Human vs. Non-human Insulin

Health Professional

I recently received the following e-mail:

I'm borderline diabetic so I haven't learnt much yet about diabetes or the medication used to treat it but I am now aware of news items concerning diabetes. The other day I saw a news item that said that non-human insulin is about twice as expensive as human insulin so the NHS (I live in the UK) has advised doctors to prescribe the cheaper alternative to new cases. This worries me because I have tried to stay off insulin by losing weight etc., and now feel that my reward might be to be prescribed an inferior form of insulin when I do need it. I've heard that the human insulin increases body fat which would also reverse all my efforts and demotivate me. What is your view on this?

My answer:

First, we need to clarify what "non-human" insulin you are talking about. I initially thought you meant animal-source insulin, but finding a recent news story about the NHS's concern, it appears your concern is with the recently-developed insulin analogs.

In any case, my view is entirely different than what you have read: "human" insulin is not an inferior form of insulin, and** all** forms of insulins are associated with possible weight gain.

First, for clarity so we are on the same wavelength on one point: what is frequently called "human" insulin does not come from human beings, but instead can be manufactured in such a way as to precisely mimic human insulin. The manufacturing technology is called "recombinant DNA" technology, and is now used for almost all insulin production, as well as the production of many other hormones and proteins. This is a completely different way of obtaining insulin than when obtaining bovine (cow) or porcine (pig) insulin, which is extracted from the pancreases of these animals (which are obtained from slaughterhouses when the animals are processed for meat and other products).

An additional point, which the NHS is concerned about: insulin manufacturers have now developed variants of human insulin that are not precisely the same as human insulin, which are called insulin analogs (or analog insulins, if you prefer). These analogs have a few amino acids that are different from human insulin, and hence have different characteristics: some (including Humalog and Novolog and Apidra) act more rapidly than human insulin, and some (including Lantus and Levemir) persist much longer than normal human insulin. There has been some concern that analog insulins might be associated with cancers, and indeed one ill-fated insulin analog [AspB10] was found to induce   breast cancer in rats. There also was some concern a few years back that Lantus might be associated with an increased risk of malignancies, although regulatory authorities were not impressed, and the American Diabetes Association thought the studies "conflicting and confusing" and "inconclusive." These insulin analogs are indeed more expensive than the earlier versions of human insulin.

You are correct on your last comment, but ascribing the problem of increased storage of fat to human insulin alone is wrong: any insulin can cause weight gain if excessive calories are eaten. Why? Because insulin can be viewed as a "storage hormone:" it works to store glucose as fat. If anyone overeats while on insulin therapy, and adjusts the insulin dose to keep the blood glucose levels near-normal, and doesn't increase their exercise levels dramatically, the result will be weight gain. Believe me, I've seen it in patients on insulin therapy for many years, including long before human insulin was first commercially available in 1983.

One final point: yes, human insulin is presently cheaper than either analog or animal-source insulin. For many years after the initial introduction of human insulin, there was a financial reason to continue to use animal-source insulin as the initial prices for human insulin were much higher than that from animal sources, but that is no longer true, and now there is no reason whatsoever for patients who are starting on insulin therapy to be started on animal-source insulin.

Interestingly, there is a long-standing myth, especially prevalent in the UK, that human insulin is somehow inferior to animal-source insulin. This is completely illogical, but has persisted for years, and has many firm adherents who loudly promote their belief.

The only question for patients starting insulin should be whether an analog insulin is more appropriate for them than human insulin. Frequently, the characteristics of the analog insulins make them a better (albeit more expensive) choice. If you need to start insulin therapy, you can discuss with your physician at that time why the choice of one or the other types of insulin is better for you to use.

Hope this helps