In my last blog post, I discussed how I was facing diabetes burn out and dealing with my insurance company forcing me to switch from Humalog to Novolog to see how it affected my blood sugar. Well, the fog of diabetes burn out is slowly lifting. But I am still fighting the insurance company to cover Humalog.
Each person with diabetes is affected differently and how various types of insulin work for each person can vary. For me, there was a huge difference in how my blood sugar was affected while I was on Novolog versus Humalog. I had a lot more highs with Novolog, and it just did not seem to lower my blood sugar as well as Humalog. This was clearly shown on two different days when my blood sugar was 197 before breakfast:
- The insulin dose was calculated to be 7.5 units.
- One day I took 6 units of Humalog and was 115 at lunchtime. (I have experienced quite a few low blood sugars by lunchtime when I take the full dose of Humalog at breakfast, so I usually take 1-1.5 units less than I calculate to prevent dropping too low, too fast).
- Another day I took 7 units of Novolog (I could not administer half units with the pen I was prescribed) and was 133 at lunchtime.
Both days, I ate the same thing for breakfast, and there was approximately the same amount of time between breakfast and lunch.
With my detailed notes and my continuous glucose monitor (CGM) reports showing how my blood sugar control was adversely affected, my doctor decided to switch me back to Humalog. Since switching back, I feel so much better; I don’t feel as burnt out–probably because my blood sugar has been in a much better range!
The yellow bars on the graphs show the times I had high blood sugar, which was practically all day when I was on Novolog. With switching back, my estimated A1C dropped dramatically from 7.4% to 6.8%, as did my average blood sugar. While on Novolog, 44.6% of the time my blood sugar was high, and I was in range only 53.3%. Switching back to Humalog, the amount of time I was high dropped to 28.3%, and I was in range 70.2%–explaining why I feel so much better! The highs I have had while on Humalog have either correlated with meals (darn pancakes!) or to stress caused by nursing school and some other personal stuff.
Though I am so glad to be back on Humalog, the fight isn’t quite over yet. Two weeks ago, my doctor sent in a new prescription for Humalog. It is still on hold and awaiting prior authorization/more information from my doctor. I am hoping that everything will go through and that the insurance company will not be able to force me back onto Novolog. Clearly, being on Novolog wreaked havoc on my blood sugars and my mental/emotional health.
It is very frustrating to me that the insurance company can dictate what medications I can receive. It is also infuriating how expensive insulin is! Diabetes Forecast had an article about “The Rising Cost of Insulin” that discussed how the pharmaceutical companies and sky-rocketing insulin prices work.
The pharmaceutical company sets the price of insulin and confidential negotiations between the company and middlemen (such as drug wholesalers and distributors, pharmacy benefit managers, health plans, and large retail pharmacy chains) are made. The pharmacy benefit managers conduct comparative drug research and develop tiered lists of prescriptions covered by the health plan. If they determine that several insulin products have the same efficacy and side effect profile (as they did with Novolog and Humalog), then the insulin that costs the plan the least will land on a lower tier.
In my case, Novolog is on the lower tier. Not all insurance plans are the same though. From being in the online diabetes community, I have seen people who have had to switch from Novolog to Humalog (the opposite of me) because of their insurance. I have even heard of some plans switching back and forth to where the person was on Humalog for a year or two and then insurance switched them to Novolog for a while and then back to Humalog. I think it is ridiculous that profits take precedence over what medication a doctor prescribes.
Update: I FINALLY received approval from my insurance to switch back to Humalog, and my prescription was filled! For now, this fight is over!