A friend is having problems with diabetes

DISCLAIMER: I am not a licensed physician. You must consult your doctor to determine if you are diabetic and how to treat it. These are simply notes to myself about what I am able to learn through Google searches:

The reason I am posting this is that IF someone were without medical coverage and little money, and type I diabetic (requiring insulin) then there only hope of survival would be to come up with $1 a day for the over the counter Humilin R or Humilin NPH and know how to administer it correctly. I have learned from a Duane Read Pharmacy in New York City that 10 hypdermics may be sold over the counter with no prescription for a cost of $5. I have learned from various internet posts that hypodermics may be reused up to 3 times if one practices good hygiene. Insulin may be kept for 30 days or longer. Insulin should not be exposed to high temperatures. IF insulin goes bad, it is not harmful, but simply loses effectiveness (i.e. you must inject greater quantities to achieve the same control.) The greatest risk with insulin is IF it is not handled in an hygienic sanitary fashion and IF the bottle becomes contaminated with bacteria and IF you contract an infection from the bacteria in the insulin bottle, or from reuse of needles (reused because you do not have much money and are forced to get several uses out of each needle.)

Walmart lists Freestyle Lite strips at a price of $124.99 for a box of 100. Amazon lists Freestyle Lite strips mail order for $28 for a box of 50, which is around $0.60 per strip. Internet advertisements can be confusing. Who knows what the hidden costs are. A person with very limited funds may be forced to rely on what is available over the counter from a local pharmacy. Once someone purchases or is given a meter then the problem becomes how to afford the strips.

I have a friend who was born and raised in Liberia, Africa. He works in New York City. He became diabetic when he was 50. He is now 61.
Someone helps him to afford the test strips. Test strips for a glucosometer may cost as much as $1 per strip. I asked him how poor people in other countries survive with type I diabetes and how they manage to use insulin if they cannot afford a glucosometer. He told me a trick that is used in some countries and which his doctor told him. If you find a places outdoors where there are ants, then, urinate on the ground and watch to see if the ants are attracted to your urine. Normal urine should be acidic and contain no sugar. Supposedly the ants will avoid normal urine. IF your urine contains SUGAR then the ants will be attracted by the sugar in the urine and that means your diabetes is not in control. This ant test is obviously very crude, but may be all that is available to someone in a very poor country who had access to insuline but cannot afford a glucosometer.

The cheapest machine I can see is a Duane Reade TRUE TRACK which advertises a FREE glucosometer with 10 strips. More TRUE TRACK strips will cost $40 for 50 strips. I tried a Duane Reade meter several years ago and found the accuracy to be unacceptable. It is entirely possible that the TRUE TRACK meter available today is more accurate. Or, it is possible that the particular unit I had several years ago was defective. Right now I am personally using a FreeStyle Lite from Abbot labs which seems HIGHLY ACCURATE.

Of course, they would also need a glucosometer and strips which can be costly.

Obviously there is some reason why the government permits over the counter sale of insulin without a prescription, and obviously there must be desperate people who need to resort to this remedy over the more effective prescription only types of insulin like short acting Humulog or long acting Lantus.

A pharmacist just told me that TWO types of insulin are available over the counter and without a prescription:

Humulin Regular (short acting)
Humulin NPH (similar to Lantus, long acting)

These sell for around $30 for a vial which will last about a month.
One friend in Tehran uses this and told me it keeps without refrigeration.

These were the insulins that were used for many years before more advanced insulins like Humulog and Lantus (prescription only) were developed.

There are message boards where diabetics post details of their experiences with various insulin treatments.

Here is an example from the above linked message board posted by someone in Pakistan. It is my surmise that diabetic living in less developed nations have less access to expert medical advice and must therefore try to survive more with rules of thumb regarding dosages and use whatever is available:

I am using Humulin N & R ,mixing in a proportion.But I am always confused about”Proportion”.I take 10 units of R and 18 of N before breakfast,then 10 units of R only before lunch and finally 10+16 before night meal.
My morning numbers are rarely 100 otherwise 120 to 140. I want to keep morning number below 100.
Experts or experienced comments r required.Will it not be wise to take R before night meal and then N at bed time?
Note it that I am T-2 since 12+ years.

The idea is that you get best results with NPH when the injections are 12 hours apart. Some people find injecting it before bed deals more effectively with the Dawn Phenomenon rise. But you will only know if injecting NPH before bed works for you by trying it out.

HOW LONG WILL HUMILIN R LAST AFTER OPENING:

Unless you’ve exposed it to extreme
heat or you feel that the usual dosage doesn’t seem to be working
correctly, it should be just fine. But why wonder, you can contact the
makers, Lilly Diabetes. Here’s their site…

http://www.lillydiabetes.com/product/humulin_family.jsp?reqNavId=5.3

And here’s their phone number 1-800-LillyRx (1-800-545-5979).

(*from their website) The toll-free number is a service provided by Eli
Lilly and Company and is not intended to replace the advice of your
health care team.

Lily will tell him 30 days after opening just like the insert says.
They have to do that or risk having a law suit by some one that has
used their’s for a long long time and gotten bacterial in it, etc. But
I am also on sliding scale and Humulin R and my doctor tells me not to
worry about how long it has been open as long as it refrigerated and
getting good results from it.

We have had posters assert that refrigerated R insulin can last for years.
When insulin “goes bad” it mostly stops working. It takes larger and
larger doses to produce the effects you want.

I was stuck out-of-town once with “bad” prescription insulin which I
couldn’t replace until I got home. I just shot more and more to get
control.

Of course, you can produce bacterial contamination just as you can with any dilute solution of protein. You could do that on the 2nd day or the 300th day that you used the vial. I believe that they add some sort of anti-bacterial to the Humulin vials but it won’t last forever.

Umm. . .I suppose you know that discount pharmacies like Wal-Mart have the
best prices around for Humulin. I believe Wal-Mart’s current price is less
than $20 a vial.

http://answers.yahoo.com/question/index?qid=20081116195939AAu6mGR

The onset time for Humulin R, or how long it will take it to go into effect, is around 30-60 minutes.
It peaks, or has it’s maximum effect, between 2-5 hours.
Generally, the total duration of Humulin R is from 8-10 hours.

there is no real “normal” range of blood glucose, but thump-of-rule is considered roughly 80-120). Somewhat overweight, obese and older people may be considered borderline at 150.

Insulin dependent diabetes takes a lot of dedication from the affected person to wanting to take care of their health. Most diabetes (late, adult-onset) etc. is completely reversible once a better health style takes effect. Humulin insulin is produced from bovine (cow) and administered INCORRECTLY can be fatal and/or cause grave brain injury due to the hyp-O-glycemia (l-O-w blood sugar) it causes. (The brain practically ‘lives’ off of oxygen and glucose alone)

A ham sandwich means A)– two slices of bread, and B) probably sugar-cured ham. Modify the diet to a turkey sandwich made with ONE slice of whole-grain bread folded over.

Timing of the insulin injections are important, but it sound like you are doing them right. You should inject Humulin R 5-10 minute BEFORE you begin to eat.

HUMILIN R SLIDING SCALE EXAMPLE

Administered every 4 to 6 hours based on glucose blood levels from a glocosometer finger stick reading

Example sliding scale:

4u Humulin R Insulin for glucose 151-200 mg/dL
6u Humulin R Insulin for glucose 201-250 mg/dL
8u Humulin R Insulin for glucose 251-300 mg/dL
10u Humulin R Insulin for glucose 301-350 mg/dL
Call physician or visit hospital emergency room for glucose > 350

Absorption of insulin occurs most quickly when injected into abdomen.

If someone has very little money for doctors visits or test strips but has enough money for insulin and hypodermics, then the most conservative plan of action is to try and survive on a diet which contains protein and fat only and no carbohydrates such as bread, rice, fruits, etc.

I have seen posts by type I diabetics in various countries who eat NO carbohydrates and control their blood sugar level as best they can with insulin injections.

TREATING CATS WITH HUMULIN NPH

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