Hello. My 12 year old niece just started using Apidra in her insulin pump. Although her numbers are spot on midnight to 10 a.m., she seems to need much more Apidra than Novolog. And her blood sugars are still high. This is only Day 2, but… We have ascertained her DIA with Apidra is two hours, if that. Which is great. We have figured out the proper ICR ratio for her meals and her numbers are good two hours post-prandial. But we cannot get her basals to respond to the Apidra. We increased her to two units an hour in the afternoon (at a time when she usually uses .95 to 1.05) and we were able to get her in range, with corrections, for dinner. Now, though, I have her up to 2.95 units an hour (on Novolog she was using 2.25 to 2.45 units an hour from 7pm thru 10pm, then back to .90 after midnight and overnight). This is crazy! She only weighs 85 pounds. Apidra users out there – Is it common to see a large increase in basal insulin? Is this increase usually temporary?
The DIA for Apidra is typically three hours- two hours seems too short. How did you ascertain that it was only two hours?
This may not be the explanation for what you are seeing, however. It could be that her body is resistant to Apidra. I am resistant to Humalog and with Apidra I use less insulin than I did with Humalog, and my infusion sites are far less irritated.
I noticed the same thing with Apidra. highs followed by lows about 4-5 hours later. It was slower than R in me. Worst insulin I ever tried! (can you tell I hate it? lol)
I test DIA all the time. I can test DIA on known basals. Her basals have remained consistent from 12 midnight until – This is Day 3 and she has been flat until 12 noon and still sleeping. She is using the same basals she has had from midnight to now 12 noon and her numbers are stable. So if you give a correction or she eats and she is back in range in two hours and stays flat, that is the DIA, for her, of Apidra. There is a teen on the CWD forum whose DIA is 75 minutes and they have the cgms to back that up. She is 12, and has these tremendous spikes, non-food related, anywhere from 6pm to 12 midnight, usually, sometimes up to 2am. On Novolog, just before the Apidra switch, she needed 2.45 units of insulin (she is 85 pounds) and she was still going high. So it may not be the Apidra; not sure. She only needs the huge increase in insulin usually between the hours of 6pm to midnight. Only sometimes does she need it until 2 a.m. But with Novolog and Apidra, it is a huge amount of insulin and very worrisome to me. I haven’t given up because it is a great meal insulin. I see that it seems to be working basal-wise, just a big increase during the later part of the day and the evening. However, she jumped from 56 units TDD – which is on the higher side – to 70 units TDD in one day. So I will keep my eye on it. I have not yet gotten back to her endo because endo does not have much experience with Apidra and is on the fence about it. By the way, DIA with Novolog is a full five hours, so that is why I was anxious to try the switch. I am hoping, once her body gets used to the Apridra, she will level off and need less. Still testing…
Apidra is a wonderful insulin. That being said it is not for everyone just like pumping and MDI’s. I personally like Apidra because it doesn’t hang around forever and works quickly. Not everyone’s body is going to work the same way. In the end it is nice to have the choice so that we can get the right insulin to do the job.
Did you ever try Humalog?
This is the exact proplem I had with Apidra, it hung around for about 5 hours in me
Apidra, evening 3: She started coming into very good range at 6 P.M., after I started increasing her basals to 2.75 starting at 5 p.m. She has been good all evening. She was 62 at midnight, 85 at 1 a.m. so I will be lowering the basals 12 midnight thru 5am. I am aware a basal of 2.75 units per hour from 5 to 11 pm is insane, but on Novolog she just started needing 2.45 units an hour during this same time period. I increased her basals greatly from 1pm through 5pm and she was on the high side. Her body has to figure out how to use it, I guess. If Apidra does not work properly, I would like to try Humalog (though it is not as stable in the pump) to see if her DIA is shorter than 5 hours, which is what Novolog takes to leave her system. Her TDD as of midnight tonight was 52.2, so that’s a little better. I just spazz out when I see basals of 2 units an hour, never mind 2.75. I am impressed with the speed of this insulin as a bolus insulin. So for someone on Lantus, I think Apidra is a great match. I’ll stick with it until we use up the bottle, and at this rate, that will be very soon, LOL.
Humalog is as stable in the pump. I used it in a pump for 10 years without any problems, this stuff about clogs is just pharmaceutical comp. propaganda
That is good to know. Her endo suggested we try Humalog because she is not that impressed with Apidra, possibly because she had not yet put many of her pedi patients on Apidra. She warned us that in her patients that have tried it, the results have been variable. Her Mom felt Humalog was so similar to Novolog that there might not be much of a difference in DIA. I had good numbers all last night again, and last evening from 6pm to midnight (though a high basal rate), so maybe we can figure this out. Terrible that pharm companies will bash another re Humalog vs. Novolog. Our endo did prescribe Novolog because she thought it was more stable in the pump, though she will prescribe both.
I got in real trouble with humalog used it for several years but when I got the cgm I finally tracked down the cause - It is only stable for 48 hours in the pump - Lilly refunded my money and agreed - Novolog is good for 6 days - I am interested in Aprida though
the shorter action seems like it should be good. How is your balance between Basal and Bolus - perhaps the high Basals are compensating for low bolus. If diet is high fat and protein, those foods linger a long time