My insurance company just switched my prescription to Novolog from Humalog. Any tips for transition–differences in dosing?
Thanks!
Unfortunately, this is such a YDMV sort of thing. Some PWD find Novolog to have a faster onset of action than Humalog. Others experience the reverse. Some need a higher dose of Novolog compared to the dose of Humalog that they used to take, while others discover they need a lower dose. The pharmacokinetics of Novolog, Humalog, and Apidra are touted as being essentially statistically equivalent, but speaking from “personal” (my daughter’s) experience with these three rapid-acting analogues, they each behaved differently. If memory serves (as she’s been on Apidra for over 2 years): She started with Humalog. When we switched her to Novolog, I believe she required a somewhat higher TDD. Humalog seemed to begin working more quickly than did Novolog. She requires an even larger dose of Apidra, but it has the quickest onset of action and shortest DIA. Granted, she’s not an adult, and it often seems like T1D is a “different animal” in kids. I hope this information can be of some use to you.
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This happened to me—at first I was really annoyed, but I actually decided I prefer Humalog (can’t remember why I switched from it to Novolog way back in the day…). It kicks in a little faster/has a little less of a tail for me, which seems to be the most typical experience, although YDMV and it’s not a dramatic difference. My doses were about the same, so I’d start by doing pretty much whatever you normally do and keep an eye on things. If you pre-bolus, you may not need to wait quite as long.
Edit: wait, I got it reversed—I was forced to switch from Novolog to Humalog, and you’re doing the opposite. So reverse that I guess—may take a little longer to kick in.
I’ve switched to novolog to humalog and then back. I noticed slight differences, I thought, but certainly nothing insurmountable
It is indeed, and very much, a YDMV thing. Humalog does nothing for me–might as well be a placebo. Novolog and Apidra have essentially the same carb-defeating power, but Apidra is quite a bit faster with a shorter tail.
Bottom line: try it and see. Only way to know.
Same for me. My pharmacy “benefits” manager switched me from Humalog to Novolog about a year ago. Maybe they’ll get a better dinner from the Humalog rep this December and I’ll get to switch back.
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Ugh. Can you get a doctor’s note if you’ve tried Novolog, and it doesn’t work as well for you? I’ve been able to get around those kinds of restrictions before, but usually have to be able to prove I tried their preferred option, and it didn’t work.
I have used such exceptions for Tresiba and Apidra, but for me the difference between Humalog and Novolog is not enough to go through the process. Humalog and Novolog are somewhat different (for me) but once you’re calibrated they’re both pretty good for what they are. I know others here have performance and allergy and other issues with either of these and if that were me I would definitely be working hard to get the one that worked. For all the pharmacy benefit managers out there who read this forum, it cannot be overstated how important it is that YDMV!
I was switched from Humalog to Novolog several years ago. For me, they were about the same, but think Novolog peaked slightly sooner, and I had to reduce my total basal slightly. But there were other factors at the time that could have been the cause for basal reduction.
Thanks, everyone. Good tips to help me through the transition 
I also bounce back and forth between the two insulins depending on which one my insurance company is covering this year. It was always Lilly way back when I first started and I remember the first time I had to switch, I flipped out. But as stated by many here, I really haven’t noticed much difference between either one. I would just watch and make any changes needed. But my TDD hasn’t changed due to insulin changes. The joys of insurance companies!
Try it. If it doesn’t work well, let your doctor know. Your can challenge it if need be. The bottom line is, it has to work for YOU. Squawk if it doesn’t.
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I’ve had to switch briefly the other way (for the same reason). Humalog is not recommended for Medtronic pumps and in fact did not work well at all for me. I went back to the endo who sent a medical necessity note to this effect to the insurance company, which seemed to work. (But this didn’t happen until I was also forced to use Apidra for a few weeks too, which was the worst of the three for me.)
Where did you hear that Humalog isn’t recommended for Medtronic pumps?
I’ve been using it in my Mini-Med 530G for a couple years with no problems.
Wheelman
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While both rapid-acting insulin analogs, aspart (Novolog) and lispro (Humalog), have been tested for safety and your pump user guide lists them as approved for use with the pump, more detailed studies of efficiency show differences. It’s not that you’ll have problems as such with either, but Novolg provides more stability and predictable action over time. My pump educator alerted me to that and I have certainly noticed the difference (including in amounts I needed to use to achieve the same results) during the periods when I had to switch.
Here are some of the studies I’ve read to this effect:
http://journals.aace.com/doi/abs/10.4158/EP10260.RA (“A series of chemical and covalent changes affecting the primary structure of an insulin preparation, however, may cause decomposition during storage, handling, and use, diminishing the potency of the insulin molecule while contained in an insulin pump. Precipitation, fibrillation, and occlusion may ensue, undermining compatibility for CSII pump use. Aspart has demonstrated the greatest chemical and physical stability in the insulin pump.”)
Precipitation of insulin products used for continuous subcutaneous insulin infusion - PubMed (Suggests why insulins that have similar action in the body when injected directly might differ when delivered via tubed pumps.)
Laboratory-based non-clinical comparison of occlusion rates using three rapid-acting insulin analogs in continuous subcutaneous insulin infusion catheters using low flow rates - PubMed (More along the same line of logic: occlusion rates over 5-day use significantly lower with aspart. “Over the whole of the 5-day infusion period, the probabilities of overall occlusion for each insulin were 40.9% [28 to 55%, 95% confidence interval (CI)] for glulisine, 9.2% (4 to 19.5%, 95% CI) for aspart, and 15.7% (8.1 to 28.1%, 95% CI) for lispro. All occlusions, except for three, occurred during a bolus infusion.”)
Better postprandial glucose stability during continuous subcutaneous infusion with insulin aspart compared with insulin lispro in patients with type 1 diabetes - PubMed (“Although both analogs resulted in similar daily blood glucose variability profiles and frequency of hypoglycemic episodes, postprandial glycemia was more stable with insulin aspart than with insulin lispro (absolute change in glucose 7.04 ± 3.16 versus 9.04 ± 4.2 mg/dl; p < .0019).”)
A randomized trial comparing continuous subcutaneous insulin infusion of insulin aspart versus insulin lispro in children and adolescents with type 1 diabetes - PubMed or full text here http://paperity.org/p/43024242/a-randomized-trial-comparing-continuous-subcutaneous-insulin-infusion-of-insulin-aspart (“Notably, the weight-adjusted mean daily dose of insulin aspart was significantly less than that of insulin lispro. Although subjects in the aspart group used less insulin, they were able to achieve comparable levels of glycemic control at the end of the study.” “Daily insulin dose (units per kilogram) was significantly lower at week 16 for subjects treated with aspart compared with those treated with lispro (0.86 +/- 0.237 vs. 0.94 +/- 0.233, P = 0.018).”)
Glycemic control after 6 days of insulin pump reservoir use in type 1 diabetes: results of double-blind and open-label cross-over trials of insulin lispro and insulin aspart - PubMed (Fewer unexplained highs for Novolog with 6-day use; fewer unexplained lows for Humalog. I guess what to do with this info mostly depends on what one’s personal greater issue is. For me it’s unexplained highs.)
This one compares Novolog and Apidra, but the reasoning why Novolog comes out better between the two is relevant for tubed usage:
http://online.liebertpub.com/doi/abs/10.1089/dia.2007.0233
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Thank-you for listing all the authoritative sources that you base your judgment on. Before there were insulin analogs, there were pumps. We used Regular insulin in our pumps. I remember using a Novo-Nordisk product called Velosulin. My doctor told me that it had buffering agents in the insulin to minimize or eliminate the insulin’s interaction with the plastic in the insulin reservoir and tubing.
I currently use Apidra. I used Novolog for a few years but stopped when I started to get “pump bumps” at most infusion sites. These allergic reactions were circular raised red welts the size of a silver dollar. I’ve resisted since then using Novolog. I will definitely follow your final link to the study that compares insulin aspart (Novolog) with insulin glulisine (Apidra).
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you should be glad, humalog is so much better than novolog, and apidra has been implicated, along with lantus in pancreatic cancer. I cannot take novolog, I get a severe cold that i cannot get rid of, and no one catches it off me, so instead of a cold (i cannot tell the difference honestly) it’s really an adverse reaction, same thing happened with me with tresiba, I got the worst cold in the history of man and no one caught it so i became suspicious, I went back to levemir and in three days the cold was miraculously cured. My insurance company didn’t wanna pay for humalog so i tried novolog. From thanksgiving to shortly after new year’s, I got that cold again. Someone commented to me it was just like the cold with tresiba, I did some reading and yes, naso pharangitis is an adverse effect with novolog. Went back to humalog with a prior authorization, and the cold mysteriously cured itself within a day. It should be mentioned that my control was very poor with novolog, half the time it was like injecting water.
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I have been using Apidra for more than ten years and this comment concerns me. I’ve done a quick internet search and I’m not finding anything solid to read about this issue. Can you point me to some studies that you may have read?
Seconding this request! Apidra is the only fast acting insulin I’ve ever used.
all i can tell you is to request the trial papers from them. AN ALARMING
number of people on clinical trials for lantus in the 90s are coming down
with pancreatic cancer. Apidra is one or two molecules away from lantus,
so my advice is get the hell off both. Do you think the stinging is good
for you?