Barrels filled with angry plague-carrying rats
“A joint investigation by Channel 4 News and the BMJ reveals the NHS spends tens of millions more than necessary on modern insulins to treat diabetes despite guidance from NICE to use cheaper products.”
Apparently “the benefits of modern insulins do not justify their cost and they recommend that patients should be started on human insulin – an older, cheaper version of synthetic insulin”.
This dog thinks that diabetics using older, human insulins is a stupid idea and the author of this report should be nailed inside a barrel with a couple of angry plague-carrying rats and rolled down a bloody steep hill into a shark infested lake. Woof!
Source: http://www.channel4.com/news/nhs-wastes-tens-of-millions-on-expensive-diabetes-drugs
It’s those Types 2’s causing all the trouble again, increasing in number and wanting expensive drugs.
There is a modicum of sense in this though. Firstly, you have to give the report author credit for correctly identifying the differences between T1 and T2 and focussing their report only on T2. If I look at my grandma, T2 on insulin, she did fine on ye olde Ultratard and Actrapid. She had a pretty routine life and wasn’t looking for tight control, just looking to keep the numbers below kidney frying territory. Others with T2 have the cheek to want to have a life and actively manage their diabetes and find that ye olde stuffe doesn’t work so well for that.
It’s almost as if we need to assess each person with diabetes based on their individual needs and prescribe accordingly. Rather than making uninformed decicions based purely on drug company marketing spiel. Or would that be too logical a way to run healthcare?
That’s madness Alison! Tailoring healthcare to an individual’s needs? Whatever next? Sounds dangerously communist to me.
Your grandma is much like my grandfather – who is type two and uses some ancient insulin twice a day. Being 90, and only having been insulin dependent for 2 years, he’s not so worried about long term complications resulting from slacker control.
I hope this guy develops type 1 Karma can be a bitch.
Is there evidence that the analogues are => human? The only information I have on this is from the already discussed hippy-new-is-bad leaning IDDT who say there isn’t any proof that analogues are as good as the old stuff… Would love something else to argue with my mum about over the festive period! 😛
Geeeze! Thanks Alison! It seems that the recent conclusion from the survey in our soar away Shoot Up blog wasn’t too far from the truth. It’s not much of a step from downgrading the treatment of T2s to summarily executing them in the name of cost savings. Maybe we should withdraw treatment from them altogether, after all, their condition is self inflicted by gluttony and idleness, they’re obviously not worth helping.
If we can’t stomach the executions, why not just withdraw treatment and keep lopping off their extremities until they succumb? Maybe not even that, we can just play the waiting game and gangrene and nephritis will reduce their numbers fairly efficiently, then the only dilemma is whether or not we can afford the opiates to make their passing relatively pain free. Once the T2s are dealt with we can start on the asthmatics, and all the smokers and ex smokers with COPD, then on to the IBS sufferers. Damn! We could save millions!
Couldn’t agree with you more @Teloz 😉
Seriously though, while I don’t support the blanket restriction of a particular drug, I do support evaluating who would actually benefit from it before seemingly switching most people to it because its a newer model that the drug company are keen to push.
My personal experience is that when I switched to an analog (Humalog) it helped me achieve much better control. But that’s only because I was actively managing my diabetes in the first place. If you’re 97, watching TV all day, sticking in 5 units with every meal and are happy with the results I’d question whether switching to an analog would be anything more than an inconvenience. Equally if you’re 97, living an active and varied life, carb counting etc the analog might help.
The is along the same lines as the pump argument – its probably not appropriate for all type 2’s but its certainly not inappropriate for all type 2’s either. If you can define the criteria for who is most likely to benefit you’re likely to get good results and value for money (ignoring that fact that a lot of the time eg pumps we write the criteria and then fail to implement it properly, thats another issue entirely!).
Hello… well, at risk of being contentious in my very first post…
I read the research papers for Lantus and Novolog. I will quote you the conclusion of the Medical review, carried out by the Doctor who was the Medical Review Officer, for the research on Lantus on January 24, 2000.
“Glycaemic control with HOE 901 (Lantus) is largely the same as with NPH (Regular human insulin), except that patients switched to HOE 901 had more hypos during the first month than patients continued on NPH. Extensive sub-group analysis yielded minor differences with respect to hypoglycaemia: patients previously on once daily basal insulin appeared to have less hypos if treated with once daily HOE 901 than once daily NPH. However, patients previously on multiple doses of basal insulin tended to have less hypos if continued on twice daily NPH than switched to once daily HOE 901.” My brackets.
This is the reviewers conclusions for Novolog:
Our analysis suggests only a minor benefit of short acting insulin analogues in the majority of diabetic patients treated with insulin. Until long term efficacy and safety data are available we suggest a cautious response to the vigorous promotion of insulin analogues. Due to fears of potentially carcinogenic and proliferative effects, most studies to date have excluded patients with advanced diabetic complications. For safety purposes, we need a long-term follow-up of large numbers of patients who use short acting insulin analogues. Furthermore, we need well designed studies in pregnant women to determine the safety profile for both the mother and the unborn child.
PMID: 15106199 [PubMed – as supplied by publisher]
As the Cochrane review pointed out in fact… there is very little benefit. BUT there is a question over whther analogues are safe in the long term as their structure is very similar to human insulin-like growth hormone – a very carcinogenic substance. We are their guinea pigs. I take animal, natural insulin.
Welcome Liz, be as contentious as you like! I think it goes back to it being a personal decision what drugs you take. I did see significant benefit when I changed from “old” to “new” insulins and consider the proven (for me) reduction in HbA1c and therefore long term complications to be worth potential long term safety issues. That said, I also know people who have had huge problems with any form of human insulin and much prefer animal. The key is that we should all making informed decisions based on the evidence (both published and personal). Sadly that doens’t always seem to be the case.
Hi! I did use human Actrapid and it was certainly good at controlling, but I began to get problems with my fingers. When I moved to Humalog (not a human insulin, but an analogue, which is unlike any mammal insulin in the world, in fact is really an artificial blood glucose lowering substance (in my pump) my fingers seized up completely, and what with various other problems, I tried pork Actrapid and all my problems disappeared. Wish it was still available!
@Lizz How very strange. I’ve heard of lots of people having problems with lack of hypo warnings on human compared to animal, but never finger problems, that must be a real pain.
@lizz – Hi there and welcome to Shoot Up; as m’colleague says please feel free to be contentious – there’s nothing like a nice bit of contention!
I’ve always been on humalog so I’ve nothing to add to this discussion. I do, however, think that sometime Big Pharma might be tempted to push a new, patented, product rather than something older and perhaps generic. They are businesses not charities, but there is a line.