Apidra in pump and being high

Diabetes Technology Insulin Pumps
#1

I recently was forced to switch to Apidra (because my insurance wouldn't pay for Novolog anymore) and at first was more concerned about lows occurring. I've had a few lows from it, but what I'm more concerned about now is how it deals with - or rather doesn't - the highs.

Does anyone else using Apidra have issues with it not working all that well when you use it for a high blood sugar reading? I haven't changed my pump settings from the ones I used with Novolog, so I might be able to fix this problem using that, but then I'll still have issues with lows. My theory is that the Apidra works too fast to cover the entire high, leaving me still high or even higher. I never had this problem with Novolog or Humalog. I know that something is not right too because since switching over from Novolog my A1C has gone from 7.2 to 8.6, yet I haven't changed anything.

Anybody else have something similiar happen? Any ideas on how to fix this so my blood sugar isn't constantly bouncing all over the place? My doctor's trying to get a prior authorization to get me back on Novolog, but I'm not all that optimistic...

#2

Apidra has a much shorter tail than Novolog. I changed my duration (DIA) to 2.5 hours, but as usual it varies from person to person. You're probably right that it's not lasting long enough to cover - with some foods you may need to bolus once the IOB is gone. You may want to try a combo/dual bolus. Do some testing, see when it's out of your system, and reset your pump.

Keep us posted!

#3

"My theory is that the Apidra works too fast to cover the entire high, leaving me still high or even higher."

This is my experience also. But you can deal with this by using a dual-wave bolus. You want the short lead time, but not the short tail. My major issue with Apidra is its iffy durability. Even on cool days, it seems to miss being in the refrigerator. Some days it would go weak after just over 24h in the pump. The third day was never as good as the first. I switched back to NovoLog. I use Apidra disposable pens for large corrections. I have a pen nearly 12 months old and it still has the kick of a mule. It's because I put it straight back in the 'fridge after use.

#4

Aye, I did know about the shorter acting time of Apidra, and I was hoping it wouldn't make too much of a difference - wrong! I've tried using the dual wave bolus feature of the pump and that doesn't seem to make much of a difference (but I will keep trying, especially if the only insulin I can get is this stupid Apidra).

I just don't want to see my A1C keep going up when it's something completely out of my control. I hate this.

#5

Ugh, another variable that I didn't think about - the durability of Apidra. I usually end up changing infusion sets (the 300 unit ones) every 2 days or so just because I need to use that much insulin, but hadn't thought about this insulin getting weaker after just 24 hours. Having had the heat on in the house and wearing extra layers of clothes here in Minnesota these past couple months can't have helped with the temperature issue either, so it looks like I'm dealing with at least a couple different things...grrrrreeeeeeaaaaaaattttt. This just keeps getting better! /sarcasm

Thanks for your replies guys, I appreciate the insight.

#6

Cara - So much of insulin therapy and diabetes, in general, is subject to a range of experience. I checked a few reputable sites such as the Mayo Clinic, the National Diabetes Information Clearinghouse, and the Diabetes Teaching Center at the Univeristy of California at San Francisco regarding the comparison of onset, peak and duration for Apidra, Novolog, and Humalog. All three have identical action within a range. Onset is 15 minutes, peak is 30-90 minutes and duration is 3-5 hours.



That being said, variations will occur from person to person and even in the same person from time to time. I have used all three of the rapid acting insulins and have not found any great differences. I use Apidra now. I know some PWD find Apidra works faster and is gone sooner. I believe them but my experience is not the same. I’ve found the duration of action for me is at 4 1/2 hours.



One thing that I did discover recently is that the Apidra package insert directs pump users to change infusion sets and sites every 48 hours. I have had some third day hyperglycemia and I attribute this to my pushing the parameters.



I gather that you use a lot of insulin each day. Have you considered that your infusion sites are getting tired and it’s affected the absorption? Do you rotate sites or do you seem to favor the same “sweet spots” time after time?



One thing you could do to test Apidra’s ability to correct a high is to deliver the correction via a syringe. That will eliminate any problems associated with the set/site.



You could also experiment with some different infusion sets. You may find another set that’s just as comfortable but can deliver more consistent absorption.



The Apidra package insert did warn about insulin degradation in a pump that’s exposed to direct sunlight in a hot climate. The upper temperature limit for Apidra is 98.6 degrees.

I wouldn’t get down on Apidra. There’s an outside chance that it will not work for you but that’s not likely. You may just need to experiment to find what works for you. As much as we’d all like to set our insulin schedule and not vary it, that’s an unreasonable expectation. It’s a game with changing rules! Not easy, but not impossible either.

#7

I’m shocked that your insurance company can dictate your medication! That should be up to your endo and you to decide the best formula.

#8

Welcome to the U.S. way of doing medicine, Kalobe! Many insurance companies also do cover all medicines but then they have "preferred" brands which are cheaper. Wow, when I describe that it sounds like a racket....well, I guess it is! You are right it should be between us and our doctors, but most of us are at the mercy of the insurance companies.