Sunday, November 25, 2012

NPH reduces A1c more compared to Lantus or Levemir in Type 2 Diabetics

When a person is started on only one type of insulin (not on a pump), making that insulin NPH or a mix of NPH and a short acting insulin, will reduce A1c more than taking Lantus or Levemir or a short acting insulin.
Probably this is for the very simple reason that if you are taking an insulin that acts as both basal and bolus, you can raise the dose to an extent that you can't do if you are taking an insulin that is only basal or bolus, and with more of your insulin needs covered.... ta da! Your A1c drops more.
Studies to this effect are included in the Lantus patient information, but a number of newer studies have shown the same thing, such as this one. I find this especially remarkable given that NPH or a 70/30 mix can be bought at Walmart for $25/1000 u vial, while Lantus can't possibly be bought anywhere for less than $90/1000 u vial (including amount paid by insurance).

And I'll throw in a bonus fact: the average A1c of a type 1 diabetic adults in different areas ranges from 7% to more than 10%. In the DCCT participants, the average A1c of the control group, and of the intensive group after they stopped getting intense attention from doctors, was 8.9%. If you are looking at data about average complication rates, you should probably assume that those are average for people whose A1cs are in the neighborhood of 9%- because that is about what average people seem to acheive if they are not personally doing a lot to change their diabetes outcomes.

Yesterday I seem to have accidentally deleted the last six months' worth of comments on this blog. I hope none of you are as bugged by that as I am. Feel welcome to go back and make up for it by leaving lots of comments.
I am kind of annoyed at Dexcom because my case manager is not doing much. Not getting back to me, not getting a prescription. And everybody at Dexcom keeps  telling me she will. Ha!
My Gentle Jet is being built now. Yay!
My blood sugar's been a mess for a couple of weeks (random highs in the 300s) and I kept thinking the issue was delayed absorption of meals but yesterday I didn't eat after 5:30 PM, didn't go to bed until midnight and still went into the 300s overnight. So I'm thinking the issue is really mostly a too low Lantus dose even though it doesn't totally look like it (I keep going low too, for one thing). Tonight I'm raising the dose although I haven't decided by how much.

1 comment:

Nathan said...

Sorry about the comments! I lost several years of blogging once and it was super disappointing.

I wonder if the NPH A1C benefit has to do with some of the potential for lows. When I was on NPH or 70/30 my blood sugar would drop around lunch time pretty fast and I had to eat on schedule or I'd have lows. It seems like that might show up in A1Cs (looking good), but in reality it's not so great.

Yeah, you are right, the standard results aren't that impressive. When I see stats saying that tight regimens are less beneficial at preventing complications, I have to take it with a grain of salt, because most people in the studies are getting higher a1cs than intensive patients are getting these days. I wonder if they even have studies to show the impact of A1Cs in the 5-6 range for T1D people.

I think we are going to see a trend of diabetics living longer and better as more time passes.