Analog insulins and Cancer?

There was a recent scare that associated the use of Lantus insulin (insulin glargine) with an increased rate of cancer. This report was based on a German health insurance database. The journal that reported it also was careful to include comparable studies from other countries where Lantus is used. The results from these other nations were less compelling. In fact one study showed no significant association between Lantus and higher rates of cancer. None of these studies looked at Levemir (insulin detemir), the other long acting basal insulin. The makers of Levemir are quick to point out that the chemical structure of Levemir is different from Lantus. This is relevant because insulin analogs (which is what both Lantus and Levemir are), also may cross react with receptors for growth factors on the surface of certain cells. The term for the cell growth promoting effect of any insulin molecule is its mitogenic effect. This is different from the blood sugar lowering effect of insulin.

It’s believed that human insulin itself does not cause cancer. However, it might be possible for an analog of insulin (like the two insulins being discussed) could drive the growth of abnormal cells that may have arisen by a separate process. For a body cell to become cancerous, it is thought that at least 6 different things (i.e., cellular “checks and balances”) must be breached in order for that cell to grow out of control (a primary trait of any cancer). It might be possible that some analog insulins could play a role in driving the rapid growth of existing abnormal cells. But the analog itself probably had nothing to do with the formation of the cancer in the first place. It may surprise some of you to know that cancerous and precancerous cells exist in many healthy people. These abnormal tissues may remain in check somehow until an outside force or substance drives the tissue to grow out of control. No one can say with any certainty that any analog insulin (including Lantus) doesn’t cause existing or hidden cancer cells to grow.

So, the bottom line is: keep using Lantus. There is no credible evidence any insulin (human or analog) causes cancer. But, without question Lantus and Levemir should both be carefully studied for any effects that might not have been apparent in the first few years of use, and not only cancer.

Don’t forget to check back later for tonight’s Diabetes Challenge Question!

There are several different ways to infer blood glucose levels through chemistry and electricity using disposable strips and meters. You might not realize it but there are clearly some meters and strips that are custom made for you and some that you need to avoid. I have some more analysis to do yet before posting a resource on mygluco.com that helps you determine which chemistries and methods are best for you vs which ones you need to avoid.

For starters however, did you know that when you are in a high altitude environment you need to avoid meters/strips that are based on glucose oxidase? How many of you take echinacea to boost your immunity? If that’s you then you definitely need to avoid test strips from 2 of the top 4 meter manufacturers. But if you’re at high altitude that same meter that might be the wrong choice for an echinacea lovin’ person might be the perfect choice.

All of this information is published online but good luck finding it and even more luck trying to make sense of it. Then why doesn’t the average physician, diabetes educator or patient know this? Hmmm? I’ll try to avoid conspiracy theories as I flesh this out and report on this as a clear and cited resource.

In summary, I know of at least 5 different categories that should influence our decision regarding which meter and test strip is best for us:
- physiology
- lifestyle
- prescriptions
- diet
- cost (formulary & co-pay)

Do you know of any other considerations?

Stay tuned for more on this life-critical topic (seriously - people have died because they used the wrong meter/strip). In the meantime, you might start asking around to see if anyone else is aware of this little secret and why it’s not in the mainstream. I’d like to know, too. You might also make sure you fill out your personal health record with information around those 5 categories so that your medical team can be aware and make better decisions with you vs for you.

Insulin pump therapy in children and teenagers never ceases to surprise me. Just when you think you’ve seen it all, along comes a new twist. The latest seems to be the “mystery bolus” and its first cousin, the “sleep bolus”.

Only Pumpers Would Appreciate This:

I’ve been seeing more and more kids and teens who have unexplained bolus doses of insulin when the devices are downloaded in the office. Often these occur during the middle of the night. While some may be recalled many are not.

Today I saw a young lady who had two episodes of severe hypoglycemia resulting in the parents stopping her pump until she came in for a check up. When the pump memory was examined, there were large boluses given within 30-45 minutes of the two events. The parents of this teen never check the bolus history, but were surprised (as was the girl, who has no evidence of secondary gain from this behavior) by these boluses.

Over the past year, I’ve seen other children do similar things.

One boy bolted up in his bed at 4:30 AM, dreaming that his mother had called him down for breakfast, then proceeded to bolus himself and fall back to sleep, only to be found severely hypoglycemic at 6:30 when the parents came to awake him. Beyond the sleep bolus, the “mystery” bolus is far more common.

At our children’s diabetes camp, the staff is obliged to check the bolus histories on all campers each day to verify dosing. It is now commonplace to find boluses that the child can’t (or won’t) explain. Many of these cases are teen boys who most likely are bolusing for contraband food, snacks or even sugar cubes. The pump enables this behavior in quite a perfect way.

There is often little parental review of the bolus history by many parents. The child has a ready supply of insulin to take for whatever extra food they wish to eat. It’s the “dark side” of insulin pump use that gets little attention. The message here is: know how to retrieve your child’s pump history. You may be surprised at what you find. And it may not be extra bolusing.

Often there are just as many skipped or missed boluses.

This brings me to my first rule of insulin pumping:

Pump Rule #1: The pump is no better (or worse) than the human being it’s attached to.

Never forget that.