Chat Transcript Open Q & A - Dr. Rajamani, Chief of Endocrinology, Unity Medical Group, December 3, 2013
Dr. Rajamani @ Unity:
Welcome to the Unity Diabetes Online Community! I’m Dr. Rajamani, Chief of Endocrinology at Unity Medical, and I’ll be hosting today’s chat. I’m glad you could join us today. We’re excited to answer all of your questions. Dr. Rajamani @ Unity: Before we get started let me just tell you how I’ll address your questions and comments today. I answer questions one at a time, in the order that they are posted to the site, and there might be a slight delay as I respond to each question. It may take a few minutes for me to type answers to your questions, so please stay logged-in to the chat to see my response, even if it takes a few minutes. And you might need to refresh every few minutes to keep up with the latest posts in the chat. Dr. Rajamani @ Unity: Let’s get started mikeamy84: is there any difference between Humalog and novolog fast acting insulins? Dr. Rajamani @ Unity: Hi mikeamy84, both Humalog and Novolog are insulins manufactured by recombinant DNA technology. Humalog is made in Ecoli a bacteria and Novolog is made from yeast. They work in pretty much the same way Dr. Rajamani @ Unity: Because they work in a similar manner the insurance companies keep making patients switch from one to the other based on pricing. mikeamy84: That is what I am dealing with as well starting Jan 1st. dg3753: Will I be able to tell any difference if my insurance company makes me switch? Dr. Rajamani @ Unity: Another insulin out there which is also fast acting is insulin glulisine ( Apidra). This is also made in E coli but and is similar in action to Humalog and Novolog but is in a different category for use in pregnancy. mikeamy84: Are there any concerns I should know about when I have to switch? Dr. Rajamani @ Unity: You should not really be able to tell the difference. Some patient sometimes get local skin reactions with one type of insulin rather than another. Dr. Rajamani @ Unity: The concern that you may have to have is probably the local skin reaction, but that is very rare. mikeamy84: Both can be used in an insulin pump, correct? Dr. Rajamani @ Unity: You are right. They can both be used in the insulin pump. Dr. Rajamani @ Unity: Use in insulin pumps is a little different, as those people with a tubed pump have a longer time for inulin to come into contact with the plastic in the tubing, but both act in a similar manner. Dr. Rajamani @ Unity: Mikeamy84, do you use an insulin pump? mikeamy84: Yes, I have had it for about 5 years now. Dr. Rajamani @ Unity: People get used to the pump and are sometimes hesitant to make a change as a pump becomes so much a part of what they do. Dr. Rajamani @ Unity: In the old days when the insulin was beef or pork, patients would be really upset when asked to change to human insulin and sometimes travelled to Canada to get the insulin they were used to. mikeamy84: I agree. I am nervous about having to switch insulins. I know how I react to Humalog and just scared of the unknown. Dr. Rajamani @ Unity: I think there is very little risk in making the change. If you have had a reaction in the past to a different insulin I would be cautious, but most people make the change easily. Dr. Rajamani @ Unity: You could monitor yourself a little closer to reassure yourself how it is working for you. mikeamy84: Good, thanks for the reassurance. It will be another road traveled in my life with diabetes. I will be sure to monitor more closely before and after the switch. Dr. Rajamani @ Unity: If you do note a lot of problems with the switch you could let your doctor know and they could then ask the insurance company to let you use your current insulin. The insurance company may change their plan back to your current insulin next year. mikeamy84: We can only hope. I will be in contact with you soon, as you are my doctor. Dr. Rajamani @ Unity: The problem with switching is very common and happens for medications and supplies, so every year many people are forced to switch their medications. Dr. Rajamani @ Unity: mikeamy84, you could let me know how you do with the switch at any time. mikeamy84: This is the first time switching for myself and you have made me feel more comfortable about it, thank you. I will keep you informed. Jane@Unity: One of my classmates asked. "I have pre-diabetes. Do you recommend I get a meter and check my blood sugar at home?" Dr. Rajamani @ Unity:
Hi Jane@Unity, I generally do not recommend a meter for people with pre-diabetes as there not currently targets for glucose control or HbA1c for pre diabetes. I think that if a patient goes on to develop diabetes they will need to monitor themselves at some time. In the large DPP study the patients did not self monitor and the incidence of subsequent diabetes decreased by 58%. Dr. Rajamani @ Unity: Some people feel a meter may help motivate patients, but I am not sure as it is also expensive to monitor and there is also the discomfort. Jane@Unity:
When you have diabetes and need to go on dialysis, what percentage of use is the functioning kidney, would you estimate? Dr. Rajamani @ Unity: Jane@Unity, What do you think about meters? Dr. Rajamani @ Unity: I think the functioning kidney may initially continue to work (many people do have urine output on dialysis). Dr. Rajamani @ Unity: Over a period of time a patient’s own kidney function may continue to decline whether or not on dialysis. Jane@Unity:
Dr. Rajamani, I do recommend patients who have pre-diabetes check their blood glucose so they know how the factors (exercise, food, stress) influence their blood glucose. In saying that, I do understand that some insurance companies may not cover the meter and strips. Dr. Rajamani @ Unity: Generally people go on dialysis when they have symptoms from renal failure or they have entered a stage of what is sometimes called "End stage renal disease” when the functioning kidneys operate at less than 25%. Jane@Unity:
Thank you so much Dr. Rajamani! Dr. Rajamani @ Unity: Jane , you are probably right in helping patients know about the rise of blood glucose with meals and the risks, as in many ways pre-diabetes and diabetes are a continuous spectrum. mikeamy84: Thank you Dr. R for all you input and assurance today. Dr. Rajamani @ Unity: That’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature. Dr. Rajamani @ Unity: Be sure to join us for our next chat Tuesday, December 17 at 8 p.m. with Joy Valvano, C.D.E. Joy will be hosting an open Q&A session and sharing tips on diabetes apps and web sites she finds helpful!