Today’s Topic: Today let’s talk about changes, in one or two ways. Either tell us what you’d most like to see changed about diabetes, in any way. This can be management tools, devices, medications, people’s perceptions, your own feelings – anything at all that you feel could use changing. OR reflect back on some changes you or your loved one have seen or been through since being diagnosed with diabetes. Were they expected or did they surprise you? To read all of the other posts in this category, click here.
Having been diagnosed with diabetes in 1976, I have experienced a huge number of changes. Some, such as the advent of home blood glucose meters, were so long ago that I don’t remember the effect on me or my diabetes care. Others, such as my insulin pump, greatly increased my quality of life but didn’t improve my A1c.
By far the biggest improvement in my diabetes care as tracked by the change in my A1c and maybe in the stability of my blood sugars was the addition of Lantus to my diabetes regimen. Those of you who were diagnosed after the days of NPH missed out on the rollercoaster peaks and valleys of this “Not Particularly Helpful” insulin. There were definite benefits to NPH such as rarely needing a shot for lunch and getting to eat bolus-free candy bars at 4:30 PM in order to make it to dinner without a paramedic visit. But it was an intermediate-acting insulin that was slow to start working and then hit with a vengeance 6-9 hours after injection. The most difficult thing about NPH was its unpredictable variability from day to day.
Lantus was introduced in the United States in May 2001. At that point I was seeing an endocrinologist whom I liked a lot and was/still is quite renown in the world of diabetes. I remember one of my last appointments with him. He looked at my A1c and BG records (using a regimen of NPH, Regular, and Humalog insulins) and said something like: “You’re doing great and seem to be able to get anything to work. Keep doing what you’re doing and let’s not make any changes.” Soon after this appointment I left this endo’s practice for insurance reasons and switched to an internal medicine doctor as required for an endocrinology referral in my new network. At my first appointment with the 
new doctor, he looked at my medications and said something like: “Why in the world are you still on NPH and not taking Lantus?” I was far from a proactive patient in those days and probably had never heard of Lantus.
I started on Lantus immediately and four months later, my A1c had dropped 1.7 points from my test 5 months earlier. Even more amazingly, my A1c was 2.5 points lower than the test of 9 months previous. I had also lost the ten pounds that I had gained in my perimenopause 40’s. So much for an endocrinologist versus an internal medicine doctor…. I got some of my best diabetes care ever from this internal medicine doctor and did not return to an endocrinologist until several years later when I chose to begin using an insulin pump.
Lantus is not perfect by any means and these days many Type 1’s take two to three injections a day rather than the 2001 “promised land” of one injection a day. I am a very happy pumper in 2015 but know that if I had to go back to a regimen of Lantus/Levemir and Novolog/Humalog/Apidra, I would be totally fine. The major change would be that I would have to become comfortable injecting mealtime insulin in front of other people and probably take several injections of Lantus/Levemir per day.
I have decided to negotiate with Medicare who will be my insurer in 23 months. If Medicare will fund my Dexcom CGM, I promise to go back to injections and probably save the insurer money. Unfortunately under current regulations, that idea is a pipe dream and I will continue to pump and save my pennies to personally fund my Dexcom.
One thing that I will not do is to go back to NPH. Unless that is my only choice….
Test Guess and Go 
I’m with you – given a choice I’d choose Dexcom over my pump.
Well, I’ve learned something new today! I was only diagnosed 5 years ago and just take Lantus for granted. I’ve never heard of intermediate acting insulin until now. I guess I should count myself lucky. Thanks so much for this post 🙂
“bolus-free candy bars at 4:30 PM in order to make it to dinner without a paramedic visit” sounds pretty good! You’re so funny.
What would we do if our insurance companies said, “if you stop pumping and go back to shots, we will keep half of the cost-savings and donate the other half to IDF or JDRF, your choice.”
NPH = Not Particularly Helpful! YES, so much so. We were so happy to be rid of it a few months after diagnosis. Never again.
Wow that’s amazing it was able to have such a great impact for you. You got me thinking about Lantus. I have had a bottle in my fridge for years but I don’t think I’ve ever used it. I started on my pump in 1997 so I’ve been on Humalog for as long as I can remember but I’ve had a RX for Lantus for a long time just in case something happens to my pump. And ugh Regular and NPH bring back memories!
I remember NPH and do you remember having no blood sugar meters? I remember having to pee on a stick and if it was blue I was good to go. Red, not good. How accurate is that?? LOL…I also remember being a little girl and asking my dad why I was putting pork insulin in my body:) Back to the good ol days.
I love my Levemir routine. I take it twice a day.:)
“Not Particularly Helpful” insulin. So sad that this was the norm. So glad that things have changed! ❤
I found this really interesting! As a fairly recently diagnosed Type 1, I’m lucky enough to have been put on Lantus straight away – though my nurse told me to take all of my units once a day in the evening. After doing my own research, I actually split the units in half and take it twice a day now, 6 units 12 hours apart. I also need to personally fund my own Dexcom, but that seems like a long way off from now.
Ah NPH – I remember it – unfortunately – got a few good snacks out of it tho 🙂
I had the exact opposite effect when I switched from NPH to Lantus – things really went downhill. I think it was the “one a day” part that didn’t work for me. I didn’t know that you could split it until I found the DOC and I also learned about Levemir at the same time so was ready to switch.
Great post, Laddie. Thanks for sharing.
My dog uses NPH. It’s amazing how quickly things can go from fine to OMG low. I cannot imagine trying to manage my diabetes with it. I’m glad you’re doing better now.
I was put on Lantus right away and never really thought about life before it. Very interesting! I’m glad it had such a positive impact and you (although hope you’re able to continue pumping if you want to).
It’s hard to believe that I spent more than half of my diabetes career on that Not Particularly Helpful insulin, and now Lantus seems to be fading amid the promise of new and great kinds of insulin. Back in the 80s and 90s, the only advancements in insulin-technology were focused on saving pigs and cows, not us.
I do remember my last shot of NPH though. On the night before I began my transition to the pump, my endo had me take a shot of NPH instead of my usual Lantus. That way, by the time I was ready to hook up to the pump, the residual long-acting insulin was out of my body. I remember when he handed me that NPH vial (a whole vial for 10 or so units) and I was astounded – “you want me to go back and use THAT!?”
I was diagnosed in July of 2001 and after trying all the oral agents with no success (no one believed I could become a Type One at age 58) went on insulin in January of 2002. I was immediately put on Lantus once a day at bedtime and Novolog at a 1:15 ratio with MDI. I only tried dividing the Lantus into two shots once a few years ago but my blood sugars were worse. I have resisted getting a pump because I like the freedom of not being attached to two devices (Dexcom and a pump) and would rather have a shot every time I eat or need to correct a high, since the lo-dose BD syringes have a tiny and very sharp needle.Since I reuse my syringes (one per day for Lantus and one per day for Novolog no matter how many shots I have), I feel that I am saving tons of plastic from going into landfills and unknown quantities of fuel and resources to manufacture all the pump equipment and saving taxpayers thousands of dollars on my Medicare bills by not having a pump. I am very lucky to have a wonderful secondary insurance (through my husband’s former employer) and by proving to them that I had hypoglycemia unawareness (through copious detailed records) they wisely agreed to cover my Dexcom, even though Medicare won’t. I’ve never had a low I couldn’t handle, even when my blood sugar dipped to 16 once when I was watching TV. (My A1C has always been in a “good to excellent” range on shots. I’m very technophobic, unfortunately for me.)
Our son was diagnosed with diabetes at age 20 months in 1974 and the changes in diabetes care since then are simply unbelievable.
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