I don’t think those of us who are commenting are being “negative” but rather just relaying our own experiences (which, yeah, with few exceptions were not great).
If I were doing this experiment, I would hope for the best but prepare for the worst. If getting a good basal/baseline dose were as simple as splitting NPH into 4-6 injections a day, I think more people would be doing that (or would have in the past). The fact that they didn’t and don’t might mean that it won’t actually work as well as you hope, in which case you’ll have to fall back on something like what most of us used decades ago. (Which, yeah, may not be a big deal when you’re doing an experiemnt that you can start and stop at will and when you have modern technology at hand, but was a big deal for many of us who used it as children/adolescents/young adults and had no choice in the matter.)
There’s some truth in this. Those “crude” insulins were all we had (I’m talking '70s, early '80s), BG meters were only just on the market and even then we knew how basically pointless urine testing was, most of us followed the orthodox regimented diabetic diet, A1c wasn’t even invented yet, and what the heck was a basal? To take our current knowledge about, for instance, insulin action and carb metabolism, combined with current technology like BG meters, and use the older insulins could be interesting.
I think I had most of this with R/NPH—pretty much everything except a CGM. My meters took closer to a minute to give me a result, granted, but I was diagnosed after BG meters came out.
I said that same thing while on a pump. I eat that way by choice, since it reduces my insulin usage, weight, and is healthier overall. The difference is that I made the choice to do so.
I’m looking forward to Sam’s experiment. It’s clear that he is an expert with modern diabetes control. And I’m happy that he’ll start with the protection of CGM while dialing in his technique with these insulins. After the CGM is dropped and he gradually reduces the number of test strips per day I imagine there will be some point at which it becomes more-or-less unworkable, and it should be illuminating to see what that point is for him, given his skills and his diet.
As a young engineer, I wanted flexibility in meals, exercise, etc. And I kept being told how much better a pump would be for my lifestyle (except by my Endo, who was against the pump). So I switched. My a1c went to the 10-12 range and I had complications. That is why I jumped on Tresiba and Afrezza when they came out.
Please don’t take this experiment as a personal attack. Sam does not mean it that way. I’ve known him for a while. He is not trying to belittle anyone’s experience here.
The point of it (I think) stems from something that happened last year. Some guy died because he supposedly couldn’t afford his normal insulin. And we were all aghast, because he could have purchased a few bottles of $24 insulin and stayed alive.
So this demo is just an illustration. I do not thing anyone should take it personally.
Things like this are what make me stay out of the politics page.
Anyway, that’s all I wanted to say. Hope everyone can play nice.
It is really difficult to read into people’s intentions and feelings from what is written in a forum post, particularly as we all post fast. So it is easy to leave interpretations that are not there.
Sam is a truly nice person who has helped incredible numbers of people through his kindness. Some of his posts may be read in the wrong way, but I am sure that his intentions were not to discount anyone’s experience.
Didn’t someone suggest @Sam try this with urine strips?
I remember those days (and pork insulin). But then that takes me back to a discussion on “modern” treatments in other countries, of which I have also been subjected to
To be clear I’m not trying to discount anyone’s struggles in the past. I have no doubt that using R and NPH 30+ years ago was very very hard. My assertion is that now, decades later, it wouldn’t be that hard. It would have been just as difficult for me as anyone else decades ago.
My grandfather plowed fields by hand decades ago. Making the assumption that it would be much easier to do it now with modern tools and equipment and techniques is in no way dismissive of how hard it used to be or indicative that someone wasn’t doing it right in the past.
I take absolutely no offense to anything @Sam has posted here. I admire him for wanting to do this experiment.
The only point I would have to make is it’s a naive assumption that NPH can be made to act like a modern analog basal insulin, and that the CGM will make this all possible.
The value of the CGM will be to catch and act upon lows. It will have no value in trying to treat highs, and if that is attempted will result in nothing more than a roller coaster.
I can’t emphasize enough the necessity to make an insulin activity graph and follow it’s results.
It sounds like R/NPH may have worked well for you because you’re comfortable with having the same eating routine day-to-day. I’ve never been on the pump while using R, but that sounds tough. I’m glad you were able to lower your A1c from what it was on the pump.
I also think it’s important for @Sam to appreciate the ability of these insulins to cause severe and prolonged lows and to be really careful if trying something like four or six doses of NPH. Maybe it’s just my own experience, but I think R and NPH are less forgiving than any of the insulin analogues if doses or schedules are off…
Well depends on how retro he wants to go. What @Sam hasn’t realized is that to do this experiment correctly, he’s going to have to also replace his smart phone with a landline rotary phone for the entire duration. And walk to school in the snow uphill both ways.
The only thing that has changed for me is the availability of a cgm. So, for me, it would be hard. It would be a big deal. Feel free to find out if it would be a big deal for you. I’m willing to acknowledge that people who are willing to adhere to a tight eating regimen may not consider the switch to R/NPH (e.g. @kmichel) a big deal. People who would struggle with this tight schedule would consider the switch a big deal.
Especially while aiming for an A1c of 5%… I mean, most of us who had not-so-great experiences weren’t even aiming for tight control compared to what we aim for today. We were just trying to get through life without too many severe highs and lows, and even just that was hard!
