*Holy cow, whatcha doing’ to me? #HAW17z

Once upon a time there was a woman with type 1 diabetes using bovine insulin who was planning to start a family. Having experienced two miscarriages (attributed to an immune system issue), she worked hard to avoid hypos and hypers so that this pregnancy would succeed.

Along came human insulin and her consultant advised a swap from the bovine insulin she’d used since diagnosis in the 60s. At that time it wasn’t understood that this change should be managed carefully, that bovine insulin stimulated the production of antibodies and the new insulin, which didn’t, would cause insulin sensitivity to rocket resulting in unpredictable hypos.

The woman began having frequent, severe hypos which came on rapidly and without warning. She collapsed frequently, she had an accident in the fast lane of the M1 (no injuries other than a damaged police car bumper caused by braking in front of her car to halt progress). She lost her driving licence. Many others suffered similar frequent, severe hypos and lost their hypo awareness.

Patients protested, campaigns began, inquests were held for those who died from severe hypos and court cases followed. The New Scientist described the situation vividly in this 1989 article.

The woman was afraid so went back to bovine insulin and remained on it for nearly 20 years, achieving a successful pregnancy. She then relaxed her glycaemic management and lived relatively well with her diabetes, despite less than perfect HbA1c results. CGM was the real game changer some years later, managing the hypo unawareness and the hypers better than ever before.

When persuaded to try a new analogue of human insulin in the 2000s, she was reluctant. She knew that the transition from bovine insulin had now been rigorously studied but the cause of the problem wasn’t identified for some time. No responsibility was accepted for the sorry saga that had blighted so many lives. As ever with diabetes, some patients blamed themselves for their ‘poor management skills’ and for getting things wrong. Same old story.

Why am I telling this story? Because it’s Hypo Awareness Week 2017 and because bovine insulin will shortly be withdrawn and I’m concerned and fear for the wellbeing of the last 100 or so people using it. They’re probably elderly, may be averse to a treatment change and they are possibly being cared for by non-specialists who do not read the type of excellent guidance from Imperial College in London, published in Diabetes UK’s UPDATE Fact File 32 (Bovine insulin Factfile – Sept 2017). They won’t read this blog, nor will their clinicians.

I’m also writing because despite penning numerous letters at the time, I need to get it off my chest! I’m grateful for the Fact File and for what I’ve recently learned about insulin development from the wonderful book Diabetes – the Biography by Robert Tattersall (see photo extract below). I now fully understanding what happened to me and why. But despite an eventual smooth transition to analogue insulin, it still hurts to reflect on what happened. Others must not be allowed to suffer life threatening hypos when they move to a different insulin.

I hope GPs and CCGs will examine prescribing records, identify the very vulnerable group of patients still using bovine insulin and ensure clinicians caring for them are vigilant, supportive and wear kid gloves with these patients this winter. 

*Holy Cow was written by Allen Toussaint and sung fabulously by Lee Dorsey (1966)

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Nov ’18 UPDATE below on availability of Bovine Insulin in the UK.

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