Ask D"Mine: Insulin By Any Other Name...

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Happy Saturday! Welcome back to Ask D"Mine, our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil reflects on varying names for insulin in different countries, even if they"re pretty much the same type of life-saving elixir.

Got your own questions? Email us at AskDMine@diabetesmine.com

Nancy, type 1 from Texas, writes: Please help! I am 58 years old and was diagnosed with type 1 diabetes 2-1/2 years ago. I had no family history of diabetes or any other autoimmune disease. I have been a personal trainer and certified nutritionist for more than 25 years, and was such an unlikely candidate for diabetes that my doctor sent me to an endocrinologist right away for a diagnosis confirmation. To say that I am compliant in my disease management is an understatement. I eat perfectly for T1 and exercise every day -- a lot. And yet I still struggle with keeping my numbers in range. Recently, due to insurance changes, I have been forced to go to Canadian pharmacies for my insulin.

I was doing well with Novolog, but Canada uses NovoRapid. I have been using it for a few days and my numbers are way out of whack. I am too high all the time. I have started upping my insulin dosages slowly and am hopeful that things will settle down. I can’t say that I have left the honeymoon stage, except that slowly over the last 2-1/2 years, my insulin needs have increased. I have a few questions. Are Novolog and NovoRapid really one and the same? If there are differences, is it normal for my body to go through an adjustment period when changing from one to the other? I was very impressed with the way you addressed the “honeymoon” question. After reading your response, I feel that I have a better handle on that aspect of the disease. I don’t know if I have actually left the honeymoon suite yet, but on a daily basis, I inject 12 units of Toujeo at night and currently about 12-15 units of (now) NovaRapid daily, which are higher numbers than 2-1/2 years ago. Is it unrealistic for me to expect to ever be in control of this disease?

Wil@Ask D’Mine answers: Welcome to the family, Nancy! Do you remember the famous Monty Python episode, “Nobody Expects the Spanish Inquisition”?

Yeah. Type 1 Diabetes. Same thing. Only we have a bunch of docs in white coats, instead of a bunch of Cardinals in red, delivering the surprise.

While we are just beginning to ferret out the genetic underpinnings of this disease, and while some families see more than their fair share of type 1, it still remains largely a lone wolf disease. It pops up unexpectedly in healthy and unhealthy people alike. It’s an equal opportunity scourge. So the lack of family history and your healthy lifestyle offered you no protection.

Vexing, isn’t it?

Anyway, I’m glad you’re eating well for a type 1—although be aware of the fact that no one agrees on what that would look like—and that you’re staying active. I share your pain that despite your best efforts, control is illusive. Some of our brothers and sisters manage to make control look easy, while others of us spend our lives banging our heads on the wall in frustration. What’s up with that? Are some of us that much better at control than others? I don’t think so. I have come to believe that there are actually many sub-types of type 1, some easier to tame than others.

Is it unrealistic to expect that you’ll ever get control? Well, more than anything else, that actually depends on what you’re satisfied with. I believe that even the most temperamental strains of type 1 diabetes can be controlled well enough to keep you safe and allow for a long and happy life. But you’ll never have blood sugar control that’s as good as someone who doesn’t have diabetes.

But this does get easier. Diabetes is dog years. I know it seems like you’ve had it forever, but it’s not even been three years. You feel like a veteran, thinking two and a half years of combat is a lot, but you’re still a newbie to this. You’ll get better and better at it as time passes.

As to the honeymoon phase, you could still be in it, and that might be part of the reason your insulin needs are changing. There’s an inverse relationship between the age of diabetes onset and the length of the honeymoon. The younger you are when you get diabetes, the shorter your honeymoon. The older you are when you get diabetes, the longer the honeymoon. The reason for this is believed to be that kiddos have stronger immune systems than us older folks.

In very young kids, the honeymoon can be weeks or months. As we get older, it stretches out. The common wisdom used to be that the honeymoon was over for everyone within two years, but newer research shows that some type 1s still have beta cell production, although not much, far down the horizon, perhaps for decades after diagnosis.

So looking at all of that: Considering the inverse relationship, and the fact that you were already over the hill when diagnosed (sorry, but it’s true), and that you’re only a little bit farther out than the traditional upper limit of the honeymoon phase, I think it’s certainly possible you are still honeymooning.

While some docs will argue that having some on-board insulin production makes control easier, I disagree. I suspect that as the immune system battles it out with the beta cells, there are rallies and defeats. In other words, as the battle rages on, some days one force is doing better than the other. The net effect on you is that some days you have more of your own insulin than on other days, and that unknown quantity of native insulin makes it hard to know how much to inject. As more and more of the beta cells get slaughtered and the mystery X factor of how much of your own insulin is in play reduces, you become more dependent on the injected insulin, and life becomes more simple because you control more of the variables.

Speaking of injected insulin, Novolog and NovoRapid are the same juice. The package inserts for both products identify it as insulin aspart. The brand name NovoRapid is used in Canada, the UK, parts of Europe, Australia and Lord only knows where else on the globe. In most places, it seems. Why the different name in the US of A? I have no idea. So I fired off an inquiry to Novo’s American media relations folks. All six of them. And this is what I learned:

Both Ken Inchausti, the Director of Corporate Branding and Reputation, and Michael Bachner, Associate Director for Product Communications responded, confirming that the two “brands” are the same product, and clarified that the molecule is called Novolog only in the United States. Bachner further said that the FDA declined to approve aspart as NovoRapid, and that Novolog “was the backup name.”

I couldn’t confirm that from any other source, and a more cynical person than me might think Novo chose the U.S. name in 2002 to more closely link their product to their older competitor, Lilly’s Humalog, which hit the streets in 1996. It would be a good way to capitalize on all Lilly’s hard work at the time playing up the differences between modern analog insulins and the older animal.

Personally, if I had to choose, I actually like the name NovoRapid better. It tells me what the product does, not how it’s made.

Still, if it’s the same juice, why isn’t it working the same? Two possibilities come to mind. Not to diss the Canadians, who are a highly civilized folk. But when insulin is shipped in from another county, I have worries about the length of time it takes to get here, and just how it might have been stored at the other end. Plus it’s summer in Texas. I was just in Texas. It’s damn hot there right now.

So it could be that your insulin got a touch of heat stroke: On the other end, in shipping, on your doorstep, or even in your house. Heat exposure doesn’t always cook insulin like a T-bone steak. Sometimes it just saps its vitality.

Or maybe it’s just that your protracted honeymoon is coming to a close and you need more insulin. Your current dosing of basal to rapid is close to 50/50, which is what I’d expect. If you were using less of the fast-acting until recently I’d worry that your doses were out of balance. Perhaps you still had some first-phase insulin production that’s now wearing off.

Either way, I think you are doing the right thing by steadily upping your dose. But a word of caution: When you get your next batch of NovoRapid, be hyper alert and test frequently. Otherwise if you’ve re-adjusted your dosages for heat-fogged insulin and then get the good stuff the next time, you may overdose.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn"t adhere to Healthline"s editorial guidelines. For more information about Healthline"s partnership with Diabetes Mine, please click here.

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