Jim B in your area

In the olden times, before I got diabetes, they used pig or cow insulin. I know nothing about this dark age. By the time I arrived on the scene, they were making insulin with SCIENCE. They jammed human DNA into E.coli and stuck it in a bioreactor and blammo, humulin.

Humulin is what they're talking about when they say "Walmart Insulin". A type of insulin made from human DNA and bacteria. There are two basic types. R (short acting) and N (long acting). The problem is, Humulin is slow and kind of unpredictable.

When I first started, in 1990, you took two doses of N daily, 12 hours apart. This was your "basal dose". Your usual metabolic processes end up making some blood sugar all day, and this was to deal with that.

You took your Humulin N at 8AM. It has an onset time of 1-4 hours, a weird peak in effect around 6-8 hours in, and then the effects dropped off but lingered out to 24 hours. So you had to have an afternoon snack to go against that peak. But it could be anywhere between 2PM-4PM

Your evening dose of N was smaller so you wouldn't bottom out in the middle of the night. And because you also wouldn't be eating three meals during its main effects.

Humulin R is your "meal dose". It has a slightly more predictable graph and lasts in your system for much less time. It onsets and peaks somewhere from 30min to 1hr after injection, and it's out of your system in 6-8 hours.

So when you were about 30 minutes out from a meal, you would test your sugar, try to decide how hungry you were, do some quick algebra, take a shot of X units of Humulin R and hope you actually got food in under an hour.

Sometimes, your meal schedule and Humulin R dose lined up with a peak in your Humulin N, (which you have no way to predict because the peaks have a wide range of when they can happen) and you'd get some hypoglycemia and maybe need emergency sugar.

Back then, I carried a tube of cake icing in my fanny pack, along with a juice box and a pack of those orange crackers with peanut butter.

Humulin also had to be kept cool BUT NEVER FROZEN, or it went bad and didn't work. So I carried around a chemical ice pack that I had to freeze overnight and thaw in the microwave before using it to transport my stuff.

At least once on the R/N combo, I had such a bad hypo reaction that my sister reported "it was like you just powered down mid-sentence". I also witnessed another diabetic have a hypo reaction with seizures. That was terrifying, "there but for the grace of science go I" stuff.

Because Humulin R takes so long to start working, and lasts so long in your body, diabetics couldn't easily chase high blood sugar with injections, because then you risk a catastrophic low later on. So things like cake or ice cream were very difficult/impossible to adjust for.

Compared to what diabetics use now, Humulin R and N are unbelievably sketchy. I take Novolog for my meal dose, which has a predictable 15 minute onset/peak and is gone from your system in 45 minutes. With the pump, you also use a tiny metered bit of novolog for your basal dose.

I'm still more comfortable with periodic injections because I'm Old, so for my basal dose I use basaglar, which still has a 1-4 hour onset, but lasts 24 hours and has a pretty flat graph with no surprise peaks, so only one shot per day.

BONUS: Modern insulins also do not need to stay cold. You store them in the fridge, but once you start using a pen or vial, it's fine for up to 28 days at room temperature.

Modern insulins are made by modifying some amino acids in human DNA, and splicing it into yeast because we live in the fucken future. Can you get by on "Walmart Insulin"? Sure. But it's much more challenging and dangerous, requires scheduled snacks/meals, and is not flexible.

Old timey insulin also requires training and a lot of input from your endocrinologist, which without insurance, you probably also can't afford. Old timey insulin is also much more likely to lead to complications. Sugar spikes are bad.