# Majority of physicians agree that Need Exists for Ultra-Fast Insulins



## Northerner (Sep 7, 2011)

BURLINGTON, Mass., Sep 07, 2011 (BUSINESS WIRE) -- Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that the vast majority of surveyed physicians in the EU5 (France, Germany, Italy, Spain and the United Kingdom) identify an unmet need for ultra-fast insulins for the treatment of type 1 diabetes. 

http://www.marketwatch.com/story/fo...eed-exists-for-ultra-fast-insulins-2011-09-07

Novo-ultra-rapid, perhaps?


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## FM001 (Sep 7, 2011)

The trouble with an ultra fast insulin is the tendency to send you hypo before the stomach has a chance to break down the food you've eaten.  I inject novorapid before eating and in some cases after if I'm eating a meal with a higher fat content than normal, to me novorapid works just fine and I rarely get what I would call unacceptable spikes, so a switch to ultra-fast would be potentially dangerous from my own perspective

Was I forced to change to a ultra-fast insulin at anytime in the future then I'd almost certainly have to inject after my meals, adopting this practise is risky as there is a likelyhood that you forget to inject altogether, particularly if you are in some company and get side-tracked


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## Northerner (Sep 7, 2011)

Somev very good points toby - I wonder how long ultra-fast would stay in your system for? Not much use if it's all gone in the first hour for some meals!


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## FM001 (Sep 7, 2011)

Northerner said:


> Somev very good points toby - I wonder how long ultra-fast would stay in your system for? Not much use if it's all gone in the first hour for some meals!





Thinking the same but forgot to mention this before, if you are eating slow release carbohydrates or a high fat meal then you'd hypo first then see your bg rise when the food hits your system, this of course if the insulin is in and out in a very short space of time.


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## rachelha (Sep 7, 2011)

I woukd definitely benefit from an ultra-fast insulin.  I have to inject before eating and always end up in the teens a couple of hours after eating before being back in range about 5 hours later.  I have tried apidra, humalog, and novo rapid but have the same results with all of them.


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## trophywench (Sep 7, 2011)

I don't actually understand exactly why they think I might need ultra-fast insulin.

So I can eat doughnuts and negate em double quick perchance?  surely, I'd be better off long-term with them explaining why I shouldn't eat doughnuts in the first place?

It would help when you are preg, at those times when your IR is at its highest, but that doesn't last 9 months, probably not 9 weeks.

What's it FOR ?


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## rachelha (Sep 7, 2011)

trophywench said:


> I don't actually understand exactly why they think I might need ultra-fast insulin.
> 
> So I can eat doughnuts and negate em double quick perchance?  surely, I'd be better off long-term with them explaining why I shouldn't eat doughnuts in the first place?
> 
> ...



I have big problems with spikes.  I try to inject about 15 mins before eating, and often spread my lunch over an hour or so. I do not eat lots of doughnuts etc, but will end up with a spike of 14 or so after a seeded bread sandwich and an apple.  It would definitely benefit me.


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## trophywench (Sep 7, 2011)

Well Rachel, I see what you mean, because you are assuming even the new stuff would be slowed down enough in your body to act like the three we have at the mo are sposed to - and do - in most people.  Perhaps it would.

However if it did what it said on the tin, then you'd just be under the table severely hypo half an hour after eating, wouldn't you? - because all of these things rely on the carb hitting your bloodstream in the same time frame as the insulin.


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## rachelha (Sep 7, 2011)

I don't think I would end up hypo 30mins later.  I think I must just process food v quickly.   I have never done a split injection for pizza or a takeaway.  If anything I get better results from those.  The miss timing of the insulin and carbs may be due to problems with my injection sites, I actually hope so and then the pump should sort this out a bit.  

We are all different and react to insulin, carbs in slightly different ways


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## Northerner (Sep 7, 2011)

I think that, as an extra option, it would obviously be good to have another type of insulin which would clearly help someone like Rachel. Brings to mind the fish sperm of the 1930s though - when protamine (the 'P' in NPH insulin) was introduced to slow the action of the early insulin because it worked too quickly. In fact, there is a legend told of it...

http://diabetespoetry.blogspot.com/2009/11/tales-of-hans-christian-hagedorn.html


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## trophywench (Sep 7, 2011)

Whatever happened to 'Soluble' insulin?

Or is this the clone of that?


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## Julia (Sep 8, 2011)

Ultrafast insulin would be great with a pump for changing basal rates without planning e.g. most people need to set temporary basals 1-2 hours before exercise on current insulins. Also if going hypo, reducing basal rates doesn't currently work quickly enough to treat the hypo.
But the main advantage I can think of would be to make "closed loop" systems between CGMs and pumps easier ie pump automatically gives insulin based on CGM. I'm guessing (I'm not a doctor, so this may be completely wrong!) that one of the main reasons why closed loop systems are not yet an option is because if the CGM senses a rapid change in blood glucose and changes the rate of insulin delivery accordingly, it will take too long for current insulins to have an effect on blood sugars and result in big swings.


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## Pumper_Sue (Sep 9, 2011)

trophywench said:


> Whatever happened to 'Soluble' insulin?
> 
> Or is this the clone of that?



It's now called neutral insulin. I use it in my pump.
It used to be called soluable then for some reason had a name change and a very slight format change. I have always used soluable/neutral for my whole diabetes life (46 years)


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## trophywench (Sep 10, 2011)

Aaah Sue - I'd always wondered what it was when I first learned you used it!  Should have just asked!

Dawn broke with a resounding crash - ROFL !!


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## Pumper_Sue (Sep 10, 2011)

trophywench said:


> Aaah Sue - I'd always wondered what it was when I first learned you used it!  Should have just asked!
> 
> Dawn broke with a resounding crash - ROFL !!





Here's the human form, http://www.medicines.org.uk/guides/insulin soluble human/diabetes


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## Robster65 (Sep 10, 2011)

Julia said:


> Ultrafast insulin would be great with a pump for changing basal rates without planning e.g. most people need to set temporary basals 1-2 hours before exercise on current insulins. Also if going hypo, reducing basal rates doesn't currently work quickly enough to treat the hypo.
> But the main advantage I can think of would be to make "closed loop" systems between CGMs and pumps easier ie pump automatically gives insulin based on CGM. I'm guessing (I'm not a doctor, so this may be completely wrong!) that one of the main reasons why closed loop systems are not yet an option is because if the CGM senses a rapid change in blood glucose and changes the rate of insulin delivery accordingly, it will take too long for current insulins to have an effect on blood sugars and result in big swings.


 
I think the main problem Julia, is that the CGMs have a lag of about 10-15 minutes due to their sampling method (interstitial fluid?) which is not a realtime measure.
Add that to the insulin lag and the margin of error on CGMs and you have a potentially erratic system. The human interface is still going to be needed for some time I suspect. If only as a psychological comfort. 

Rob


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