Newer Insulins under pressure from QIPP

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marke Site Administrator
South East Kent PCT
665 posts

since I know at least one of the DAFNE 'top brass' read this forum I will let them give a 'full' answer if they wish too. However at last weeks DAFNE Collaborative I attended a workshop that contended that NPH could well be preferrable to newer analogue insulins. Indeed the original DAFNE program was and still is based on NPH insulin NOT the newer insulins.
One of the problems with new analogues is there is not the long term evidence and experience of using them like there is NPH. It was said at the DAFNE workshop that if they had known years ago what they now know about NPH insulins they would use them differently and more effectively. Newer is not always best ! Although all new insulins have obviously been safety tested before being generally available that is not the same as years of experience of using them over a very wide range of people who are all different. Perhaps QIPP is just trying to trying to avoid the 'newer is better' syndrome, or maybe not, I can't really comment on that.

Peter DUAG Committee Member
University College London Hospitals (UCLH)
109 posts

Mark, Don't forget, as Carolin said, that the second part of the message given at the DAFNE Collaborative was "ANY type of BI taken twice daily was better than analogue taken just once daily".

Brum_Taffy 13 posts

We seem to have gone into a blind alley, as can sometimes happen Embarassed The only way to decide a 'Which is better?' argument is the Harry Hill method, IMO Laughing

Instead, I am still hoping to get some observations from people with type 1 diabetes in the forum: what you think, what you experience each day, how things are today, compared with how you used to use insulins previously.

In essence, Lance Armstrong famously said "It's not about the bike"- do you experiences agree? Idea

sphillips DAFNE HCP
University Hospitals, Leicester
24 posts

Hi I'd like to add my support to what Carolin is saying. In my 9 years experience as a DAFNE educator in a centre that has tended towards analog BI's we are now reviewing this based on the evidence gathered from the DAFNE database and our clinical experience. We are seeing the benefits of NPH insulin, especially for those who exercise a lot, work shifts, like to drink alcohol (!) and in some cases it has been more beneficial than glargine in dealing with the dawn rise. I think we are right to be sceptical about issues around funding and insulin and protecting peoples choice but there is a lot of good evidence in support of NPH.

AllanR DAFNE Graduate
Cumbria Diabetes
15 posts

Very interesting this. As a new graduate am finding this topic very interesting due to the exercise element mostly and how different insulins behave. Am quiet interested in if there are any recommendations for a "better" handling insulin for someone who exercises regularly?

As for me, since doing the DAFNE course last month and switching to Lantus twice a day (a few of us changed to this plan during the course), have noticed that my liver doesn't seem to be giving me quick shots of BG at quick exercise as it was before DAFNE and on once a day. I used to find a recorded jump of about 3-4mmo/l on my BG from a quick 5 mile bike ride before it would drop down again (and crash down) after about 45mins ride. My consultant always put this down to liver kicking in and dumping it into my system very quick. Yet since DAFNE and the twice a day Lantus it has really changed it a lot now into pretty much a solid reduction from 5 mins all the way to a couple of hours rides, and very rarely getting the jump in BG as I used to experience.

Have my DAFNE class follow up meeting later this week, so this has given some nice topics to bring up concerning background insulins v exercise thanks.