well maintained list at Children with Diabetes that breaks down the requirements for both Insulin and syringe requirements by state.
Either they will ship to you or they won’t; @elver’s list works too but Amazon is quicker What is more you can tune issues like gauge and length; gee, if you want to go complete @eric intramusculature you can get 3ml syringes with a half inch, or longer, needle. Much better than some stupid prescription for “syringes”.
The same applies, with bells on, for pen needles. Buy them online, don’t trust a pharmacy to cater to our exact needs.