Hi - recently started using a CGM and have discovered that it takes 45 minutes or so for Humalog to kick in. Is there any faster insulin or maybe a better place to inject than the stomach for faster results? Don’t use a pump - also use Levemir - Type 2. Thanks!
That was a surprise for me, too, when I started using the CGM. And sometimes it can take longer than that, e.g., when I give a correction dose. @Sam19 is a big proponent of Afrezza (inhaled insulin)–he posts about his experiences in several threads on the forum.
FWIW, I wear my CGM on the back on my arm, use my abdomen for my Lantus injections, and use my thighs (left one week, right the next) for my Humalog shots (really easy in summer–shorts weather). You’ll find people make use of “limited real estate” for MDIs, pumps, and CGMs in very creative ways.
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Some report that Apidra works faster.
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Remember that the CGM is also delayed by about 15 minutes from the actual blood glucose since it measure glucose in your interstitial fluids.
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Apidra is faster for me than Humalog, but Humalog is faster than Novolog. For me Apidra was only minimally faster getting started, but was finished at least an hour sooner than Humalog, so the curve was a little more condensed.
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Everyone is different of course, but for me (on MDI with a CGM) Apidra has the fastest onset and shortest tail of activity, so I value it especially for knocking down highs. I like Humalog for its consistency, but I find it has a slower onset (like up to an hour) and several hours duration. Lots of people say Humalog and Novolog are identical, but I find Novolog even slower for onset and somewhat longer, lower duration. They all “work”, but some are matched better to certain foods than others, so it’s always the usual titration dance depending on which you’re using. I also find I need more Apidra than Humalog or Novolog for the same number of carbs.
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For me, Apidra is noticeably faster than anything else, both in terms of onset and a shorter tail.
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Thanks everyone. I started with Apidra. Didn’t work well so was switched to Humalog. I’m going to see if I can get Apidra to use for correction doses. I have one more question - this has to do with the CGM settings so maybe it belongs in another category. When I first started using the CGM, I talked to a diabetes educator. I mentioned that I frequently get high alerts soon after eating with the alert threshold set at 190. She said it’s common to get high readings after eating and to set the high alert threshold very high so as not to get the alerts. Sound right? Thanks again.
Hi @CatLady06 - thanks for the info. Do you cover the CGM with tape or something? I bruise easily and am running out of places on my stomach. When I talked to the Dexcom people they said the only place that was approved was the stomach/abdomen area and they couldn’t recommend anywhere else.
I don’t have a CGM and I don’t always check my postprandial BG, so I could miss some highs, but I personally consider 190 too high. I try to adjust my carb intake to avoid going any higher than 160 as much as possible, though I know it happens occasionally. Because my BG is so sensitive to carbs, what I often have to do is to inject enough insulin for say, 56 carbs, but only eat about 32 carbs with the meal and save the remainder for a snack two or three hours later after my BG has come down to near 100 before going back up again from the snack. Of course, I’m retired and at home most of the time, so that works for me most days. I know that most poor working souls couldn’t get away with such a schedule.
Another thing that helps is to plan ahead and perhaps inject long enough before the meal that one can allow the BG to drop to around the 80s before eating if it has been higher at the premeal reading.
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“Couldn’t recommend” as in “aren’t allowed to recommend.” Because the abdomen is where they tested when they got FDA approval so that’s the approved location and others (AFAIK) aren’t tested so can’t be recommended. But tons of people use the back of the upper arm. It’s a little awkward to get to but quite doable (lots of how-to videos around), but it leaves more of that high-value abdominal real estate free and the results are at least as accurate if not more so compared with the tummy.
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Thanks. That sounds like something I can try. Yes, 190 is high to me also but they seem to think its not a problem if it’s within the 2 hr window, and is ultimately 140 or below after 2 hrs. I would prefer it to not get that high.
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You will have to decide what your personal targets are. Most diabetes educators want you to eat a high carb diet and have you aim for 180 mg/dl 2 hours after your meal. With that strategy, you could go into the 300s and it wouldn’t matter. Most of us are a bit different and want to aim to much better control. You should set your CGM to “actionable” alert levels. If you are not going to do anything when your blood sugar is 190 mg/dl then fine, set it higher. But if you want to do something like go for a walk or inject insulin then you should leave it at a lower level. And I would argue that even more importantly, overnight, do you want to be woken up to correct if your blood sugar goes over 190 mg/dl. I would.
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I have also found this. However, Apidra is more prone than the other two rapid analogs to form insoluble fibrils at the infusion site and this can lead to premature loss of absorption efficiency at the site. I was struggling to get two days out of a site using Apidra. I switched to Humalog, which has a longer tail, but mysites will now work reliably suing a 2-day rotation.
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I’ve read elsewhere that Apidra is all but impossible to use with a t-Slim pump. Fortunately, Apidra works well for my daughter; I suspect this is because she uses the (tubeless) OmniPod pump.
Gracie, I first learned about using alternate sites on TuD. There were really only two spots on my abdomen that worked. There’s a member who uses her leg above the ankle, another who uses her thigh. The main concerns are that the placement gives you accurate information and is comfortable to wear.
To help keep mine on longer I use Opsite Flexifix tape (comes in a roll on Amazon) with Skin Prep (helps with adhesion). I watched a video about making a “donut” template that’s larger than the Dex patch (so that the transmitter fits in the “donut hole”) and use that to cut out a piece of OpSite to put over it and keep it in place. My husband very kindly puts the tape on when I’m using my arm for the Dex 'cos it wants to stick to itself when I try to do it myself.
FYI–there are many other products available to help keep the device in place that members use and discuss in posts. As with most things in diabetes, finding the stuff that works best is often a case of trial-and-error.
As an OmniPod user, this interests me. Can you tell me about your experience? I currently use Novolog. Although I couldn’t tolerate Afrezza, I sure did like having something that acted quicker with a shorter tail.
The Everyone’s different thing is always evident, as @truenorth pointed out. For me, Humalog is by far the slowest and the longest-acting. Novolog is a little bit faster for me and ends its action a lot faster (than Humalog. Apidra for me is the same as Novolog in terms of when it starts to work, but its tail of action is shorter, which is why I use it currently. As it is, I get bad reactions, anyway, from Humalog, so I don’t use it at all. Ironically, Novolog is the most “comfortable” - in terms of nearly no irritation at the injection site (though I use a pump, so at the infusion site). Apidra can cause soreness after a fair amount has been injected at a particular site. I also seem to need marginally more insulin with Apidra than Novololg, but the difference isn’t enough to be of a concern to me.
When Novo Nordisk gets approval for it’s newer, faster Novolog, I will ask my endo to let me try it and consider switching. Like the OP, a faster insulin will be greatly appreciated - provided it also comes with a reasonably short tail.
My daughter, much like many other newly-diagnosed PWD, started out with MDI (with Lantus and Humalog, specifically). Waiting from the time of pre-bolusing until the onset of action before beginning to eat is a significant challenge for growing children who want to eat RIGHT NOW once they become hungry. I had heard that for some people, Novolog began working faster. So we tried Novolog, but no difference in onset of action/time until peak action was noted, so we moved on to Apidra. This insulin provides my daughter with a faster onset of action/time until peak action and shorter duration of action. Which shortens the time she has to wait until beginning to eat. Which makes her happier, which in turn makes me happier. I have read that Apidra does have a tendency to “crystallize” much more readily than the other rapid-acting insulin analogs, however. For some reason unclear to me (as I did not research this issue because my daughter does not use a t-Slim pump), this undesirable quality of Apidra causes much more of a problem with the t-Slim pump than it does with other tubed pumps, to the extent that I currently know of no one using Apidra in their t-Slim pump.
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I heard that, too re: Apidra crystallizing more. It’s also supposed to be more heat sensitive than the others. I don’t use T:Slim pump, but I think the problem there has to do with temperature - though I am not certain.
My first pump was the Asante Snap - which only officially worked with Humalog (due to the availability of pen cartridges), though, with my sensitivity to Humalog, I discovered through research and experimentation, that Apidra cartridges (as inside pens) are close enough to Humalog ones as to work in that pump perfectly. I mention that, because, from the Snap pump, I learned some “bad habits” – I tend to change the parts of an “infusion set” separately, based on need/usefulness. I usually refill cartridges at least once ans use them well longer then the 3 days prescribed, plus I reuse the tubing between set changes at least once to save a little on the insulin otherwise wasted on priming the tubing. In my experience, switching between Novolog and Apidra, I have actually seen more crystallization in the tubing with Novolog, than with Apidra - contrary to published information. Thankfully, I have not seen problems from heat, though I believe someone (@clare3, I think?) has mentioned along the way that she had heat-related problems in her Omnipods from heat and had to stick to Novolog.