I guess I’ve heard so many horror stories from people who have been diabetics since before the new fast-acting insulins were available that I react in horror to the idea. I’d be interested in hearing more about how it works for your patients, Qad. How does it work with the varying carb counts in meals? What about exercise? Are there lows/highs/etc to deal with? Would you prescribe it to a normal-functioning non-inmate diabetic, if the cost was not an issue?
I’m sure the Regular/NPH routine works great - for people who live a very regimented life or who are willing to work their life around the insulin rather than the insulin around their life. And there are a lot of folks who that suits their needs and their finances just fine, and that’s why those insulins are still made and sold.
But - I have seen a lot of people who couldn’t achieve any kind of decent control on those insulins suddenly improve greatly with the newer ones. We have so many different insulins because diabetes isn’t a cookie-cutter disease and different people have different needs.
The one thing I hate as a CDE are the blends - the 70/30 and all that stuff. It creates peaks at what may be unpredictable times and I think it contributes to unnecessary hypoglycemic episodes. I see these blends being prescribed a lot less these days, and I think that’s a good thing.
BTW, since it was mentioned up thread - Walmart sells their insulin and their meters under the ‘Relion’ brand name. I’ve heard complaints about the accuracy of the meters, none about the insulin. (I have contact as an educator with probably about 40-50 diabetics a week, so I hear a LOT of stuff.)
This thread makes me very glad for the NHS. My wife just fills in a repeat prescription form and gets her Lantus absolutely free 
If cost were not an issue, I’d go with fast acting insulin, no question. But for basal insulin, I still feel NPH is a pretty good product. However, I’d have a relatively low threshold for changing to lantus if nocturnal hypoglycemia was a consistent issue.
The whole goal is to achieve acceptable A1Cs while avoiding hypoglycemia. There are many routes to get to that. Tight control is no longer one of those routes, given how it sends too many folks too low too often.
My most successful patients vary their fixed regular insulin doses based on the carb counts of the menu of the day, and their exercise plans.
Don’t get me started on 70/30 and other mixes, though.
I use diet and lantus vial and syringe twice a day and victoza once per day. I average 6.6 on my quarterly A1Cs. Considering I went from 1980 until 2004 on nothing but dietary control until 2001 and dietary and metformin until 2004, not bad. Still no neuropathy anywhere, good retinas, good kidneys … only thing that really happened is my BP went seriously chaotic evil malignant about 5 years ago, and it is not heart related [I think something went haywire in my brain when I had that nasty assed migraine and showed up in preop with a 210/190, and it never went away.]
FYI A new inhaled insulin is coming on the market very soon. The last inhaled version was a real pain to use so nobody used it and it was taken off the market.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm403122.htm
It’s fast acting and it likely won’t be cheap.