Apidra with Medtronics pump experiencing clogs

I would be interested to hear from anyone using Apidra in an insulin pump.

I’ve been using Novolog since I started on a Medtronic 722 (with CGMS) pump 3 years ago. I recently tried a switch to Apidra to help reduce postpandrial blood sugars. It has accomplished this…but I find it annoying that the pump seems to clog (NO DELIVERY msg) after only about 2 days with the Apidra insulin.

Novolog (NovoRapid) isn’t as fast acting, but doesn’t require as frequent infusion set changes (at least 5 days for me). I have never experienced a clog (or NO DELIVERY msg) with Novolog.

The Apidra product write-up from Sonofi-Aventis does indicate a 48 hour limit in any pump. I’m not sure if that is just a manufacturers CYA thing or if everyone sees this limit. Since clogs occur at unpredictable intervals - this doesn’t seem to be a vial insulin for pump users. i.e. if I’m sleeping, by the time I realize I have a clogged infusion set, my blood sugar is extremely high (normally I’m well controlled).

As mentioned, I use a MM 722 with the Quickset (43") infustion set. The clog is repeatable in that I’ve never completely used a 3.0ml reservoir without experiencing a NO DELIVERY message from the pump (have been using Apidra for a month now). When using Novolog, I was going 5-6 days (avg. 50 units/day) on a 3.0ml reservoir. With Apidra I am throwing out about 1/2 the reservoir every time due to the NO DELIVERY message as a result of the clogs.

I would be interested if there’s anything I could change to extend the life of Apidra in the pump…i.e. would a shorter infusion set help, would inserting the infusion set in a different location help? Also, once a clog has occurred, is there anyway to clear it (and avoid throwing out the infusion set).

Thanks.

Brad.

I have an Animas pump and not a Minimed but I do have some problems with Apidra in the pump. I find that Apidra breaks down pretty fast. I had a lot of problems especially in the summer because of the heat (even though I don’t spend that much time outside) and was having to change my cartridge every day and a half. If I don’t do that, my BS goes up like clockwork. I did not have problems with clogging but probably because I decided to yank the cartridge before that point.

If you like the Apidra and want to continue using it, I would suggest not filling your cartridge the whole way and changing the cartridge every 48 hours (you don’t have to do a site change to change the cartridge). When I have a bad site, I save the tubing so I have some extra tubes if I have a problem with tubes.

Hi Brad! I’m sorry to hear about your troubles! I do know that Humalog, for example, has been seen to clog pumps as well. Especially in heat (like if you live in Texas), or so my Endocronologist says since he used to live there. He says the Humalog insulin swells in the heat, which will cause it to clog the tubing in pumps. Novolog doesn’t seem to do the same thing.



Is it possible for you to use Novolog on the pump and maybe use an Apidra Solostar insulin pen for corrections?

I have had very good success with Novolog but apidra didn’t work for me at all. It seemed very slow but I don’t believe it clogged the tubing. If you want to improve post prandial BGs have you tried Symlin? It works wonderfully for me for preventing the spikes after meals. You might talk with your doctor about it. Since you weren’t having problems with the Novolog clogging maybe you could go back to Novolog in the pump and use Symlin before meals (it would be an injection before each meal). I wondered at first why I would want to inject again after being on the pump but it is worth the better control. (for me at least).

Thanks for the reply Kelly. I had assumed (probably incorrectly) that when the clog occurs it could be in either the infusion set or the cartridge. As a result, I assumed it would be necessary to replace both the cartridge and the infusion set early.

I’m going to try partially filling the cartridge (reservoir) as you suggest and see if that allows me to extend the life of the infusion set. Good idea!

Thanks Marps. That sounds like a good alternative if I can’t find a way to prevent the Apidra pump clogs. I had been using a pen prior to going on the pump - so I know it wouldn’t too much trouble to add to the mix if needed.

Thanks Donna. I had never heard of Symlin before. I will definitely ask my doctor if it’s something he’d recommend.

The 48 hour limit is a CYA move… I commonly go 4-5 days with my reservoirs (even in the summer) and the insulin is just fine over that time (I usually do change my infusion set every other day though… they stop working as well if I don’t). I think either Novolog or Humalog has the same 48 hour “rule” but most people don’t pay attention to it.

I’ve not actually had a single no delivery/clog since starting Apidra… but I got them all the time with Novolog (and ages ago, with Humalog). I use an Animas pump though, not MM.

The 48 hour rule is not a CYA maneuver. Most insulin is four molecules of “real insulin” that must be broken down to be used by the body. Apidra has already been divided in to those four parts and goes to work faster. Hence, its name is RAPID in pig-Latin. The problem is with smaller molecules, it penetrates between tubing molecules more easily and faster than Novolog for instance.

Ideas:

  1. can you detach and prime about 3-5 units to get up and running again?
  2. can you make the MM more sensitive to obstructions? (I wear an Animas Ping)
  3. changing tubing length will not change the problem because the Apidra is going to co-mingle with the tubing its entire length - so the problem is tubing long regardless.
  4. I missed, do you have a CGM - if so lower the upper level, get up fix the problem and return to bed.

Sarah - thanks for the reply. You mentioned that you change your infusion sets every other day or they stop working. Does that mean that your infusion set is clogging as well, or, are you just experiencing high blood sugars when the infusion set is not changed frequently?

We have recently had a lot of no deliveries with Apidra. I feel like they occur most often after my child has dosed a lot of insulin in a short time (for pizza, chinese, etc). We are using the Sure T’s. I’ve tried 8 and 10mm Sure T’s also - we get less No delivery errors but the site only lasts 2 days.

Hi Jay - thanks for the reply. I recall my doctor describing the benefits of the smaller molecules as being both faster acting as well as reduced clogs (he was only half right).

Based on my experience, I agree with you, in that the smaller molecules are not reducing the likelihood of clogging (which I’ve never experienced with Novolog). Given that the Animas users that have responded don’t have the same problem with Apidra, it may also be a problem unique to the structure of the Minimed resevoir and infusion sets (or maybe increased sensitivity of the MM pump - which can’t be modified).

One thing I haven’t tried is detaching and priming to try to remove the clog. That would be an easy fix, so will give it a try next time I get the pump clogs.

I think the standard Animas set is Inset made by Unomedical. I know I use this with a 9mm cannula and 43" tubing. However, I am using Novolog and see a 3 hour peak time.

The Minimed infusion set is also made by Unomedical. I’m also using a 9mm cannula and 43" tubing. It’s not obvious who makes the reservoir. Unfortunately, it’s impossible to tell whether the ‘No Delivery’ error is a result of a problem in the infusion set or the reservoir.

Other Animas pump users have indicated they’ve had no problem with Apidra, so, if they use a similar set as yourself, it seems unlikely that the infusion set is too blame.

Next clog, I may try just swapping out the reservoir and leave the infusion set in place to see what happens.

MidwestMommy, when I’m on the MM pump and need a lot of insulin in a hurry, I take half of the amount with a syringe on the other side of the body, which works very well. I use Apidra.



In other postings on this site, it has been suggested that Apidra becomes denatured over time by the plastic in the cartridge. This idea fits into my experience. I prefer to change every two days with my Sure-Ts, but in experimenting I’ve found that one cartridge with Apidra stops working at 3 1/2 days.



As far as actual clogging at the entrance to the cartridge, only Humalog was a problem; I had that type of clog with Humalog in about 12 hours.

OmniPod user here. Caleb has been using Apidra since October. He went 2 months swimmingly! It was almost heavenly. Then this 48 hour thing started. It’s very inconsistent. Sometimes we get beyond it, and sometimes we get through it - meaning we have a little bump and then it’s okay. It’s been very frustrating. And we never ever get an occlusion alarm. And lots of times the cannula looks just fine - clean as a whistle.

Thanks for this thread. It gives me something to think about. Any users I know are able to use Apidra a full three days with no issue so I was really baffled.

Is this the second time you’ve tried Apidra, or am I getting my post dates all mixed up?

https://forum.tudiabetes.org/topics/583967:Topic:58261?page=5&commentId=583967:Comment:734217&x=1#583967Comment734217

Just read further through the thread - it seems it is. I hope some of the suggestions here help you and this proves to be a more successful attempt. I really like the lack of tail on Apidra and don’t want to go back to Novolog.

Hi Lorraine - you’re right, I’m on my fourth reservoir with Apidra now. In addition, I had given Apidra a try about a year ago, but had only tried a couple reservoirs, so thought it might be worth another attempt.

So far, all attempts have resulted in more clogs than I’m used to seeing while using Novolog. The other thing I’m noticing is some unexplained high blood sugars beyond the 48 hour mark. The last reservoir did not result in a clog (in fact, I went 5 days with is the longest I’ve gone with Apidra without clogging), but I did experience more highs beyond the 48 hours than I’m used to. I’ll probably try at least 1 more reservoir before going back to Novolog.

I feel like we are seeing something very similar. It’s not consistent which is why it’s been hard to diagnose. Caleb’s been ill, we’ve had a couple Pod errors (which I wonder if it relates to the Apidra use since we typically get no errors).

May I ask, how do you know it’s clogged - are you able to see a build up in the cannula, or concluding it because you know you would not otherwise have high bgs.

Fingers crossed with your new reservoir!

Lorraine