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Medical Forum / Diseases and Disorders / Diabetes / November 2005Insulin cost?
I have been using metaformin for 5 yrs now and recently my blood sugar has been staying higher. My doctor has been after me to lose weight but as we all know it is easier said than done. He asked me how I felt about insulin and I was negative, wanting to avoid daily injections. I am starting to come around on this because this blood sugar is staying too high even when I do eat better - not exactly "right" - and exercise. I am also looking at changing jobs. How much does insulin cost for this scenario without a health plan that covers prescriptions? Prices will vary from one pharmacy to another but this site will give you an idea of the price range for insulin, syringes and other supplies. The price of insulin depends on what type of insulin you will be using. http://www.diabeticexpress.com/content/default.aspx >I have been using metaformin for 5 yrs now and recently my blood sugar > has been staying higher. My doctor has been after me to lose weight [quoted text clipped - 6 lines] > I am also looking at changing jobs. How much does insulin cost for > this scenario without a health plan that covers prescriptions? >I have been using metaformin for 5 yrs now and recently my blood sugar > has been staying higher. My doctor has been after me to lose weight [quoted text clipped - 6 lines] > I am also looking at changing jobs. How much does insulin cost for > this scenario without a health plan that covers prescriptions? I buy most of my medicines at: drugstore.com They are, for most meds, cheaper than any of the local drug stores. >>I am also looking at changing jobs. How much does insulin cost for >>this scenario without a health plan that covers prescriptions? Depends on which insulin. The newer prescription insulins including Lantus and Lispro seem to sell for something like $84 a vial. How long a vial will last you depends on how much you are taking, which depends, in turn, on your size and insulin resistance. A lot of people seem to be able to get a month out of a vial of Lantus, which is a basal insulin (i.e. used to keep your fasting blood sugar flat, not to counter spikes caused by eating.) The older insulins like NPH are a lot cheaper. Anywhere from $20-37 dollars per vial, but they may be more uneven in their effect on your blood sugar. --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info > >>I am also looking at changing jobs. How much does insulin cost for > >>this scenario without a health plan that covers prescriptions? [quoted text clipped - 16 lines] > http://www.geocities.com/lottadata4u/ Type 2 Diabetes info > http://www.geocities.com/jenny_the_bean/ Low Carb info HOLY CRAP! I pay CDN $31.96 a vial for Novolog. Even that's too expensive, when regular is 19 bucks a bottle. It'll be interesting to see how much Levemir retails for here. It's not available yet except through the endo, but will be needed if the cat outlives his stash of UL. Vicki |I have been using metaformin for 5 yrs now and recently my blood sugar | has been staying higher. My doctor has been after me to lose weight [quoted text clipped - 6 lines] | I am also looking at changing jobs. How much does insulin cost for | this scenario without a health plan that covers prescriptions? Depends upon what insulin(s) you want or what you're prescribed. Insulins requiring prescription are: Novolog Humalog Lantus -- not sure about Lev?? Insulins that can be bought OTC: NPH Regular Used to be Ultra Lente but think that has been discont. So, Regular would be the cheapest if you have no insurance. IIRC it's like $17 a vial at Walmart. You can always call around for cheapest cost. Most states you will also need a prescription for syringes (IGNORE anything Ted might say, half the time his syringe info is bogus) It's ALWAYS best to call your local pharmacy and see what YOUR states syringe law is. If the pharmacist knows your a insulin using diabetic most times you wont need a prescription for it... but still best to always check locally. If you're going to go the insulin route, it's always best to make sure your doctor is UP to DATE on the newest insulins that help the best. The "best" route would be to go Lantus and either humalog or novolog--- I find I do better with Novolog then Humalog some do better the other way around. Lantus is a slow very flat insulin, it's not meant to lower your glucose in any way. If it does, then you are taking way too much of it and you need to re-evaluate dosage with your doctor. Lantus is a background insulin, which is made to keep our glucose at a steady level. So, if you are running 300mg then Lantus should keep you at 300mg --- that is where the faster acting insulins come into help. Faster acting insulins such as Novolog and Humalog are made to help lower your glucose quickly when too high (ie: correction) or to take before your meal to help keep your post-prandal lower. These are not insulins for a T2 who already has a VERY low A1C. Your doctor will most likely start you off at a very low dosage to help determine your correct dosage. Since T2's are usually very Insulin Resistant they normally require double the amount of a T1, sometimes even triple the amount. -- Thus this can start a serious issue with T2's. Because you already have too much insulin in your system not being utilzed correctly (ie: Insulin Resistance) -- it's proven that too much insulin will begin to cause damage to the heart over time. So, the more you take is not really always the best route. -- This is why taking insulin is not a license to eat just whatever they want. A correct diet, coupled with daily exercise, along with STILL insulin resistance oral medications are the best route for a T2 who wishes to add insulin to their routine. -- It's certainly not a bad thing just have to be more cautious then T1's in some respects, with taking too much insulin. Just remember for a T2, once you start taking insulin, you can stop at any time. It also doesn't by any means show you've failed control either. T2 Diabetes is a progressive disease... At some point it's said, every T2 will be on insulin as well.. .it's just a matter of when they progress to that point. HTH RK, t1, pumper > Lantus is a slow very flat insulin, it's not meant to lower your glucose in > any way. If it [quoted text clipped - 5 lines] > 300mg --- > that is where the faster acting insulins come into help. This may be true for type 1s (which is what RK is) but it is most definitely false for type 2s. For a type 2 Lantus is prescribed to bring down the fasting blood sugar--both when you wake up and what you see 4 or 5 hours after a meal. It is often the first insulin prescribed for someone with Type 2 because lowering the fasting blood sugar with Lantus will also lower the peaks they get after a meal. --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info | > Lantus is a slow very flat insulin, it's not meant to lower your glucose in | > any way. If it [quoted text clipped - 8 lines] | This may be true for type 1s (which is what RK is) but it is most | definitely false for type 2s. perhaps for YOU it is false, but READ their website which I did 4yrs ago when I FIRST took Lantus. (started taking it 1mon after it was released for almost 2yrs prior to pumping) | For a type 2 Lantus is prescribed to bring down the fasting blood | sugar--both when you wake up and what you see 4 or 5 hours after a meal. Cite please from Lantus site. | It is often the first insulin prescribed for someone with Type 2 because | lowering the fasting blood sugar with Lantus will also lower the peaks | they get after a meal. Again, wrong, cite please from ONLY Lantus site. I was JUST there, again they profess it will NOT peak, it is not given for those wishing for a peak insulin. Stick to diet mumbo Jenny, insulin is OUT of your league. | --Jenny <non-doctor medical advise sites snipped for safety> > | It is often the first insulin prescribed for someone with Type 2 because > | lowering the fasting blood sugar with Lantus will also lower the peaks [quoted text clipped - 5 lines] > > Stick to diet mumbo Jenny, insulin is OUT of your league. The Lantus may not peak but the BGs still do.  SignatureNo Husband Has Ever Been Shot While Doing The Dishes >>| It is often the first insulin prescribed for someone with Type 2 because >>| lowering the fasting blood sugar with Lantus will also lower the peaks [quoted text clipped - 8 lines] >> >>Stick to diet mumbo Jenny, insulin is OUT of your league. > The Lantus may not peak but the BGs still do. RK, You are seriously uninformed about Type 2. You throw fits anytime a person with type 2 diabetes responds to a type 1, but that doesn't stop you from giving erroneous or confused information to any newbie type 2 who posts here--when you aren't screaming "troll" at them. You misunderstood the information at the Lantus site--the insulin levels in the blood don't spike with Lantus, but after eating a meal containing carbs, the blood sugar of a person on lantus most definitely does. However, for a type 2 who still produces insulin (which is almost every newbie who has ever stopped here), because the basal blood sugar level is lowered, the height of the post-meal spike is also lowered. So many doctors only prescribe Lantus for type 2s, not meal boluses. --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info | >>| It is often the first insulin prescribed for someone with Type 2 because | >>| lowering the fasting blood sugar with Lantus will also lower the peaks [quoted text clipped - 30 lines] | | --Jenny Nope you are WRONG. Read Macks reply, I'd believe him over you any day of the week. Lantus does not create a drop in glucose it keeps it steady it is the T2's own insulin production that creates the drop. Get your info correct, misinformation is bad, BOB! > Nope you are WRONG. Read Macks reply, I'd believe him over you any > day of the week. Lantus does not create a drop in glucose it keeps it > steady > it is the T2's own insulin production that creates the drop. Get your info > correct, misinformation is bad, BOB! Go read the Prescribing Information. Lantus is designed so that once injected, it is very slowly absorbed into the blood stream over a long period. It has a very long half life, so that even 24 hours after it is injected, half of it is still in the subcutaneous depot--which is why it takes a couple days to judge its effect, since you may be getting Lantus from your daily injection and the remains of the past two days injections. The steady release causes a steady level of insulin in the blood stream which (duh) removes blood sugar. However, since the level being released is much lower than the amount needed to remove a large dose of glucose from a meal, it isn't sufficient to counter post-meal blood sugar rises. Once again, you are confusing the way that a Type 1's body works--where there is no insulin being produced and the lack of insulin will cause liver dumps, so a basal insulin is needed to keep blood sugars level, with what happens in a Type 2 who still produces some insulin, but not enough to keep fasting blood sugars in a healthy range. Your statement that "it is the T2's own insulin production that creates the drop" is confused, BTW. The total amount of circulating insulin in the blood stream is what causes the drop. (Duh). The person's own insulin added to the slowly released Lantus insulin is what causes the drop. But by supplementing the Type 2's failing insulin production, there is less demand on the beta cells. You can rely on Mack's posting, or you can read the Prescribing Information and see how the stuff works. Do some googling for "Lantus half life" to learn more. And note that the graph of the level of insulin in the blood stream with Lantus shows that it has not dissipated at 24 hours. So the second injection is additive to whatever hasn't been released yet. It would be nice if you'd back up your insulting responses with some references that go beyond Mack's summary of a dumbed down consumer-oriented site. http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info You're absolutely right, Jenny. The correct dosage of Lantus will keep the person's fasting levels within a normal range, and for some T2s and all T1s a bolus insulin is needed for post-meal increases in bgs. Lantus is similar to a pump--the first thing when starting on a pump is to get the bgs at a normal fasting level with the correct basal rate. The action of Lantus is the same for both types (it cannot distinguish if you are a T1 or a T2!), but treatments may differ depending on what is needed after meals. >> Nope you are WRONG. Read Macks reply, I'd believe him over you any >> day of the week. Lantus does not create a drop in glucose it keeps it [quoted text clipped - 41 lines] > http://www.geocities.com/lottadata4u/ Type 2 Diabetes info > http://www.geocities.com/jenny_the_bean/ Low Carb info >Go read the Prescribing Information. Lantus is designed so that once >injected, it is very slowly absorbed into the blood stream over a long [quoted text clipped - 20 lines] >drop. But by supplementing the Type 2's failing insulin production, >there is less demand on the beta cells. none of this contradicts what I wrote previously. SignatureMâck©® Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o o) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." Jesus never hated anyone. http://tinyurl.com/dgb3q | none of this contradicts what I wrote previously. Bah, i'm just going to ignore her now... She's too busy off telling lies about me in other threads... She's proven what type of person she is... Sad, lying by saying it's my surgery that caused my chronic pain.. when gee not what my blood work nor my doctors tell me -- but hey she's gotta be right! then lying by saying i've had TWO surgerys... when gee when did I ever post that? -- then lying and saying i'm "dependant" upon pain meds... funny, I've not had anything for 2 days... OMG! no tramadol, no morphine and no percocet... yep I'm real dependant... She's what women call a "Busybee" sticks her nose in where it don't belong, lying to make others look bad... Hope others see her for the vicious mean person she truely is! > Hope others see her for the vicious mean person she truely is! Ha! Ha! Pot kettle Black >| none of this contradicts what I wrote previously. > [quoted text clipped - 10 lines] > >Hope others see her for the vicious mean person she truely is! she should have known that making those comments in this forum of people with chronic illnesses would not go over well with everyone. but don't waste your time defending yourself against those false statements. trolls will pick up on it and keep it going. SignatureMâck©® Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o o) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." Jesus never hated anyone. http://tinyurl.com/dgb3q | >| none of this contradicts what I wrote previously. | > [quoted text clipped - 15 lines] | but don't waste your time defending yourself against those false | statements. trolls will pick up on it and keep it going. very true... why it's over on my part.. lol what's that song... "dust in the wind...." <g> thx mack | "To announce that there must be no criticism of the | President, or that we are to stand by the President [quoted text clipped - 13 lines] | | http://tinyurl.com/dgb3q > | >| On Tue, 29 Nov 2005 09:32:40 -0500, Jenny > <lottadatacarbs@hotmail.com> [quoted text clipped - 25 lines] > > thx mack no worries RK, those with half a brain know who's advice to follow ...and I personally have been around you long enough over the past three years to know without a doubt that you know what you're talking about. I told you before, you missed your calling by not going into the medical profession...and by that, I meant d-o-c-t-o-r NOT p-a-t-i-e-n-t *wink* just chalk her up as another 'Timmy' ;) > | >>| It is often the first insulin prescribed for someone with Type 2 > because [quoted text clipped - 39 lines] > it is the T2's own insulin production that creates the drop. Get your info > correct, misinformation is bad, BOB! you are so wrong. if Lantus didn't lower bg, it would be useless! Imagine a diabetic who's bg's would be 400 every day. then they go on Lantus and find the correct dosage. then their bg's run around 90-140 day and night. HAS LANTUS FAILED TO LOWER THEIR BG'S?? All insulin lowers bgs, the only difference between the types, is the ACTION (onset and duration). Stupidest thing you ever wrote, to date, RK. dave > | >>| It is often the first insulin prescribed for someone with Type 2 > because [quoted text clipped - 39 lines] > it is the T2's own insulin production that creates the drop. Get your info > correct, misinformation is bad, BOB! Maybe if you stopped parroting Mack, you'd think for yourself, and maybe once in a while say something that MADE SENSE. D'ya think? Nah...you feel more secure riding on someone else's coattails, even if they are a whack job. Has it ever occurred to you that Mack keeps changing his address to avoid killfiles? A "normal" person would accept the fact that some people don't care to read him, and would stick with ONE address. He's changed about 3 or 4 times since last year. Just recently he's changed his addy twice. That's one of the definitions of a TROLL. Learn to pick your friends more carefully, as other posters (and lurkers) will associate you with the troll. I know I do! Dave | > | It is often the first insulin prescribed for someone with Type 2 because | > | lowering the fasting blood sugar with Lantus will also lower the peaks [quoted text clipped - 8 lines] | | The Lantus may not peak but the BGs still do. It's exactly what Mack said it was.. It's NOT the lantus the peaks, it's the T2's OWN insulin that creates the drop.. Jenny is PLAIN WRONG. >> Lantus is a slow very flat insulin, it's not meant to lower your glucose in >> any way. If it [quoted text clipped - 17 lines] > >--Jenny that's because it works with the phase 2 insulin response that type 2s still have with their own natural insulin. If the type 2 was not still making their own insulin and having this late phase 2 response, then the lantus would work in exactly the same fashion as with a type 1. I think you should both include that detail so as to be accurate about this particular difference and not create confusion or misunderstanding. SignatureMâck©® Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o o) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." Jesus never hated anyone. | >> Lantus is a slow very flat insulin, it's not meant to lower your glucose in | >> any way. If it [quoted text clipped - 28 lines] | this particular difference and not create confusion or | misunderstanding. Doesn't mention that at all on their site. And I quote... "LANTUS® is a clear, long-acting insulin with no pronounced peak. It provides a consistent 24-hour basal insulin level in the blood. LANTUS® cannot replace short-acting insulin such as Regular, Humalog® or Novolog®, which provide a "bolus" at mealtime. For people with type 2 diabetes, therapy may consist of a once-daily long-acting insulin (LANTUS®) in combination with oral agents or with rapid- or short-acting insulins.2" http://www.lantus.com/consumer/learn_about_lantus/about_24hour_lantus/what_basal bolus_regimen.do RK, t1 *snip* > Faster acting insulins such as Novolog and Humalog are made to help lower > your glucose [quoted text clipped - 17 lines] > license to eat just whatever they > want. *snip* Too much sugar vs too much insulin in your blood system.... I didn't know that increased insulin caused damage to the heart over time. Can someone please direct me to some articles that can show scientific proof regarding this? I did some googling and found some article but it appears as if they are from those who want to sell things. Thank you, Mimi heres several... happy reading. http://search.yahoo.com/search?p=HYPERINSULINEMIA%2C+AND+CORONARY+HEART+DISEASE& prssweb=Search&ei=UTF-8&fr=FP-tab-web-t&fl=0&x=wrt http://www.google.com/search?hl=en&q=HYPERINSULINEMIA+AND+CORONARY+HEART+DISEASE Hyperinsulinemia refers to high insulin levels in the blood. The pancreas, a gland behind the stomach, often produces excess insulin when tissues in the body do not respond properly to insulin (insulin-resistant). Hyperinsulinemia and insulin resistance usually are both early symptoms of type 2 diabetes. People who are overweight and take large doses of insulin or who take other medications that interfere with the action of insulin also are at risk for hyperinsulinemia. Hyperinsulinemia may: Be associated with the process of hardening of the arteries (atherosclerosis), which decreases blood flow to the legs and organs, such as the heart, brain, and kidneys. Atherosclerosis increases a person's risk of heart attack and stroke. Cause high blood pressure (hypertension). Contribute to weight gain. Increase blood cholesterol levels. Losing weight helps decrease hyperinsulinemia and insulin resistance. http://www.uhseast.com/172278.cfm | *snip* | > [quoted text clipped - 30 lines] | | Mimi Thank you, RK. Mimi > heres several... happy reading. > [quoted text clipped - 72 lines] > | > | Mimi you're welcome Mimi hth rk | Thank you, RK. | | Mimi | | > heres several... happy reading. http://search.yahoo.com/search?p=HYPERINSULINEMIA%2C+AND+CORONARY+HEART+DISEASE& prssweb=Search&ei=UTF-8&fr=FP-tab-web-t&fl=0&x=wrt http://www.google.com/search?hl=en&q=HYPERINSULINEMIA+AND+CORONARY+HEART+DISEASE | > Hyperinsulinemia refers to high insulin levels in the blood. The pancreas, | > a [quoted text clipped - 66 lines] | > | | > | Mimi > *snip* > [quoted text clipped - 12 lines] >>Because you already have too >>much insulin in your system not being utilzed correctly (ie: Insulin > Too much sugar vs too much insulin in your blood system.... I didn't know > that increased insulin caused damage to the heart over time. Can someone > please direct me to some articles that can show scientific proof regarding > this? I did some googling and found some article but it appears as if they > are from those who want to sell things. Mimi, About five years ago, everything I read seemed to agree that high insulin levels caused heart disease. However, I have heard since then that this might not be true. The problem is that the studies that implicated high insulin levels may not have distinguished t the effect of high insulin levels from the effect of the high blood sugar levels that usually accompany them. So the known fact that people with heart disease often have very high insulin levels does not necessarily imply that these high insulin levels CAUSE heart disease. It may be the damage to the vasculature caused by the uncontrolled high blood sugars that go along with insulin resistance that are to blame. There is increasing evidence that the risk of heart disease rises in close correlation to the A1c even in people who are at what have been previously considered "normal" levels (A1c from 5% to 6%). No one has yet tested whether reducing A1c in people whose results fall into this level reduces heart disease. If it did, that might change the way that this research is looked at. So for now, this is an important question for anyone taking or thinking about insulin, but for now, the whole answer is not known. We know that high insulin coupled with higher than normal blood sugars and, often, the other components of metabolic syndrome most definitely go along with cardiac disease, but the true role of insulin remains to be understood. --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info >> *snip* >> [quoted text clipped - 15 lines] >> Too much sugar vs too much insulin in your blood system.... I >> didn't know that increased insulin caused damage to the heart over >> time. Can someone please direct me to some articles that can show >> scientific proof regarding this? I did some googling and found some >> article but it appears as if they are from those who want to sell >> things. > [quoted text clipped - 6 lines] > The problem is that the studies that implicated high insulin levels > may not have distinguished t the effect of high insulin levels from > the effect of the high blood sugar levels that usually accompany them. > So the known fact that people with heart disease often have very high > insulin levels does not necessarily imply that these high insulin > levels CAUSE heart disease. > > It may be the damage to the vasculature caused by the uncontrolled > high blood sugars that go along with insulin resistance that are to > blame. > [quoted text clipped - 4 lines] > No one has yet tested whether reducing A1c in people whose results > fall into this level reduces heart disease. If it did, that might > change the way that this research is looked at. > > So for now, this is an important question for anyone taking or > thinking about insulin, but for now, the whole answer is not known. > We know that high insulin coupled with higher than normal blood > sugars and, often, the other components of metabolic syndrome most > definitely go along with cardiac disease, but the true role of > insulin remains to be understood. Jenny, yesterday I did a similar search "hyperinsulinemia coronary heart disease" and came up with a number of hits of trials that showed evidence independent of high blood glucose levels. From memory it was done on non diabetics with insulin resistance. I have a migraine getting worse and heading back to bed soon but I am sure you can get something out of that search. The med speak was highly evident, too much for my brain this morning ;) From memory one was a Finnish study. > Too much sugar vs too much insulin in your blood system.... I didn't know > that increased insulin caused damage to the heart over time. Can someone > please direct me to some articles that can show scientific proof regarding > this? I did some googling and found some article but it appears as if they > are from those who want to sell things. Go to www.nlm.nih.gov and search on Pubmed for "hyperinsulinemia and cardiovascular disease." Susan >Too much sugar vs too much insulin in your blood system.... I didn't know >that increased insulin caused damage to the heart over time. Can someone >please direct me to some articles that can show scientific proof regarding >this? I did some googling and found some article but it appears as if they >are from those who want to sell things. FWIW, this is my endo's philosophy and he's not selling anything. I'm so insulin resistant I'd be taking a couple hundred units of long-term insulin a day. My endo has said right from the start (started insulin in '99) that that much is hard on the heart. Instead I've been taking about 200 units of Humalog (recently switched to Apidra) which is taken in smaller doses and doesn't hang around in my system. >>Too much sugar vs too much insulin in your blood system.... I didn't >>know that increased insulin caused damage to the heart over time. Can >>someone please direct me to some articles that can show scientific >>proof regarding this? I did some googling and found some article but >>it appears as if they are from those who want to sell things. > FWIW, this is my endo's philosophy and he's not selling anything. I'm > so insulin resistant I'd be taking a couple hundred units of long-term > insulin a day. My endo has said right from the start (started insulin > in '99) that that much is hard on the heart. Instead I've been taking > about 200 units of Humalog (recently switched to Apidra) which is > taken in smaller doses and doesn't hang around in my system. Weight loss didn't lower the IR? >Weight loss didn't lower the IR? What weight loss? I gained 60 pounds the first year on insulin and only took off 20 for a net gain of 40 since 2000. > I have been using metaformin for 5 yrs now and recently my blood sugar > has been staying higher. My doctor has been after me to lose weight [quoted text clipped - 6 lines] > I am also looking at changing jobs. How much does insulin cost for > this scenario without a health plan that covers prescriptions? Regular insulin (Novo R, N, or mixes) costs $19 at WalMart. Lily Insulin, or Novo at places other than WalMart costs about $32. The Analogs cost about $55-$60, and have a shorter shelf life. There are also lots of penfil and prefill of various types which are slightly easier to use, and more expensive > Regular insulin (Novo R, N, or mixes) costs $19 at WalMart. Lily > Insulin, or Novo at places other than WalMart costs about $32. > > The Analogs cost about $55-$60, and have a shorter shelf life. Not in Western Massachusetts they don't. I called around for prices. U and R were around $38 and the Lantus was in the 80s. We don't have much competition in this rural area. --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info >> Regular insulin (Novo R, N, or mixes) costs $19 at WalMart. Lily >> Insulin, or Novo at places other than WalMart costs about $32. [quoted text clipped - 6 lines] >We don't have much competition in this rural area. >--Jenny do you have walmart? SignatureMâck©® Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o o) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." Jesus never hated anyone. >>We don't have much competition in this rural area. >>--Jenny > > do you have walmart? Mack, We're the town that is featured in the movie about the town that kept Wal-mart from moving in. So no, we don't have Walmart. I can get to one, but it is a 40 minute drive. --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info >>>We don't have much competition in this rural area. >>>--Jenny [quoted text clipped - 9 lines] > >--Jenny so you shot yourselves in the foot on that one. you do know you can get the same price from walmart's online pharmacy. SignatureMâck©® Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o o) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." Jesus never hated anyone. Jenny wrote >>We're the town that is featured in the movie about the town that kept >>Wal-mart from moving in. So no, we don't have Walmart. [quoted text clipped - 3 lines] > so you shot yourselves in the foot on that one. you do know you can > get the same price from walmart's online pharmacy. Don't blame me. I didn't live here at the time, and besides I don't vote in the town where the vote was held as I live in an iddy-biddy town to the north. I have drug coverage for now, so I don't have to mail order anything. But my insurance copays are so high that I have started to check out the prices before I fill a prescription, because sometimes the prescriptions are cheaper without the insurance than with. --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info > I have been using metaformin for 5 yrs now and recently my blood sugar > has been staying higher. My doctor has been after me to lose weight [quoted text clipped - 6 lines] > I am also looking at changing jobs. How much does insulin cost for > this scenario without a health plan that covers prescriptions? I'm a Type II who uses insulin and Metformin. I need very little insulin because I've lost 45 pounds, exercise daily, and strictly control carbs. I avoid the starches and eat plenty of greens and lean proteins. I get by nicely with OTC insulins: NPH and R. A vial of either one costs me about $25.00 at Costco. One vial gives me 1000 units. I rarely, if ever, use more than 20 units a day. Many days, I only need 12 units. So let's say I average 15 units a day. That gives me 67 doses for $25.00, or 37 cents a dose. Each syringe costs 25 cents. So, for about 62 cents, I'm shooting insulin and keeping my blood glucose well controlled. Last A1C was 5.3. The NPH and R insulins have a long shelf life and seem to last months in the fridge in light-tight containers. I keep them off the door so they don't get jostled around. The expensive insulins have a short shelf-life...30 days. I could use these insulins with penlets and cartridges and avoid having to throw away unused insulin older than 30 days, but I'm doing so well with the NPH and R, I don't feel the need to pay more at this point. Uncle Enrico: I did not know that insulin could be purchased without prescription. I wonder if this would be beneficial to use (the NPH) for my live dump in the morning. It seem like my am FBS is harder to control any more even though I'm exercising and watching what I eat. It's been any where from 120's all the way up into 160's. It's really disheartening especially when I feel like I'm doing everything right. At the moment I'm on Actos 30mg and Amaryl 4mg with regular insulin in the morning to cover my high FBS. Mimi >> I have been using metaformin for 5 yrs now and recently my blood sugar >> has been staying higher. My doctor has been after me to lose weight [quoted text clipped - 28 lines] > unused insulin older than 30 days, but I'm doing so well with the NPH and > R, I don't feel the need to pay more at this point. > Uncle Enrico: > [quoted text clipped - 9 lines] > > Mimi I didn't start insulin until my doctor approved of it and I wouldn't recommend anyone use insulin without a doctor's approval despite the availability of OTC insulin. For example, if your doctor approved your starting insulin, he/she would likely change and/or discontinue some of your meds. Also, the choice of insulin to deal with your morning numbers needs to be carefully considered. There is considerable support among endos and doctors who treat diabetics that insulin should be started much earlier in the disease process to preserve the beta cells and achieve good control. I began using insulin specifically to deal with my high morning numbers which were not easily contolled with metformin and the bed time snack. I have a somewhat unconventional approach to the liver dump problem by using NPH and R. I wake up at 3 am for my morning bathroom run, and afterwards inject 5 units of R and 5 of N and then go back to sleep. I wake up two to three hours later around 95 to 100 instead of 130 to 150. If I stay low carb the rest of the day, I only need Metformin. Dosages are highly individualized and need to be determined, first by your doctor and then by you and your meter as you become knowledgeable about how your body works with the food you eat. Most doctors will now recommend using Lantus to deal with the problem because it is "peakless" and lasts about 24 hours. Unfortuntely, it costs twice what my NPH and R cost and its shelf life is less than 50% of the cheaper insulins. Talk to your doctor. 2liberal wrote in message <1133110719.967824.163000@g49g2000cwa.googlegroups.com>... >I have been using metaformin for 5 yrs now and recently my blood sugar >has been staying higher. My doctor has been after me to lose weight [quoted text clipped - 6 lines] >I am also looking at changing jobs. How much does insulin cost for >this scenario without a health plan that covers prescriptions? This is a situation which allows you work harder, "go the extra mile" and save some money. Lantus is a premium-priced insulin which is extremely convenient to use. For most T2, a single shot a day does a lot of good. However, it has about the worst stability of all the insulins so you may end up opening a new vial every month (~$65 at a "good" store) NPH can be substituted for Lantus at somewhere around 1/4 to 1/3 the cost. . . .BUT you have to take several small shots spaced through the day to get the same effect. NPH is very stable. You can use almost all of a vial. I exploit this effect with my current slow insulin, Ultralente, and end up paying about 25% the cost of equivalent Lantus. I suppose the mail order places have good prices but I haven't seen any that beat our local Wal-Mart. Shop around with great diligence if you can't find a Wal-Mart. The differences in insulin prices from store to store are reprehensible. Stores that brag about their "discount" prices scr*w diabetics. The above argument can be repeated in a comparison between the "before-meal" insulins Humalog and "Regular". Humalog is very convenient; you shoot just before each meal and it works almost as if by magic. Regular takes several hours to reach maximum effect so you must shoot perhaps as much as an hour (or more) before each meal and do some guessing about exactly when and how much you will eat. However, Wal-Mart Regular is less than 1/3 the cost of Humalog. Novolog is about a 1:1 substitute for Humalog in price and action. Regards Old Al . > NPH is very stable. You can use almost all of a vial. I exploit this > effect with my current slow insulin, Ultralente, and end up paying about > 25% the cost of equivalent Lantus. Are you still able to buy Ultralente? I thought it was discontinued??? > I have been using metaformin for 5 yrs now and recently my blood sugar > has been staying higher. My doctor has been after me to lose weight [quoted text clipped - 3 lines] > too high even when I do eat better - not exactly "right" - and > exercise. Try this first, 81 pounds lost so far. http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm SignatureNo Husband Has Ever Been Shot While Doing The Dishes >Try this first, 81 pounds lost so far. >http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm Wow! A year ago it was 23lbs. And then you had joined the 5% club. That's wonderful! C O N G R A T U L A T I O N S!!!!! Cheers, Alan, T2, Australia. SignatureEverything in Moderation - Except Laughter. >>Try this first, 81 pounds lost so far. >>http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm [quoted text clipped - 7 lines] > > Cheers, Alan, T2, Australia. Same here. I've also been loosing weight for the last 23 months coincident to getting my bg in control. I *know* that kind of weight loss isn't easy. Way to go! Congratulations! Peter G. >>Try this first, 81 pounds lost so far. >>http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm [quoted text clipped - 7 lines] > >Cheers, Alan, T2, Australia. I missed the original post, so thanks Alan for pointing this out! WOW!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Congratulations, NG!!! Way to go!!!! > >Try this first, 81 pounds lost so far. > >http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm [quoted text clipped - 5 lines] > > C O N G R A T U L A T I O N S!!!!! Thanks, I was at the dr's again a little while ago, it's now 88 pounds. The MRI showed my problem between L4&L5, I am supposed to see a neurosurgeon next. This worries me I don't think I want to be cut on. Isn't there some kind of physical therapy or chiropractor or something, I can try first? SignatureNo Husband Has Ever Been Shot While Doing The Dishes > > >Try this first, 81 pounds lost so far. > > >http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm [quoted text clipped - 10 lines] > next. This worries me I don't think I want to be cut on. Isn't there some > kind of physical therapy or chiropractor or something, I can try first? If all you see is a neurosurgeon, then all you'll hear about will be surgery. Find a good chiro and get a consult. Priscilla On Mon, 28 Nov 2005 17:21:33 -0500, "Priscilla H. Ballou" <vze23t8n@verizon.net> Huffed and Puffed the following into the madness of usenet: >> > >Try this first, 81 pounds lost so far. >> > >http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm [quoted text clipped - 15 lines] > >Priscilla be very wary of chiropractors, many have been investigated and busted for fraud and instructing patients on how to commit insurance fraud. Many will sell supplement scams and profess to have cures for diseases there are no cures for. SignatureMâck©® Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o o) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." Jesus never hated anyone. > > Thanks, I was at the dr's again a little while ago, it's now 88 pounds. > > The MRI showed my problem between L4&L5, I am supposed to see a neurosurgeon [quoted text clipped - 3 lines] > If all you see is a neurosurgeon, then all you'll hear about will be > surgery. Find a good chiro and get a consult. How do I find a good one? SignatureNo Husband Has Ever Been Shot While Doing The Dishes I would first consult a pain management doctor or a physiatrist. A surgeon will want to do surgery first, but your problem may be manageable with epidural injections. I've done this and it's worked wonders for me. >>>Thanks, I was at the dr's again a little while ago, it's now 88 pounds. >>>The MRI showed my problem between L4&L5, I am supposed to see a [quoted text clipped - 11 lines] > > How do I find a good one? >>If all you see is a neurosurgeon, then all you'll hear about will be >>surgery. Find a good chiro and get a consult. > How do I find a good one? How you DON'T find a good one is getting referrals from friends who have minor aches and pains who tell you how wonderful their chiropractor is. That was what I did, and what a mistake it was! This is true about finding doctors too. If you ask people who are rarely sick and who don't have a chronic disease, they'll often tell you that their doctor is "wonderful" based on his friendliness. The best source of referrals is people who work in hospitals and know the local doctors. Nurses, in particular. They know, as they say, "Where the bodies are buried." <G> --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info > Thanks, I was at the dr's again a little while ago, it's now 88 pounds. > The MRI showed my problem between L4&L5, I am supposed to see a > neurosurgeon next. This worries me I don't think I want to be cut on. > Isn't there some kind of physical therapy or chiropractor or something, I > can try first? What exactly is the problem? What kind of doctor(s) have you already seen about it? And did you already ask them if there are alternatives to surgery? Emphasize your desire to try other (reasonable, not crackpot) approaches first. Ask why surgery is the only (or even the best) option (if that's what they say it is). (My orthopedic surgeon has *never* suggested surgery as the first thing to try for my various problems with ankles, knees, back, shoulders, elbows, wrist..... though I did end up needing surgery for both torn rotator cuffs.) And good luck. bj > What exactly is the problem? What kind of doctor(s) have you already seen > about it? And did you already ask them if there are alternatives to surgery? > Emphasize your desire to try other (reasonable, not crackpot) approaches > first. Ask why surgery is the only (or even the best) option (if that's what > they say it is). I have a pain in my hip that shoots down my leg, it started after I had a spasm in my back, but it didn't get better like it has before it just moved into my hip instead. My regular dr took xrays and said it is sciatica then sent me for the MRI. She said it shows I have the problem at L4-L5 and my muscle in that area is in spasm but I don't feel a spasm, I just feel the pain in my hip and leg. If I go to a surgeon is it certain that he will say I need surgery or is he supposed to see if he thinks it will help or not? Do surgeons do more tests for stuff or what? SignatureNo Husband Has Ever Been Shot While Doing The Dishes > I have a pain in my hip that shoots down my leg, it started after I had a > spasm in my back, but it didn't get better like it has before it just moved [quoted text clipped - 4 lines] > I need surgery or is he supposed to see if he thinks it will help or not? > Do surgeons do more tests for stuff or what? If you don't have an actual rupture visible on MRI, the problem may very well be a muscle spasm, in which case, acupuncture might be exactly what you need. It is extremely good at releasing muscles that have locked up. I had a shoulder that was excruciating for over 6 months, which did not respond to cortisone or physical therapy, which became completely normal after two acupuncture treatments. The acupuncturist said that it was a case where the original injury that had caused the muscles to lock up around my shoulder had healed, but the muscles continued to be in spasm around the damaged area. Acupuncture can fix that. So of that's really what is going on in your back, it might be worth a try. I'd be very careful with the surgeon. Some that I've met are very honest and will say, "this isn't a good thing to operate on." Others will try to push you into surgery. The guy who ended up NOT doing my surgery told me that I'd never recover feeling in my leg and that without immediate surgery (like in two days!) my paralyzed leg muscle would get worse. Even with surgery he said I'd never get feeling back, and he wouldn't promise that I would not end up in pain after the surgery. My family doctor told me that I didn't need to have the surgery in any two days, and that it would be fine to wait a week or two. I did, and within the two weeks, the feeling came back into my leg--which the surgeon said would never happen. Within a few more weeks I could push up on my toes again on my right leg, which had been impossible before. That undercut my feeling of confidence in him, and reinforced the feeling I'd gotten from several things he'd said at the appointment that he was Dr. Happy Knife. A surgeon should give you a bunch of neurological tests, hit you with little hammers, make you walk around, stand on one leg, stand on your toes, etc, to evaluate your neurological function, and he should spend a bunch of time looking at your MRI. If he tells you surgery will help, be sure to ask a lot of questions about what he thinks is wrong, why, and what kind of surgery he wants to do. Talk it over with the family doctor before making a decision. Mine was very helpful when I went through this. --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info what you described is very much what I have on a moment to moment basis... steriod injections in the back help, muscle relaxers help... but I think it would do you good to get a blood test for a HBL-A27 marker. what you described is how AS begins in many. | > What exactly is the problem? What kind of doctor(s) have you already seen | > about it? And did you already ask them if there are alternatives to [quoted text clipped - 12 lines] | I need surgery or is he supposed to see if he thinks it will help or not? | Do surgeons do more tests for stuff or what? thanks for the responses, i got what I was asking for and quite a bit more. If i steer clear of carbs my levels is about 120-140. With any carbs such as whole wheat bread i spike up to 200 and stay there for awhile. It looks like I have gone to a new stage as my level used to drop down to 70 at times when I ate right but that is not happening lately. > Thanks, I was at the dr's again a little while ago, it's now 88 pounds. > The MRI showed my problem between L4&L5, I am supposed to see a neurosurgeon > next. This worries me I don't think I want to be cut on. Isn't there some > kind of physical therapy or chiropractor or something, I can try first? My ruptured disc was L4/L5. I didn't have the surgery because I knew several people who had very poor outcomes, one them a much-loved professor who had to retire early because he was in so much pain. The chiropractor I saw made things worse. Much worse. I would caution you to avoid chiropractors if you have a serious back injury. The physical therapist my doctor sent me to didn't do anything that caused improvement and gave me a list of "off the shelf" exercises which made my particular injury worse, not better. I tried acupuncture, which I have found very helpful for other problems. The acupuncturist (much more honest than the Chiropractor) told me that I should be able to tell within two treatments if acupuncture would help the back injury. He said it sometimes did, but mostly it didn't, which was the case for me. So after trying all these things, I just waited it out since the numbness cleared up and then the pain very slowly started to abate. When I got back to where I could walk, I did as much gentle walking as I could. I got a lot of flak from the family for not having the surgery, because it took so long for me to get back to any kind of half-decent shape. But over time the people who did have the surgery ended up back in the hospital, and one of them came back out in very bad shape, so finally, I stopped getting the "Why didn't you have surgery like So-and-so" and instead I was hearing, "I'm really glad you DIDN'T have the surgery like So-and-so." My pain levels subsided from life-changing to minor-annoyance in time. But it took over a year to get my mobility back and my back it is still far from 100%--I can't carry anything heavy at all and I can't twist, which means I can't swim or do any other sport that is fun. On the plus side, I don't have scar tissue growing up through my spinal nerves making my life pure, living hell, which is what happened to my uncle. Best wishes for whatever solution you go for! --Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info > The chiropractor I saw made things worse. Much worse. I would caution > you to avoid chiropractors if you have a serious back injury. What serious back injury, it started when I sneezed, there has to be something I can do, right? Does walking help? I notice after I have to go shopping where I end up walking a lot my hip feels really sore. Should I just wait, for how long, it's been 5 months, so far? > My pain levels subsided from life-changing to minor-annoyance in time. > But it took over a year to get my mobility back and my back it is still [quoted text clipped - 3 lines] > nerves making my life pure, living hell, which is what happened to my > uncle. >>The chiropractor I saw made things worse. Much worse. I would caution >>you to avoid chiropractors if you have a serious back injury. [quoted text clipped - 11 lines] >>nerves making my life pure, living hell, which is what happened to my >>uncle. None Given, Sneezing yourself into a back mess is a sign of chronic back injury, the kind that isn't as responsive to surgery. Mine was apparently caused by limping many miles for a couple weeks after taking a flying leap while dancing and tearing a muscle in my calf. Unfortunately, we had a hiking vacation scheduled and I toughed it out. Bad move. It turns out that an uneven gait stresses an already marginal back. Five months is a long time. Did the doctor mention "piriformis syndrome" when talking about muscle spasm? This is something that physical therapists treat with stretches, muscles somewhere in the hip/butt region clamp down around the sciatic nerve. It can occur the follow up to an injury to the back or can result from postural stresses. This might be something that does respond to physical therapy or cortisone. If you haven't tried acupuncture or physical therapy, they could be worth a look, particularly if the MRI does not show damaged discs, which sounds like the case if your doctor says the problem is muscular in origin. If you have an appointment to see a surgeon, go, just be wary about promises of cure. The problem with "successful" surgeries, is that the method of evaluating a surgery as successful is to look at the patient in 6 weeks and see how they are doing. So a doctor who claims that 95% of his surgeries are successful may not know that in 5 years half his patients have had a second surgery and are in bad shape. Another problem that I've seen happen is that the surgery is declared a success and when you need the second surgery on the same area the doctors insist it is for a different problem. Doctors tend to protect each other and won't tell you that a previous operation wasn't as successful as you were told. Or that the problem is caused by scar tissue built up around the first, "successful" operation. Re RK's response: Notice how RK, who gets furious when people suggest contacting a doctor about a possible side effect from Metformin, saying that they are "playing doctor" plays surgeon here and assures you that a non-trivial surgery is safe. After what examination???? Notice, too, that like most people who rave about how great their surgery was, she ended up with a second surgery that has left her in chronic pain and dependent on powerful painkillers. And as is so often the case, she is wrong about disc rupture being a sentence to a lifetime on ineffective painkillers. My disc ruptured completely (which is why I'm almost an inch shorter than I used to be) but the extruded material (highly visible on MRI) shrank or was reabsorbed by my body (which is what happens) and, as mentioned before, my back pain is mostly in the "aches and pains" category, not the "dependent on powerful painkillers" category. Signature--Jenny http://www.geocities.com/lottadata4u/ Type 2 Diabetes info http://www.geocities.com/jenny_the_bean/ Low Carb info | Re RK's response: | Notice how RK, who gets furious when people suggest contacting a doctor | about a possible side effect from Metformin, saying that they are | "playing doctor" plays surgeon here and assures you that a non-trivial | surgery is safe. After what examination???? lol... can't stand it when i'm right.. you have a severe complex of needing to be top dog... sorry you just don't cut the mustard. | Notice, too, that like most people who rave about how great their | surgery was, she ended up with a second surgery that has left her in | chronic pain and dependent on powerful painkillers. Excuse me? more of your trivial lying there Jenny? I've never stated I've had 2 surgeries, I've had ONE. My chronic pain isn't from my back surgery at all... and I'm not dependant on any pain medication. I happen to enjoy NOT hurting 24/7. As for my chronic pain, I have OS along with AS which are both arthritis and one is genetic along with being auto-immune. So get your lies straight next time. | And as is so often the case, she is wrong about disc rupture being a | sentence to a lifetime on ineffective painkillers. My disc ruptured [quoted text clipped - 3 lines] | my back pain is mostly in the "aches and pains" category, not the | "dependent on powerful painkillers" category. Then it's doubtful that you had a ruptured disk at all, perhaps mildly herniated. A ruptured disk would have resulted in the complete loss of disk material between the disks therefore leaving very painful bone on bone rubbing until natural scar tissue had built up. Again, get some new material, because you're very boring with your misinformation. | > >Try this first, 81 pounds lost so far. | > >http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm [quoted text clipped - 10 lines] | next. This worries me I don't think I want to be cut on. Isn't there some | kind of physical therapy or chiropractor or something, I can try first? congrats on the weight loss. the diskectomy and lamectomy was the best thing I ever did for myself. being nearly 5yrs "almost" painfree was a blessing. my neurosurgeon told me a chiro would only cripple me more in the end, which I was stupid and went to one ONCE... and I was in bed unable to move to do sensation loss because of how they "twisted" me. diskectomy's are very common now and are done mostly laproscopic, which reduces recovery quite a bit. mine took 8 months for the 217 stitches and 7 layers of muscles inside to heal. don't screw around with it, if the disk ruptures completely, you'll risk ending up having a lamectomy which is what took me to so long to recover from, it screws up the vertebrea ... that then is bone on bone.. and believe me it hurts far worse then what you feel now. there are days I seek death if only for a hour or two to gain relief. best of luck. |
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