Insulin: A Voice for Choice

Dr. Arthur Teuscher is the author of 'Insulin, A Voice for Choice', published by Karger Press.

| Nov 23, 2007

In the early 1980s, human insulin produced by recombinant DNA technology came onto the market. It was the first time that this technology had been used in medicine, so hopes were high.

Like many physicians, I used the new human insulin in some patients under the assumption that it was a more physiological alternative to the animal insulins that had been in use for years.

Some of my patients, however, reported a sudden loss of the symptoms that had previously warned them when their blood sugar was low. This development of hypoglycemic unawareness related to human insulin was confirmed in two clinical studies. As a result of these findings, I believe that animal insulin is safer than human insulin for the ten to twenty percent of diabetic patients in whom animal insulin produces more pronounced hypoglycemia symptoms.

Reports of the loss of low blood sugar warning symptoms led insulin manufacturers to acknowledge the potential dangers of human insulin. Nevertheless, they soon began to withdraw bovine (cow) and porcine (pig) insulin from markets all over the world, while promoting the more expensive human insulins as a superior replacement. Diabetics had no option but to switch to the new insulins. This led to an active movement by patients who demanded to keep porcine and bovine insulins available for those who experience a loss of warning symptoms or other side effects from human insulin.

Now, manufacturers are withdrawing the first generation of human insulins and replacing them with even more expensive, patent-protected insulin analogues. Patient organizations such as the International Diabetes Federation have concluded that "there is no overwhelming evidence to prefer one species of insulin over another, and patients should not be changed from one species of insulin to another without reason."

My fifty years of experience as a diabetologist has convinced me that the "one insulin fits all" approach is not working. Alternative treatments - such as bovine and porcine insulin - must remain available.

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Categories: Animal Insulin, Blood Sugar, Diabetes, Diabetes, Insulin, Low Blood Sugar, Type 1 Issues

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Posted by Anonymous on 27 November 2007

Dr. Teuscher, I read your book and appreciate having a doctor like yourself articulate some of the issues which are far too often blamed on things such as patient error or something else, in spite of clinical evidence which suggests otherwise. The real issue is since Novo Nordisk's foundation ownership seems to have abandoned its original intent, it seems that the number of suppliers remaining in the world has been declining steadily, as Brazil's BiobrĂ¡s S.A. was acquired by Novo Nordisk A/S in 2001.

For that reason alone, we should support efforts by Saudi Arabia to develop its own, domestic source for insulin, as well as Indian pharmaceutical companies global ambitions.

Posted by bdebruler on 29 November 2007

I suspect, (and this is purely conjecture), that the reason that the rDNA produced insulins are causing a reduced awareness of hypoglycemia is that they are more effective, and the patients that switched from less effective insulins are having more episodes of hypoglycemia, leading to decreased awareness of symptoms. I can't imagine any scenario involving the insulin molecule directly affecting the awareness of hypoglycemia.

Still, it's better to have more choices, particularly less expensive, non-patented choices.

Brad (an analytical chemist and Humalog pumper)

Posted by Anonymous on 29 November 2007


The clinical evidence strongly suggests that rDNA produced insulins are NOT more effective than refined animal sourced insulin, and may in fact, increase the inflammation that causes the autoimmune destruction of the beta cells in type 1 patients the first place, thus causing more harm than help.

No fewer than five major meta-analysis conducted over the past 8 years, which collectively reviewed several hundred clinical studies undertaken on a worldwide basis have all reached the same conclusion: there is absolutely no clinical benefit to synthetic insulin, and it is not more effective.

I would add that a study actually confirmed the opposite, namely that type 1 diabetes begins when the body's immune system reacts to the hormone human insulin. The study was published in the May 12, 2005 issue of the British science journal Nature, and raises questions as to whether any form of "human" insulin is better for these patients, since it causes inflammation that not only destroyed the pancreatic beta cells, but causes ongoing damage that may also be responsible for some complications.

(a type 1 who is a former insulin pump user whose basal rates were so low my basal rates could not be reduced enough (zero will cause issues with losing the prime in the tubing, and therefore returned to MDI and better glycemic control as a result).

Posted by Anonymous on 13 December 2007

I liked the article- it's always good to have other options.

Posted by Colleen on 21 December 2007

Scott, can you cite the edition of Nature magazine you referenced above?

Thanks, Colleen

Posted by wannaliv on 20 January 2008

This is the best and yet heart wrenching info I have had in years ! I have had diabetes for 34yrs with all of them being insulin dependent. I was testing urine with the drops of urin and the pill. While I am gratefull for the advances in the treatment of this I have no faith in the healthcare that moves forward based SOLELY on money. Not for a minute would I believe the crap healthcare providers and some doctors or healthcare institutions would put forth. They said that reincumbunt DNA would eventually be cheaper for diabetes care and 10 years later after talking to a rep for Lilly his answer was that some of our people would like raises. I am not kidding, I talked to him myself!!. The healthcare system in this country is based on profits far more than care. That's a fact. I am not a Michael Moore fan but the movie "SICKO" is an accurate account of whats going on in this,,The Greatest Country".

Posted by wannaliv on 20 January 2008

Sorry but I need to continue. We buried my wonderful sister in 1995 and a big reason for that was that her insuance provider made it unbelievably hard with denials for a pancreas only transplant. You have to be so close to death that your chances for a fruitful life are almost nonexistant. It was terrifing for me to sit in her room and see my what lies for me ahead. She never came home and was a wonderful 37yr old. I have said all this to say that I remember changing from pork to dna insulin and within a couple of years I had lost my insulin reaction warning signs ( sweating,tingleing and shakey)It has almost cost not only my life but the lives of others. What I read hear was the first I have heard of this difference in the insulins and what can happen. It was like the lights went on for the first time in alot of years. I have been married for 25 yrs and have 3 grown kids with 1 grandchild. I am a productive member of society and still can't afford the continual care that I have needed my whole life to avoid complications that if I don't pay for the general public will. An I V with just glucose after my wife drove me to the emergency room ( total time 1 hr )was 3,500. That is criminal!!

Posted by Anonymous on 22 November 2008

If the world ever loses the US as a research source with a monetary gain as an incentive for that research, they will have lost the last best hope for real research in the world. Without this incentive you can kiss all of it goodbye.

Where do most new drugs come from? The US and really nowhere else. You can thank your lucky stars that this is still available to the world but how long that will last is anyone's guess at this point. You'd better pray you don't lose it with some kind of national health plan in this country, because the result of that would be devastating.

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