Analogy time. For many years I used craftsman tools before insurance pools started buying me snap-on. Snap-on are without a doubt tremendously better. Doesn’t mean we should trash craftsman— they certainly get the job done, though granted sometimes with some additional frustration compared to the best money can buy
Well, I’m not really bashing them, just relating my own experiences in using them, and my experience happens to include severe lows and large daily swings in my blood sugar. Certainly they kept me alive for a decade until MDI came alone. It’s totally possible that different people react very differently to them, just as is the case with modern insulins. Did you ever experience severe lows or DKA while using them? Did you use them with two shots a day, or in an approximation of MDI?
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Yes I had severe highs and lows! I was 5 years old, and we didn’t even have blood tests yet! 
I started with one shot per day, then moved on to two, and eventually many shots per day.
I guess the point I wanted to emphasize is that the guy who died because he couldn’t afford NovoLog, or Humalog, or Apidra, or Lantus, or whatever. That is why I wanted to post this. Because I just don’t get that! What happened to him? Did he not know?
I just wanted people to know how cheaply they could get a survivable insulin regimen for very little money.
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Oh yeah, I agree with that. I was just talking about what I would do if there was a major disaster and those were the only insulins I had access to.
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You’d be fine. Certainly you are more experienced now than decades ago. We all are.
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I would be fine. I’m just saying I’d be using R and NPH differently from the two shots that were recommended back then so that my blood sugar would be as stable as possible.
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It’s comparable to what we see happening in Texas today. It’s comparable to a frog in room temperature water slowly heated to boiling. We know the risks. Human nature dictates we will not respond appropriately unless prepared in advance. Therefore, we can easily determine that our only chance is to prepare in advance.
That water didn’t scream in there without warning. The water in the beaker with the frog didn’t get hot instantly. We can never assume we will never be in a bad situation. Those of us who have already, and those who think ahead, have learned to prepare for the next one-- those who don’t perish and their genes do not reproduce— that’s natural evolution in the grand scheme (no disrespect to the victims)
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FYI, we have an old thread (a wiki, in fact) that came out just after we found about poor Shane Boyle, that discussed the same topic, and also covers other diabetic items (not only insulin):
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I think the DOC offers an enormous wealth of connections, information, and resources. I wouldn’t hesitate to say it’s absolutely changed my diabetes life, and I’m not sure what my diabetes control would be like without engaging with the DOC for the past 12 years. I can imagine that someone not connected to the DOC may be completely unaware that they can get insulin cheaply and without a prescription, and would have no one around to tell them… I don’t know of the specific instance that’s being referred to, but it sounds tragic. 
Hopefully your post will pop up in Google should anyone be searching for such information in the future.
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Sadly, my own mother, a physician who primarily treats children in a community with low economic means, wasn’t even aware of this… until I became active in the DOC
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That’s pretty much how I recall doing it. The parameters are–or at least were–very loosey-goosey because at first we didn’t have BG meters, and even after we did the way these insulins work just doesn’t really adapt itself to carb counting, I:C ratio and whatnot. But there are some modifications. One thing I’ve heard of people doing is splitting the NPH across more, smaller doses throughout the day, which simulates something closer to the much flatter curve of a basal insulin like Lantus. But R is never going to act like Novolog. A hybrid regimen using N this way for basal, but still using Novolog (or other analogue insulin) for meal boluses, would be another approach. That would at least save you money, but doesn’t exactly fit the stockpiling-for-zombie-apocalypse scenario here.
As for traditional R/NPH therapy, my advice:
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Start off dosing low and edge up incrementally as you get accustomed to how this stuff works. That R/N overlap can be especially tricky. This stuff can really hit like a hammer when it decides to (a.k.a., The pre-bolus from hell). Which leads to…
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Test a LOT, especially at first.
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Try to be as regular and predictable in your timing and amount of carb consumption as possible. Same goes for exercise. I imagine this would be the hardest part to get used to for anyone whose only experience is with modern MDI or pump therapy. Once you take that double shot in the a.m. those effect curves are gonna do what they’re gonna do, you don’t have any control over it, and it’s not like Lantus where it’s just a low-level flat effect and you can delay lunch if you’re stuck in a meeting. R/NPH doesn’t care, it’s going to come on anyway. Hence my nickname for this whole regimen: Eat Now Or Die.
Of course YDMV always applies and R/NPH has its fans even today, but most of the ones I’ve encountered are people who started on it, tried modern MDI, and decided they liked their old way of doing things better. We love what we’re used to I guess. After 20 years on it, I sure didn’t though.
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As I read this–
–that’s a significant expense too. There are also cheap test strip alternatives, as @sam has often pointed out. But if you’re really wanting to get the low down on lo-fi treatment, that other nostalgic relic of the D past, Diastix, are still available. Scissor 'em the long way and you get two for the price of one. Might as well get the whole 1983 experience!
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BG testing can be kinda expensive. We have a thread on cheap test strips on Amazon: strips-on-amazon-best-choices
I like the mention of the Diastix. And the mention of splitting NPH doses would also be helpful. We didn’t do that back then, it just wasn’t really thought about or whatever. Good points you added. Thanks!
In general, the idea of surviving on $50 without insurance for insulin was just about staying alive for a while. You would have to accept a bit of downgrading on your control.
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Yes, I like to think of it as the lo-res approach to D care. Very noisy and pixelated!
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Here’s an activity graph for various insulins, including NPH and Regular, that I thought might be valuable to those who have not experienced those insulins.
It readily implies a starting point for the old insulin therapy we used back in the day. As @Eric said, you have to eat to the insulin, which is backwards to how we do it with more modern insulin.
One caveat is that YDMV to an even greater extent with NPH (Lente) and regular. If you think a few Skittles is going to stop a crash initiated by the intersection of the NPH and regular curves, think again.
And it’s all the more complicated because for most people the onset, peak, and duration of these insulins can vary from injection to injection.
But, all in all, it surely beats the alternative of not having any insulin.
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Possibly why some of us oldies are so much more into the big fixes, like donuts and stuff…
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It was also a major improvement over the previous one-shot-per-day Lente approach. I really do think it’s correct to think of it as an increase in resolution as the medication tries to come closer to what a functional pancreas does. With R/NPH you at least have a couple of curves to work with. With analogues-based MDI you have a low baseline insulin more or less like what a healthy pancreas does, but a much more accurate (if still imperfect) multi-curve way of targeting individual meals and carb intake. With a pump, you add multiple basal rates customized to your own metabolism–multiple square waves instead of just one. And with the 670G in auto mode (which I just started a few days ago, huzza!) those big chunky square waves are replaced by hundreds of micro-doses, responding to a reasonably good sampling of actual BG. Kind of like going from 8-bit to 64-bit processing, though it has taken a devilishly longer time to get there.
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Looks to me like you could just eat more pizza and it would work out great!
Kidding… after all my afrezza useage I’ve come to take these curves with a grain of salt… sometimes lab results don’t match the real world
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Or a couple of tablespoons. That intersection part was the real joker in the deck. And yet it sits there looking like such a nice, predictable point on the old x/y in that graph, doesn’t it.
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Can I talk you into starting a thread about that? I’m really interested in how well it does or doesn’t work
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