Diabetics with GE insulin intolerance need help!



Kathy Cole wrote:

> On Wed, 30 Jun 2004 14:08:12 -0500, willbill
> <[email protected]> wrote:

>> William C Biggs MD wrote:

>>> willbill wrote:

>>>> after all, Armour is the cheapest source of T3

>>>Not after you include the costs of extra doctor visits
>>>and lab testing.

>> doc, you need to engage brain
>>
>> if one starts with a combo of Armour and synthetic T4 (as
>> i did), then Armour is the cheapest way to get some T3
>> into your routine
>>
>> why can't you bloody docs understand that?

> Color me confused by your reaction; I think the doc was
> suggesting that the total cost of ownership (so to speak)
> is more pricey for Armour, since in his experience there
> are additional doctor visits and lab tests required
> because the doses aren't stable, where more expensive meds
> that are more stable are cheaper in the aggregate given
> the smaller number of doctor visits and lab tests.

there are in fact a minimum of two or three "total cost of
ownership" issues

1. whether having some T3 in one's daily thyroid meds is a
plus or not (and which has been an open issue for
roughly the last
2/5 years (since a significant study showed up in the
New England Journal of Medicine))

anyhow, followup studies are still underway, and imho
are unlikely to prove anything (one way or another) for
the next 3-to-10 years

frankly, i'm old enough that i don't have "3-to-10
years" to bet on the "goodness" of synthetic meds
anymore. and fwiw, i learned my synthetic med lesson
after having used semi-synthetic "human"-R insulin (via
pump) for 7 years, and rDNA synthetic lispro insulin
(a.k.a. Humalog) for 1 year (via pump)

both synthetic insulins caused me subtle problems
(with lispro it continued as "subtle" for my 1st 6 or
7 months, but then escalated to "significant" in the
last 3/4 months, and now that for the last 6 years
that i'm back on mainly pork/beef insulin (overall is
currently roughly
3:25 pork:beef)), my healh is back to what it was in the
70's and 80's. :)

good riddance to synthetic med trash!

fwiw, i was certain enough about my problems with
synthetic lispro that i did report it to our bloody USA
FDA, but i'm not holding my breath on it (lispro
insulin) being pulled

imho, when it comes to synthetic insulin, it's mainly
(all?) politics. what we (t1 diabetic!) need is a real
10 year study on the issue of beef insulin vs. synthetic
insulin ("human" and lispro and aspart and glargine),
similar to the 10 year DCCT Type-1 study

4. whenever one changes thyroid meds, one needs to not only
pay attention to their hypo/hyper symptoms with the new
meds (and amounts), but also to at a minimum run an
expensive set of thyroid blood tests (at an independant
lab it's roughly $150 for a blood draw for TSH/T4F/T3F).

at a hospital lab in the USA, those same 3 tests are
likely to cost $300!

5. on the issue of T3 thyroid med costs, specific to only
having *some* T3 in one's daily thyroid med routine, you
only need to shop around (a lot) for the lowest costs for
thyroid meds...

for example, expensive Cytomel (pure synthetic T3), with
lowest current USA cost likely to be mailorder 50 mcg
Cytomel from www.canadapharmacy.com, (maybe Europe is
even lower, per a recent informative post by ted
rosenberg)

vs. low cost Armour (from www.costco.com in USA),
(Armour is dessicated pig and T4:T3 4:1)

vt. expensive Thyrolar (synthetic T4:T3 4:1 combo very
similar to the cheap natural Armour T4:T3 combo).
(i've only made a few inquirys on Thyrolar cost at
local pharmacys, but never searched for lowest cost
(on the web) for Thyrolar)

to the best of my knowledge/experience, of these, Armour
is the cheapest source for small amounts of T3

imho and more importantly, a case can be made for
having some Armour in one's thyroid med routine as
being *superior* to any of the pure synthetic thyroid
med routines

but that's still an "educated" guess on my part, at this
point in my short experience with thyroid meds, and not
something that i'm willing to get into a fight over in a
n/g "battle"

best, bill t1 since '57
 
William C Biggs MD wrote:

> Perhaps you are retired (so your time is worth zero?)

i am retired, but my time isn't worth zero

although, given my posting here (this last 6 years), it is
easy to think that maybe my time *is* worth zero. :\

you're an active doc, so given your own posting here (on
m.h.d.) in the last 6 years, is your own time worth zero?

trust me doc, it's a rhetorical question and NOT meant as a
slam against you

i've learnt a LOT from you and other t1's here, not to
mention the many thoughtful t2's!!

best, bill t1 since '57
 
Well, right or wrong, I've not had a need to get tested near
as often on Armour as I did on the synthetics. Where I was
being tester 2 and 3 times a year on the synthetics and
adjusting, it has only been necessary to be tested twice in
2 years with Armour, and the results two months ago were
almost identical to those two years ago ( the difference was
0.1+- on Free
T4. everything else was the same ). That being said, if
others have similar experiences, I'd place my bets on
Armour as being more stable and consistent. Add that to
it's being just plain cheap, it falls squarely in line
with the recent realization of a need to reduce pharmacy
costs to patients.

"willbill" <[email protected]> wrote in message
news:[email protected]...
> Kathy Cole wrote:
>
> > On Wed, 30 Jun 2004 14:08:12 -0500, willbill
> > <[email protected]> wrote:
>
> >> William C Biggs MD wrote:
>
> >>> willbill wrote:
>
> >>>> after all, Armour is the cheapest source of T3
>
> >>>Not after you include the costs of extra doctor visits
> >>>and lab testing.
>
> >> doc, you need to engage brain
> >>
> >> if one starts with a combo of Armour and synthetic T4
> >> (as i did), then Armour is the cheapest way to get some
> >> T3 into your routine
> >>
> >> why can't you bloody docs understand that?
>
>
> > Color me confused by your reaction; I think the doc was
> > suggesting that the total cost of ownership (so to
> > speak) is more pricey for Armour, since in his
> > experience there are additional doctor visits and lab
> > tests required because the doses aren't stable, where
> > more expensive meds that are more stable are cheaper in
> > the aggregate given the smaller number of doctor visits
> > and lab tests.
>
>
> there are in fact a minimum of two or three "total cost of
> ownership" issues
>
> 1. whether having some T3 in one's daily thyroid meds is a
> plus or not (and which has been an open issue for
> roughly the last
> 4/5 years (since a significant study showed up in the
> New England Journal of Medicine))
>
> anyhow, followup studies are still underway, and imho
> are unlikely to prove anything (one way or another)
> for the next 3-to-10 years
>
> frankly, i'm old enough that i don't have "3-to-10
> years" to bet on the "goodness" of synthetic meds
> anymore. and fwiw, i learned my synthetic med lesson
> after having used semi-synthetic "human"-R insulin
> (via pump) for 7 years, and rDNA synthetic lispro
> insulin (a.k.a. Humalog) for 1 year (via pump)
>
> both synthetic insulins caused me subtle problems
> (with lispro it continued as "subtle" for my 1st 6 or
> 7 months, but then escalated to "significant" in the
> last 3/4 months, and now that for the last 6 years
> that i'm back on mainly pork/beef insulin (overall is
> currently roughly
> 75:25 pork:beef)), my healh is back to what it was in
> the 70's and 80's. :)
>
> good riddance to synthetic med trash!
>
> fwiw, i was certain enough about my problems with
> synthetic lispro that i did report it to our bloody
> USA FDA, but i'm not holding my breath on it (lispro
> insulin) being pulled
>
> imho, when it comes to synthetic insulin, it's mainly
> (all?) politics. what we (t1 diabetic!) need is a real
> 10 year study on the issue of beef insulin vs.
> synthetic insulin ("human" and lispro and aspart and
> glargine), similar to the 10 year DCCT Type-1 study
>
> 2. whenever one changes thyroid meds, one needs to not
> only pay attention to their hypo/hyper symptoms with
> the new meds (and amounts), but also to at a minimum
> run an expensive set of thyroid blood tests (at an
> independant lab it's roughly $150 for a blood draw for
> TSH/T4F/T3F).
>
> at a hospital lab in the USA, those same 3 tests are
> likely to cost $300!
>
> 3. on the issue of T3 thyroid med costs, specific to only
> having *some* T3 in one's daily thyroid med routine,
> you only need to shop around (a lot) for the lowest
> costs for thyroid meds...
>
> for example, expensive Cytomel (pure synthetic T3),
> with lowest current USA cost likely to be mailorder 50
> mcg Cytomel from www.canadapharmacy.com, (maybe Europe
> is even lower, per a recent informative post by ted
> rosenberg)
>
> vs. low cost Armour (from www.costco.com in USA),
> (Armour is dessicated pig and T4:T3 4:1)
>
> vs. expensive Thyrolar (synthetic T4:T3 4:1 combo very
> similar to the cheap natural Armour T4:T3 combo).
> (i've only made a few inquirys on Thyrolar cost at
> local pharmacys, but never searched for lowest
> cost (on the web) for Thyrolar)
>
> to the best of my knowledge/experience, of these,
> Armour is the cheapest source for small amounts of T3
>
> imho and more importantly, a case can be made for
> having some Armour in one's thyroid med routine as
> being *superior* to any of the pure synthetic thyroid
> med routines
>
> but that's still an "educated" guess on my part, at
> this point in my short experience with thyroid meds,
> and not something that i'm willing to get into a fight
> over in a n/g "battle"
>
> best, bill t1 since '57
 
willbill <[email protected]> wrote on Thu, 24 Jun 2004 16:44:44 -0500:
> Alan Mackenzie wrote:

>> I'd have to side with Nico on this one. Nobody (so far
>> as we know) has tested insulin many years after it's
>> expiry date.

> bill van antwerp (MiniMed) (who's posted here (m.h.d.) in
> the past, but is now absent for "a while" (likely due to
> his new boss (Medtronic)) has to some extent (out to 20
> real years?), but BVA's not a full- time insulin person
> (like Brange), and my guess is that Brange has real 20+
> year experience

I'd like to hear BVA tell us about this. But what is
your basis for believing JB has done longevity tests out
to 20 years?

>> Several years is as far as we've got. We don't know for
>> sure what the stuff's going to be like after 30 years in
>> the fridge.

> formulation is everything! and my hunch is that acid based
> insulins are very short lived

That's going off at a tangent, and has little to do with the
main point here.

>> But I'd agree with you, it seems a reasonably safe bet.
>> (For me, personally, 30 yo insulin is likely to be safer
>> than whatever analog is going to be fashionable in 2034.)

> :)

[ .... ]

>> Hey, steady on Bill! Nico isn't suggesting the results in
>> Brange are rubbish. He's just saying that beyond a
>> timescale of several years they're untested. They're a
>> reasonable best guess.

> incorrect

> Brange's insulin longevity table (in "Galenics") is
> bettter than a "reasonable" best guess

I quote here from the book itself:

> The biological potency ..... according to a first-order
> reaction P(t)
> = P0 e^-kt, where k follows the Arrhenius equation k =
> = e^(A-B/T).

This indicates the formula used for the interpolation and
extrapolation.

> These constants [A and B] have been determined from
> accumulated stability data by Pingel and Vølund (1972).
> For each type of insulin ..... after storage of the
> insulin at different temperatures ... for different
> periods ranging from a few months to several years.

I don't know offhand exactly how long "several years" is,
but we can be fairly sure it's nothing like 20 years. (Did
Rapitard exist in 1952? What young scientist is eager to
start research about which he'll first be publishing results
well into his middle age?) I'd guess "several years" means
four or five years.

I don't know of any scientific principle which enables one
reliably to extrapolate data from five years'
experimentation to a hundred years. Who knows that some part
of the protein won't get "tired" after, say, thirty years,
leading to a sudden deterioration? I think it's unlikely,
but who knows really?

> bill

--
Alan Mackenzie (Munich, Germany) Email: [email protected]; to
decode, wherever there is a repeated letter (like "aa"),
remove half of them (leaving, say, "a").
 
Alan Mackenzie wrote:

> willbill wrote on Thu, 24 Jun 2004 16:44:44 -0500:

>> Alan Mackenzie wrote:

>>> I'd have to side with Nico on this one. Nobody (so far
>>> as we know) has tested insulin many years after it's
>>> expiry date.

>> bill van antwerp (MiniMed) (who's posted here (m.h.d.) in
>> the past, but is now absent for "a while" (likely due to
>> his new boss (Medtronic)) has to some extent (out to 20
>> real years?), but BVA's not a full- time insulin person
>> (like Brange), and my guess is that Brange has real 20+
>> year experience

> I'd like to hear BVA tell us about this.

me too. :)

but assuming that BVA still works for MM/Medtronic, i'm
betting that he's been "muzzled" at this point. :(

> But what is your basis for believing JB has done longevity
> tests out to 20 years?

reading between the lines

you've got his "Galenics" book. slowly read every page. then
slowly re-read every page

>
>>> Several years is as far as we've got. We don't know for
>>> sure what the stuff's going to be like after 30 years in
>>> the fridge.
>
>
>> formulation is everything! and my hunch is that acid
>> based insulins are very short lived

> That's going off at a tangent, and has little to do with
> the main point here.

no it's not. it was one of the points that BVA made in a
response to me about 4 or 5 years ago when i asked him about
how old the oldest insulins were that MM had in their lab
refridgerators (my memory is 20 years, but i'll be the 1st
to admit that that needs verification)

>> Brange's insulin longevity table (in "Galenics") is
>> bettter than a "reasonable" best guess

> I quote here from the book itself:
>
>
>>The biological potency ..... according to a first-order
>>reaction P(t)
>>= P0 e^-kt, where k follows the Arrhenius equation k =
>>= e^(A-B/T).

> This indicates the formula used for the interpolation and
> extrapolation.

>>These constants [A and B] have been determined from
>>accumulated stability data by Pingel and Vølund (1972).
>>For each type of insulin ..... after storage of the
>>insulin at different temperatures ... for different
>>periods ranging from a few months to several years.

> I don't know offhand exactly how long "several years" is,
> but we can be fairly sure it's nothing like 20 years. (Did
> Rapitard exist in 1952?

no it didn't, and as i pointed out in my post the "Rapitard"
is surely Novo's semi-synthetic product and not Novo's
current rDNA product ("Galenics" is copyright 1987 and "human"-
insulin only showed up in 1982 (rDNA from Lilly))

the most likely insulins to be in insulin company lab
refriderators with 20+ years of age are beef and/or pork
R(egular) insulin (aka soluble/neutral)

i mean, internal insulin pumps use R insulin (*semi-
synthetic "human"-R insulin*), BVA also posted useful info
about that too

why R? coz when used in an internal pump, R insulin is just
as fast as lispro or aspart

> What young scientist is eager to start research about
> which he'll first be publishing results well into his
> middle age?) I'd guess "several years" means four or
> five years.
>
> I don't know of any scientific principle which enables one
> reliably to extrapolate data from five years'
> experimentation to a hundred years. Who knows that some
> part of the protein won't get "tired" after, say, thirty
> years, leading to a sudden deterioration? I think it's
> unlikely, but who knows really?

maybe BVA will show up and say something useful

don't hold your breath

assuming that google's n/g info now goes more than 5 years
into the past, you could also try finding BVA's response to
me. i likely still have it on one of my PC's but don't plan
to blow away the 10+ hours (20+?) that it'd take. an hour or
two on google might be the best bet (don't use "willbill" in
the search coz i was likely using a different handle at that
time, not to mention a different isp)

best, bill t1 since '57
 
willbill wrote:
> Nico Kadel-Garcia wrote:
>
>> willbill wrote:
>
>>> Sabine Hancl wrote:
>
>>>> It is the first time I hear, that it is possible to
>>>> exceed the used-by date of the insulin for years.
>
>>> synthetic "human" insulin lasts close to 100 years with
>>> good refridgeration and 5% potency loss (same is true
>>> for pork and beef):
>
>
>> Keep in mind, no one has actually *tried* this stunt.
>
>
> it's not a stunt stupid, it's real

I was referring to the "100 years with good
refrigeration", not to your use of insulin past its "use
by" date. The 100 years is extrapolated from much, much
shorter refrigeration times and matching curves to guess
the date of 5% potency loss.

I can tell you from experience that matching curves like
that is a ***** and a half and easily prone to error.
Your vastly shorter experiences are not unreasonable: I
just meant to point out that the 100 years figure is
fairly useless.
 
IDDT is worried that Novo will pull the plug on pork in
England in 2006.

The following is from their July 2004 newsletter:

IDDT meets the Diabetes Policy Section of the Dept of
Health, 26th May

IDDT made the following points:

· We have never disputed that the majority of people get on
with synthetic insulin but our concerns are for the over
30,000 people who cannot use it.

· Being left with CP pharmaceuticals as the only supplier is
an unsafe position.

· Our concern that if/when Novo Nordisk withdraw pork
insulin, CP has the capacity to increase their production by
the required 66% within the time scale especially if there
is a sudden surge in demand.

· The evidence from the Cochrane Reviews of human and animal
[2002/3] and of human and short-acting analogues, and we
emphasised our concerns about the potential carcinogenic
risks of analogues and the lack of long-term safety and
efficacy data thus making them an unacceptable alternative
for people using natural animal insulins that have an 80year
history of safety.

· That the National Institute for Clinical Excellence [NICE]
should issue guidelines on the use of insulins, especially
taking into account the clinical evidence and the cost
effectiveness of all insulins.

· We asked who is responsible for ensuring that people
obtain their essential medications [pork insulin] if there
is a shortage.

The outcome produced little new information: · There
appeared to be no acceptance of our arguments about poor
quality research and lack of research and little movement
from the past position of 'no evidence' and 'the majority of
people get on with synthetic GM insulin'.

· It seemed to be accepted that Novo Nordisk will withdraw
pork insulin and the year 2006 was mentioned and CP would
supply pork insulin when Novo Nordisk withdraw supplies.

· It was accepted that animal insulin had an epidemiological
record of safety but no such records exist for the analogues
but there are no plans to carry out long-term studies into
the risks.

· We received no answer to the question of who is
responsible for ensuring that people in the UK receive their
essential medicines but interestingly, we were advised to
look into alternative sources abroad. Surely this is not
IDDT's responsibility although obviously we have been doing
this for several years anyway!

http://www.iddtinternational.org/

willbill wrote:

> if you can still get Novo's pork-Lente (a.k.a. Lente
> Monotard MC), i suggest that you immediately stock up 15
> years worth of it coz it is probable that it will soon
> disappear (as it has in USA/Canada)
>
> (the recently discontinued Lilly-pork-Lente was likely
> Novo's (offered/re-labeled thru Lilly per our not so
> lovely FDA/USDA))
 
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