Diabetes Talking » Diabetics » Use of Lantus
Use of Lantus
Question:
I just too a look at the structure and saw only 2 correct amino acids in the 29 amino acid human IGF-1 B-chain, not the 30 amino acid B-chain of human insulin.
I take the homology check back. If you count the amino acids from the wrong end, (i.e., what reference point to start the count when comparing 29 to 30?), then you have two matches on the B-chains. If you start the count from the lispro end (threonine end: B30 side of HI), then you have 15 (includes lispro switch for Humalog) of 29 matches on the IGF-1 B-chain. So much better, — Jim Dumas T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate exercise, typically <6% HbA1c
Response:
Re: Use of Lantus the moral of the story is: don’t switch insulins without giving it a lot of thought and keep an adequate supply of the insulin that you do use, on hand in the fridge coz running out of insulin isn’t an option xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx bill, my insurance C. will not let me stockup. 30 day supply max. to bad for me case the case, minus a few cans!
Response:
Anyone that has a stable situation probably should not change their operating mode. As an aside, I have a T1 friend that has been stable on Lantus+Humalog. He was talked into trying Novolog instead of Humalog. He used Novolog for 6 months then decided it was too slow and went beack to Humalog.
Never used humalog. I use Lantus as basal and either novolog or regular for bolus. I usually limit my use of novolog to breakfast and snacks, since, for me, it peaks and fades too soon with most other meals. I find regular insulin taken 20 – 30 minutes before the meal gives me the most stable and normal bs readings. – Hide quoted text — Show quoted text -He found that when he went back to Humalog, it was now slower than before and he was angry that he had been talked into trying it. So we could hypothesize that his immune system reacted to the "secondary" use, (stop using it for a few weeks then restart), of Humalog by producing more anti-Humalog antibodies (see Guyton’s Medical Physiology, 8th ed. p 377 for an example of "secondary" use of antigens) that delayed the Humalog action profile from the faster action when he first began using Humalog. Since his immune system is now sensitized to the Humalog as a foreign protein, he can never go back and achieve the fast peaks with Humalog that he once had. If this happened to me, I’d be angry. This sounds like a lawsuit to me. The US legal system is wonderful,
Response:
- Hide quoted text — Show quoted text – Humalog is a hybrid human molecule, (A-chain is human insulin and B-chain is human insulin-like growth factor 1), that tricks my immune system into accepting it as belonging in the body. Jim, actually the B-chain of Humalog is the same as human "wild-type" insulin except that the amino acids at position 28 and 29 are reversed. The switch was made based on IGF-1 homology at that end of the B-chain with the observation that IGF-1 does not associate into hexamers as insulin (or at least the association constant is much smaller). Strictly speaking, the humalog B-chain is almost identical to the human insulin B-chain, not the IGF-1 B-chain. Luckily the switch seems not to break immune tolerance to insulin (humalog) for most people.
Hi Axel, You’re right. The Humalog B-chain is very different from the IGF-1 B-chain. I just too a look at the structure and saw only 2 correct amino acids in the 29 amino acid human IGF-1 B-chain, not the 30 amino acid B-chain of human insulin. So the Humalog B-chain is more like insulin than IGF-1. My mistake. Thanks for correcting it, — Jim Dumas T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate exercise, typically <6% HbA1c
Response:
This sounds like a lawsuit to me. The US legal system is wonderful, Whom would he sue? The person that talked him into switching to Novolog?
that’s exactly right. the big pharmas have their asses fully covered. they also have the big bucks to pay for the best lawyers and the best lobbyists, and believe me they do. his best shot might be to sue his doc, even though the doc doesn’t have the deepest pockets Or were you kidding? I don’t doubt what you are saying (although I don’t know much about it) but I don’t really see any *fault* here by anyone. Furthermore,
agreed the most likely outcome is that even if they are at fault, it will all get written off to him being diabetic On a related note, our insurance covers Novalog at a much better rate than Humalog. My daughter continues on Humalog however. Now I guess I am
the moral of the story is: don’t switch insulins without giving it a lot of thought and keep an adequate supply of the insulin that you do use, on hand in the fridge coz running out of insulin isn’t an option for t1 diabetics problem is, insurance companies constantly insist that you do this (i.e. switch) so that they can save a nickel. :( and with all these new analog insulins now on the market, it’s easy to forget that switching can cause problems. after all, all that allergy and skin stuff was 50 years ago, right? as far as i can tell, few docs caution against switching bill t1 since ‘57
Response:
This sounds like a lawsuit to me. The US legal system is wonderful,
Whom would he sue? The person that talked him into switching to Novolog? Or were you kidding? I don’t doubt what you are saying (although I don’t know much about it) but I don’t really see any *fault* here by anyone. Furthermore, On a related note, our insurance covers Novalog at a much better rate than Humalog. My daughter continues on Humalog however. Now I guess I am BL "As the waves pass the rock, their shape is changed. There is a hologram of the rock within the wave that comes forward and crashes on the beach, then there’s a reflected wave back." Ralph Abraham "I’d like to learn to windsurf." BL
Response:
Whom would he sue? The person that talked him into switching to Novolog? Or were you kidding? I don’t doubt what you are saying (although I don’t know much about it) but I don’t really see any fault here by anyone. Furthermore, he would have a hard time with the burden of proof
Hi BL, This fellow was good about the issue and he had no way to quantify these changes in insulin action. But I’m looking down the road with the Glucose Transform as a common place measurement by the MD as well as patients at home. You’d have before and after insulin action data to make good comparisons with therapy changes. The upshot is more knowledge and potential lawsuits if insulin therapy stability suffers. The problem is where to focus the anger. It will probably be at the large pharmaceutical companies since they have the money and most patients don’t want to hurt their doctors. This will probably have a chilling effect on new analogue insulin development. But this may be a good thing considering immune system responses to these new molecules. This also suggests that if you’re doing well with Lantus, then change to Detemir for 6 months before returning to Lantus, you could be in for different insulin action from Lantus. It may be better with more antibody binding for all we know. Knowledge is the great equalizer in our society. If the patients have access to personal insulin action data, it will change the balance of power by keeping big pharma earnings trimmed from fighting lawsuits. My concern and anger at Novo, as an example, is their removal of rDNA human ultralente in the US a few years ago, in preparation for FDA approval of Detemir. There is something wrong here. They just pushed all their patients over to the Lilly rDNA human ultralente without consideration of patient needs. This obviously looks like market manipulation to me: "Get them doggies moving, Rawhide!" What bothers me about Detemir is the extremely high plasma concentrations to achieve basal glucose homeostasis. This looks like CVD city to me. So I have no interest in Detemir. But if we T1s are herded into the few basal insulins, that may not be human insulin molecules, then we have a problem that must be resolved legally, since the FDA is useless. (I’ve been watching generic manufacturers gaining ground. There is one that specializes in injectables and maybe the insulin market is big enough to get its attention. Could be interesting.) In any case, how to us the legal system effectively. That’s the question, — Jim Dumas T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate exercise, typically <6% HbA1c
Response:
Anyone that has a stable situation probably should not change their operating mode.
As an aside, I have a T1 friend that has been stable on Lantus+Humalog. He was talked into trying Novolog instead of Humalog. He used Novolog for 6 months then decided it was too slow and went beack to Humalog. He found that when he went back to Humalog, it was now slower than before and he was angry that he had been talked into trying it. So we could hypothesize that his immune system reacted to the "secondary" use, (stop using it for a few weeks then restart), of Humalog by producing more anti-Humalog antibodies (see Guyton’s Medical Physiology, 8th ed. p 377 for an example of "secondary" use of antigens) that delayed the Humalog action profile from the faster action when he first began using Humalog. Since his immune system is now sensitized to the Humalog as a foreign protein, he can never go back and achieve the fast peaks with Humalog that he once had. If this happened to me, I’d be angry. This sounds like a lawsuit to me. The US legal system is wonderful, — Jim Dumas T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate exercise, typically <6% HbA1c
Response:
Anyone that has a stable situation probably should not change their operating mode. New is not better.
Hi Guy, Just want to say that my goal is to use insulins that are human molecules to begin with. I’ve always used rDNA human insulins and plan to stay with these preparations. Humalog is a hybrid human molecule, (A-chain is human insulin and B-chain is human insulin-like growth factor 1), that tricks my immune system into accepting it as belonging in the body. Novolog is the first non-human analogue I’ve ever introduced to my metabolism. It will probably be the last if I have my way. My conservative view is traced back to my biology teacher mother who was a lab tech at Harvard Medical school just after WWII. So don’t mess with the freaking monkey and you won’t get bitten, — Jim Dumas T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate exercise, typically <6% HbA1c
Response:
Jim, I had allergy work in the early 1960’s and was aware of the immunity problem in many situations. The method then was to identify the allergin and overload your system with it and exhaust your supply of antibodies, The many skin tests were used to find the culprits. In the 80’s there was an article in about a better understanding of the mechanisms. I know so little about this area but I see anomalies that suggest that antibodies are a factor in insulin use. I put out a feeler once and a while to see if someone will provide more data. As a side issue people like myself that had high radiation exposure seem to have immunity and allergy problems. I do worry about medical x rays but just a feeling. I will look for your reference, Thanks. Guy – Hide quoted text — Show quoted text – Anyone that has a stable situation probably should not change their operating mode. As an aside, I have a T1 friend that has been stable on Lantus+Humalog. He was talked into trying Novolog instead of Humalog. He used Novolog for 6 months then decided it was too slow and went beack to Humalog. He found that when he went back to Humalog, it was now slower than before and he was angry that he had been talked into trying it. So we could hypothesize that his immune system reacted to the "secondary" use, (stop using it for a few weeks then restart), of Humalog by producing more anti-Humalog antibodies (see Guyton’s Medical Physiology, 8th ed. p 377 for an example of "secondary" use of antigens) that delayed the Humalog action profile from the faster action when he first began using Humalog. Since his immune system is now sensitized to the Humalog as a foreign protein, he can never go back and achieve the fast peaks with Humalog that he once had. If this happened to me, I’d be angry. This sounds like a lawsuit to me. The US legal system is wonderful,
Response:
Anyone that has a stable situation probably should not change their operating mode. New is not better. Diabetes is a spread of conditions, One size does not fit all. So if there are problems we need to look at all products to see if they will solve some problem. If there is an improvement then it is to watch for problems until you have long experience with it. The real folly is to be faddish and get caught where you are harmed by some new product.. I was put on one "new miracle pill" and I will pay for that the rest of my life. Would it be proper to report your experiences and opinions and to be careful to not use undue pressure on others. Yes Guy