Apidra...too fast! Highs 3-4 hours later

Hi,I use apidra in a pump,how many people find it works a little too fast? My numbers are good (if not a little low) at the 2 hour mark but can rocket by 3-4 hours.I’m not experienced enough with the multiwave bolus to get it right often,would it be worth trying to bolus after eating? I’m thinking of asking for my novorapid back at my next appointment as I’m a bit disheartened with this : (. My basals are great and corrections are fast and mostly accurate…just the bolus thing!!!

I use Apidra and love it. You may want to do a square wave bolus to help cover hours 3 and 4. A square wave bolus is similar to a multiwave or dual wave except you are not taking a large amount up front you are just taking your total units over a certain period of time. Try doing .5 hours and see where you wind up, the next time try an hour.

When you experience highs at hour 3 and 4 are you consuming food that is high in fat? If so that will slow digestion and cause a late spike in BG. Similar to the pizza affect. Another thing is that your sensitivity to Apidra may be different than other insulins so you may not be taking enough insulin even though you are counting your carbs correctly.

Keep us posted, I will be curious to hear what others say and what your thoughts are,


I’m an Apidra pumper as well and do not experience what you’re going through. I bolus ahead of meals by about 20 minutes. My post-prandials are pretty good. (It’s my corrections I can’t get right, personally.)

But, like David said, you have to use the insulin that gives you the results you want.

I recently switched to Apidra with my pump and had the same experience as you. Apidra is not as forgiving as some of the other rapid-acting insulins, imo. But now I have used it for about 6 weeks and actually prefer it over anything else I’ve tried. I bolus right when I eat or immediately when I am done, and I use a 90 minute to 2 hour square or dual-wave bolus, depending on the type of food, type of carbs, time of day, high or low tide, waxing or waning moon, etc… Overall I find Apidra to be very precise and consistent in action.

I also use Symlin, so my boluses are likely a lot further extended than what you would want to use with Apidra alone. Have you considered Symlin use? It would address this problem extremely well, among other benefits.

Hi Tracy,

I don’t have a pump & inject, but I had the same issue with Apidra. Was great for correcting highs, but worked too fast & left my body too quickly to cover meals. I’d have lows followed by highs. Played around with the basal dose, but that didn’t help me.

Since your numbers are good after 2 hours, sounds like you’re taking the correct amount. Any more & you’d be too low. My problem, which may also be yours, is that I have slow digestion. The Apidra was gone before my meal was digested. Didn’t make a difference if it low fat or not. My endo switched me to Humulin R & my numbers are much better now. I still keep Apridra around to correct highs, but can only use Apidra if it’s 6-7 hours after or before Humulin. That timing doesn’t happen often.

Hi David, the meal that caused my huge spike yesterday was toast with a little pate,hardly any fat,some protein(but not enough to cause a spike) it was wholemeal bread so lower GI.My bs before eating was 6.2,two hours later it was 6.6 and at 31/2 hours it was 16.7.
I assume the square wave bolus would be the extended bolus on my pump,I will try this. I had a sandwich at lunchtime time yesterday and it covered perfectly but I was at work and very busy which helps alot.
Most of my diet is low GI foods which do take longer to digest and the Apidra for me is gone at 31/2 hours.
I’ve also thought of keeping my carbs down to under 40 per meal as it’s the larger carb meals that seem to cause the problems.
Thanks for the advice,I’ll try that today and see what happens! :slight_smile:

hi there,I’ve read alot about symilin and will speak to my nurse about it when I next go,I have always been troubled with post meal spiking to an extent,hence the switch to the low GI foods.That helped loads on my Novorapid,but Novorapid also hung around for 5 hours or so and did lots of mopping up :). The Apidra seems great for it’s accuracy with corrections and prevents the post meal lows as it disappears at a predictable time,I’ll have to get experimenting with the bolus types!

DN just started with Apidra two nights ago and I am noticing this. I just put a 20 percent to 50 percent temp basal on top of her bolus. 50 percent too much; 20 percent too little. I think I will need a combo bolus for all meals with Apidra (been giving lower fat food though). I am not sure yet if I need extended bolus for three or four hours; the duration is four hours exactly. I like it, though so far. We do not have to feed the insulin; it is the reverse. If I can figure this out, it will be safer in the long run. Also it is faster; it brought her postprandials down to 160 at the two hour mark, easy and with the 50 percent plus temp basal she was 95. I will be able to meet the postprandial target endo prescribed; just have to figure out what to do hours 3 and/or possibly hour 4. P.S. First night she was high, no IOB; Apidra worked like a charm and kicked in quickly but the duration was exactly four hours. The problem is with Apidra as a bolus insulin. It is different and I am not sure of how to handle it yet. A correction when there is food in her system is not quick as a correction without food.

I am sorry but there should be no dependency at all between bolus and basal. The basal is correct when it keeps you steady at fasting times (fasting for 24 hours). To use both to reach good postprandial numbers will lead to chaos (which insulin drives the BG now?). For example it will force you to watch your activity level closely for more than 2 hours after eating because of the higher basal. It could also mean higher numbers and slower correction response in times of low carb intake because of the missing basal.

If pp numbers are too high then insulin type, insulin mode (combo etc) and waiting time should be questioned. To me it is obvious in your case that Apidra is just too fast and acts too short because you can not eat any food without combo bolus.

I would not want my NovoRapid to act faster. This would be very scary to me. What was the reason for the switch? Was there any evidence that you needed a faster insulin response?

Okay… results of last night’s combo bolus. ICR of 1 to 6 combo 70/30 over two hours. 69 at hour 2.5 with 2.7 IOB. Only gave 12 grams free carbs (as covering the whole thing has backfired with Apidra). One hour later, BS 59?? Covered with 12 grams. Slept through the alarm and she woke up 200ish. When I covered the first time I used grapes and unbuttered Saltines. Thinking the Saltines took longer than one hour to hit? They are supposed to be fast. Breakfast today 1 to 6, combo bolus 70/30 over 1.5 hours. BS 160 at lunch. So I think 1.5 hours is the time; I have to fiddle with what percentage to give when. Yes, I have used temp basals to bring down highs with corrections (if BS very high she needs more of a correction than normal) and I have used temp basals to cover hours 3 and 4 of her Apridra bolus when it was so obvious to me that it was not covering her food. I am not going ot run her high whle I figure all this out. She is a child. We use temp baals all the time. She is nowhere near as preductable ans an adult male. There is no reason in the world you cannot use temp basals to cover digesting food; it is done all the time. I have had many fasting basals the whole week (she had been on vacation. Her basals are 100 percent correct at the moment)

To add to Holger’s point, it sounds like what you’re doing is using a temp basal instead of a dual-wave (extended) bolus. Instead of upping your DN’s basal, I’d recommend you extend some of her bolus an hour or two, to see if that helps with the higher post-prandials.

I’m like everyone here, in that I need to take Apidra right when I eat, and usually need to extend it (especially at night and when my bg is under 80 to start, and/or when I’m eating high fiber or fat meals.) There’s a lot of intuition involved, but it’s not hard once you get used to figuring out when/how to extend the bolus. I know how certain foods will affect me, rarely go over 140 after meals now, and boluses almost never make me go low. I compare this to Humalog, where I’d need to take it 15-20 minutes before meals and would almost always dip low then shoot to 180 or higher for a half hour, before finally settling down…

I would recommend to treat lows with glucose tabs - no grapes, no saltines. This way the low is treated fast, the exact number of carbs is known and the effect of the carbs will not last long.

I am a little confused about “I have had many fasting basals the whole week”. Does that mean you have seen one complete day or two 1/2 days (covering 24 hours) without carb intake to be sure about the basal profile of the pump?