The cheaper insulins: Humulin N and R
Did you know that insulin can be bought over the counter and with NO prescription?
Let’s talk about some “cheaper” insulin options.
Before we start…I want to be clear that I in now way condone switching to these insulins from current long and rapid acting unless it’s ABOSLUTELY financially necessary (no insurance, for example)!!! Adequate control is much more difficult on this regimen, however with real diligence by the user and appropriate follow up with a clinician, control can be had!
Humulin N is considered an intermediate-acting insulin (used in place of long-acting insulin) and lasts approximately 14-24 hours. It is typically taken 2-3 times a day. This insulin begins working within 1-3 hours and peaks between 4 and 10hrs. Remember, long-acting insulins (Lantus, Levemir, Basaglar, Tresiba, and Toujeo) have a much flatter profile and their peaks don’t necessarily need to be considered (person dependent). This is different with intermediate-acting insulin. For example; Humulin N given before breakfast may peak around lunch time. Therefore, someone on this regimen may need to take less or no rapid/short acting insulin at all for lunch.
Humulin R is considered short-acting (not to be confused with rapid-acting) and may be used for meal coverage in the place of Humalog, Novolog, Fiasp, or Apidra. It begins working in 30-45 minutes, peaks in 3-4 hours, and has a duration of action of 5-7 hours. As you can imagine, these time frames can make prandial BG control much more difficult. It is even more important to give mealtime insulin EARLY with Humulin R because it takes longer to have an effect. It also takes much longer for Humulin R to bring down a high BG. Additionally, the longer duration of action makes insulin stacking a real concern.
I have seen different price points for both Humulin N and R, but they typically cost between $50 and $150 over the counter (depending on coupons etc). Like I have said, control on this regimen isn’t easy, but I have seen it done with a strict routine and frequent follow up.
If you are considering this option, make sure to ask yourself how much this sort of routine will change your lifestyle, and is it worth it? If so, have a serious chat with your clinician about the positives and negatives. Good luck