Apropos to last week’s post on Testing Driving Insulin, I was thinking about the ‘older’ versions — and discovered a reader letter I received back in February of 2006. It seems just as timely today, considering that research supported the case for continuing to offer patients the option of animal insulin:
“In our systematic review we could not identify substantial differences in the safety and efficacy between insulin species. Many important patient-oriented outcomes like health-related quality of life and effects on diabetic complications and mortality were never investigated. Human insulin was introduced into the market without scientific proof of advantage over existing purified animal insulins, especially porcine insulin” — B. Richter & G. Neises
Hmmm. Take a gander at my original post:
The Quest for Animal Insulin
Apropos to Diabetes Health Magazine’s latest feature on “Where Have All the Insulins Gone?” I had no idea that the evolving insulin market might have been bad for some patients — much less the celebrated changeover to synthetic human insulin. Meet Jim Daly from Massachusetts, who shared his brutally honest story with me this week (reprinted uncensored, except for inserted links, with permission):
Hi Amy,
My name is Jim. I am 32 years old, type 1 since age 10 (1984). I love your website. I am glad I found it.
I hope you will listen to my story. I just went on humalog and lantus after being on Lilly’s iletin II
pork insulin (mixed R and NPH split dose regimen) for many years. I admit my control wasn’t great and I have been a “lazy” type 1 diabetic for many years but I do have good reason for this. I was on humulin from 1986 thru 1992 and had severe episodes of hypoglycemia unawareness and also instances of not being able to get glucose in time to avoid a loss of consciousness. The final two times – I fractured my skull and bruised my brain during these severe hypos.
I saw a Dr. William Black at the Joslin and was advised to let my sugars run a little higher and was also put back on beef pork insulin at my mother’s urging. My mother was type 1 from age 4 thru age 74 (she died of a stroke). She was a wealth of knowledge on the subject of living with this disease. She was insistent that the “new” insulin was to blame for these severe lows.
By the way – my mother had no complications other than possibly heart disease (which led to her stroke). This may not be directly diabetes related but more of a lifestyle issue. I was able to obtain pork insulin in 1998 when Lilly took beef-pork off the market. I also began corresponding with the IDDT a England based diabetic public interest group founded on the principle of insulin choice – synthetic or animal source. I have tried to obtain animal insulin to no avail. I even complained to Lilly. My phone call was met with a request for my mother’s medical files and a Lilly magazine in the mail. Seems that the fact that animal insulin is better for me doesn’t matter when a company is faced with an “economic” decision.
After being told no by my second opinion Dr. I gave up and am compliant with the “physiologic regimen” of minimum 4 shots and constant monitoring. It’s a horrible way to live. The lows are more debilitating than on pork and I feel more disabled now than ever. I wish someone would listen. I know what most would say – “better this quality of life than when you are blind, missing limbs, kidneys fail, etc.” I maintain that “newer” insulin isn’t always better. Animal insulin was better for me, but I can’t get it. No doctor will “go along with” what I want unfortunately.
The “industry standard” – the Joslin Guide makes no mention of different warnings animal vs. synthetic, and animal insulin is a mere sentence stating that is was highly impure when first developed. IT WORKED FOR OVER 80 YEARS AND PORK INSULIN in recent years WAS HIGHLY PURE according to reports I was literally yelled at and berated by an endocrinologist this last September.
Granted, I have been running A1c’s of 10 and most recently 11.9. Not good. I was not taking care of myself I know it – I was letting my sugars go high. I do have background retinopathy. I do not have the chance now to be “more vigilant” on my old regimen. I fear the worst on this new insulin – instant death from a hypo. Oh well. I am doing the best I can on the new regimen despite the fierce lows and the changes in symptoms of lows (my lows before were more “gentle” and now I am experiencing vision changes vs. shakiness as the first sign of a low).
I do feel as though my life is not my own anymore – I am consumed with this disease every second of every day. There are advantages. No more nocturnal hypos (from the regular I used to take at dinner). My sugars are running better and my glycohemoglobin will probably be better. It has been a month now. I just wish that there was a choice for diabetics – animal or synthetic / analog source insulin, especially for those experiencing hypoglycemia unawareness or severe hypos in general. As someone who just “switched”, (or maybe even stepped out of my time warp -) I know this insulin is very different and the feeling on it is also very different. I feel like a zombie on auto-pilot half the time. The other half of the time I am cranky and not being very nice to my partner.
Hopefully, with time this will pass as I adjust to the new regimen that is so highly promoted. Hopefully I will survive without a hypoglycemia catastrophe. Too bad we all have to put up with this footnoted side effect mentioned in the DCCT research. This is how Lilly’s decision has impacted my life. This is how this disease has impacted my life.
Thanks for listening!
- Jim
You’re welcome, Jim. I wish I knew what else to say.
Here we are in 2009, and the issue seems closed. Does anyone out there know anything that Jim and I don’t know?
Most patients in this situation (and I’ve met many of them, all of whom are very knowledgeable about diabetes management and feel very strongly about this topic), find the easiest solution is to simply buy animal-sourced insulin from a Canadian pharmacy, as it doesn’t even require a prescription from a doctor. One Canadian pharmacy that sells porcine insulin online is http://www.getcanadiandrugs.com/ and search for “Hypurin R” or “Hypurin N”, but it’s costly (at $131.00 per vial, although that isn’t significantly more costly than newer analogues at retail prices) since it’s imported from the UK, but may be purchased with a Flexible Spending Account using pre-tax dollars!
I always assumed that synthetic insulin was a medical advancement, but I guess it was not for some.
As vegetarians, I wonder if we would even consider using a pork-based insulin. I think I would have to research how it is actually harvested and if it would benefit my child greatly.
My concern with feeding my family meat is more from an environmental standpoint–meat production takes a large toll on the environment from the amount of water and grains needed to the pollution created. If I ever gave my children meat it would have to be organically grown so as not to expose them to growth hormones, antibiotics etc.
That being said, when you have a child (or yourself) with a life or death medical condition, you do what you have to do, whether it is in agreement with your underlying belief system or not.
Like the fact that we are creating a landfill of used test strips, lancets, syringes, pen needles, alcohol swabs, juice boxes, etc., none of which can be recycled.
And even responsible disposable of those products that can be recycled costs the patient money (like OmniPod’s recycling program).
I am almost certain that it was 1986 that all new type 1′s were placed on synthetic insulin. Shortly after that time Eli Lilly began to crystallize beef, pork and beef/pork insulins for storage purposes.
I remember hearing that there was enough of a stash to last 75 years or so.
If my memory is correct the idea was that anybody in the U.S. that needed to go back to an animal insulin could in there lifetime (with the expectation that in 75 years you would have passed on). Everyone diagnosed after 1986 has always been placed on synthetic insulin first.
I am sure that there is a process in which someone can contact Eli Lilly, fill out forms and get your doctor to support the need for you as well.
Sounds bizarre but I got this from a retired Eli Lilly scientist about 8 years ago at an ADA event.
Timeframes and dates may not be perfect but I believe I am spot on.
I don’t know what to think! I’m with Leighann, I always thought synthetic insulin was a medical advancement.
Thanks for giving me something to think about!!
Kelly K
Check out some of Scott Strumello’s back posts and Allie Beatty’s back posts — both have posted misgivings concerning the structural form, pH, lot-to-lot variability, and other issues concerning synthetic insulin.
Synthetic insulin was an advancement … for the biotechnology industry, but NOT for patients (BTW, a number of animal-derived raw materials are used in the production of synthetic “human” insulin [rDNA]. These are peptone, beef extract and pepticase which are used in the preparation and storage of cell banks, and L-threonine and trypsin- used in the purification process to convert the synthetic insulin precursor to human insulin methyl ester. Pepticase is derived from casein from milk from healthy cows only and no other ruminant materials are used in its preparation. L-threonine is sourced from avian feathers and porcine gelatine and trypsin-calcium acetate solution from PORCINE PANCREAS, raising questions about just how “human” any synthetic insulins/analogues really are since their production depends exclusively on animal-derived ingredients).
Most patients in this situation (and I’ve met many of them, all of whom are very knowledgeable about diabetes management and feel very strongly about this topic), find the easiest solution is to simply buy animal-sourced insulin from a Canadian pharmacy, as it doesn’t even require a prescription from a doctor. One Canadian pharmacy that sells porcine insulin online is http://www.getcanadiandrugs.com/ and search for “Hypurin R” or “Hypurin N”, but it’s costly (at $131.00 per vial, although that isn’t significantly more costly than newer analogues at retail prices) since it’s imported from the UK, but may be purchased with a Flexible Spending Account using pre-tax dollars!
It could be that the hypo unawareness is due more to Jims BG averaging 300+ rather than the type of insulin.
Im one of the ones that was started on Human insulins when DX in 1988.
Another consideration is that some patients are allergic to the human synthetics. I remember meeting a young man several years ago who was on pork insulin because he experienced terrible allergic reactions to synthetics. It’s criminal that there isn’t a reasonable outlet for U.S. patients to get the very thing that Banting and Best worked so hard to develop for them.
i feel that the animal insulin is the best type of insulin for my body. i have been diabetic since 1972 and have had very good results using animal insulin and no damage from it.
i suffer from hypothermia and the animal insulin doesnt hide it like the human insulin does for me.
so i need to get and stay on the animal insulin. it makes me feel better and my body enjoys food more when im on it.
[...] saline trial with the OmniPod last week. But first I wanted to expand upon a comment I left over at The Diabetes Mine regarding animal [...]
Check out Standard Process supplements–they are animal based for various conditions–and prescribed by holistic practitioners and MD’s
I am currently taking them for a pre-diabetic condition (preventative maintainance as such) results pending.
Hope this is helpful to someone.
. I wish someone would listen. I know what most would say – “better this quality of life than when you are blind, missing limbs, kidneys fail, etc http://www.canadadiscountdrugstore.com
Its Really my choise