http://www.kevinmd.com/blog/2009/10/newest-longlasting-insulin-necessarily.html medical blog Fri, 19 Mar 2010 02:47:15 -0400 http://wordpress.org/?v=2.8.4 hourly 1 http://www.kevinmd.com/blog/2009/10/newest-longlasting-insulin-necessarily.html/comment-page-1#comment-115829 Dr. Mintz Wed, 28 Oct 2009 13:29:28 +0000 http://www.kevinmd.com/blog/?p=40852#comment-115829 I agree that, especially in primary care, that split mixed is often better tolerated than basal bolus, and though basal bolus is more physiologic, there is limited data that says it is actually better. However, I find there is a big difference between old 70/30 and Humalog or Novalog 70/30 which contain the analogue insulin. Regular human insulin peaks too slow and stays around too long. I find I get better control and less hypoglycemia using these more expensive drugs. These insulins are always at a tier 2 status for patients with prescription coverage, so I would only use the generic insulins for patients who pay out of pocket, which is fortunately becomming more infrequent. Finally, since Lantus has been shown to be potentially associated with cancer, I have avoided it's use. Levemir is equally effective as Lantus and does not cause cancer. I agree that, especially in primary care, that split mixed is often better tolerated than basal bolus, and though basal bolus is more physiologic, there is limited data that says it is actually better. However, I find there is a big difference between old 70/30 and Humalog or Novalog 70/30 which contain the analogue insulin. Regular human insulin peaks too slow and stays around too long. I find I get better control and less hypoglycemia using these more expensive drugs. These insulins are always at a tier 2 status for patients with prescription coverage, so I would only use the generic insulins for patients who pay out of pocket, which is fortunately becomming more infrequent.
Finally, since Lantus has been shown to be potentially associated with cancer, I have avoided it’s use. Levemir is equally effective as Lantus and does not cause cancer.

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