I’ve had pretty big post-prandial rises in BG after meals, mostly after breakfast. (before breakfast, my BG is fine when I bolus, then I shoot up at “double-up-arrow speed” to a BG in the mid 200s before crashing at “double-down-arrow speed” to the 60s or 50s.) My endo suggested that I was probably taking too much of a bolus (causing the crash) and that I should lower the true bolus but take advance-basal with it … essentially a Super-Bolus. (This is described elsewhere on TuD if you’re not familiar with it).
Rather than play these kinds of games with my pump, I asked about faster-acting insulins (me, thinking Humalog vs. Novolog). My doc is pretty reluctant to accept what amounts to marketing by the insulin distributors, but gave me a vial of Apidra to try out. I haven’t tried it yet.
Does anyone here have experience switching from Novolog to Apidra, and what change have you seen? Did you need to change the time settings for your basals (assuming you pump) to offset the faster onset and tail-off of the Apidra? Any other advice?
I was put on Novolog (which we call Novorapid, but which I call Novoslow for reasons that will be obvious) at diagnosis.
I don’t have a pump or CGMS but mocked up a CGMS by doing a week of testing every 15 minutes. That’s how I found out that Novolog takes 2 hours to work for me.
I had heard on here that Apidra worked faster for some people and thought I had nothing to lose from trying it out. My endo insisted that ‘studies show there is no difference between Novorapid and Apidra’. I sat in his office and refused to budge until he wrote out the prescription.
Apidra starts working for me in about 10 minutes. It has made a huge difference in my life, knowing when I inject that this is going to start working in 10 minutes, rather than wait around for 2 hours, with horrible spikes in those 2 hours. My A1C on Novolog was 5.9; after a full 3 months on Apidra, my latest A1C is 4.9 so the results speak for themselves.
I can’t offer any opinions about the pump stuff but I can’t say enough good things about Apidra itself. Of course, everyone reacts differently, but I’d say you have nothing to lose from trying it out.
Hi Scott. I’ve tried them all! As I read comments on TuD, I’ve decided that responses to the different insulins can be quite different from one person to another. I find Novolog to respond more slowly than Apidra, doesn’t seem to take care of spikes as well, has a longer tail. I take Apidra, although the downside is that I find it to be more temperature sensitive than Novolog,so I keep the vial in my fridge between doses. I have no experience with the pen except for my Levemir. I use the pump part-time, and the Novolog is too slow with it as well. I’d certainly give the Apidra a try.
That’s good to know about the temperature sensitivity. It might make filling a pump reservoir a bit tougher (more bubbles, apparently, when cold!). I’m a bit worried that I will go low after taking a bolus, before the carbs in my meal have a chance to work. That said, I usually have relatively high-carb (60 g or so) meals, so that shouldn’t always be a factor. Plus, there’s always a square wave!
If getting rid of those peaks after meals can lower my A1C by a full point, that sounds phenomenal! Though I must say that an A1C of 5.9 sounds phenomenal by itself… 4.9 is unbelievable!
Scott, I let the vial come up to room temperature for about a half hour before filling a cartridge and have no bubble problem. As for the bolus timing, I’m a great believer in experimentation!
I see the same pattern with my bs levels: after meals it’ll spike more or less high and by 2.5 hours I’m somewhere around 60. So it’s often hard to tell whether I’m taking too much or too few insulin as both seems to be the case… although that doesn’t make any sense.
I recently had an appointment with someone else than my regular endo/diabetologist to whom I mentioned this problem and who then suggested switching to Apidra.
For now, I refused since I’ll be at my parents place for a while and everything’s different there anyway so I’d never be able to tell where any possible changes come from.
I also like the Novo pens and don’t want to get yet another new one.
If it actually makes a difference I may get a pre-filled pen for testing.
Only problem is: As far as I know there is no pen for Apidra that has half units. If that’s the case I won’t be able to switch, I need 0.5 steps.
Hi Anne. One possible solution is to use 1/2 marking syringes to extract the insulin from the pen. I use the BD brand, but I understand that Walmart also carries a 1/2 marking syringe. I use this type of syringe for my Levemir pen, since I take 5 units at night, and twice during the day take 1 1/2 units. If you use a pen needle for whole units after the syringe, it is important to prime the pen.
I was already on Apidra when I used the pump so can’t give you any tips for switching, but I agree with Trudy about the Apidra being more sensitive to temperatures. I especially had trouble in the summer and had to change my cartridge out every day and a half in the summer. I have seen posts here with some other people complaining about the Apidra because they were used to changing stuff out every 3 days and had a harder time with the Apidra doing that.
I am one of the people that it is not faster for but I think it is more consistent. It takes about 20 minutes for it to kick in for me so I prebolus. I especially like that it gets out of my system faster.
Hi, Scott ~ I just conducted my own (very brief) experiment with Apidra, after many years on Humalog. I experience similar post-prandial stuff to you. All the reading I’ve done on Apidra suggests that its action really does vary from person to person, and I probably didn’t give my experiment enough time … but what I found was that the benefit of the quick onset of action was offset for me by Apidra’s early disappearance (ie. it didn’t seem to stick around long enough to finish dealing with my meals, and I was finding myself high at the 3 or so hour mark). I was also seeming to need higher basal rates with Apidra. For now, I’ve gone back to Humalog, BUT I’ve recently corrected two significant highs with an injection of Apidra (instead of a pump correction bolus), and it’s great for that!
P.S. Another disadvantage for me is the official 48-hour max time in the reservoir. I know some people change out their Apidra reservoirs less frequently, but …
Now that you mention it, I do recall my Endo questioning the quicker onset, but believing in the quicker disappearance. I have it, so I might as well give it a try, but I must admit I’m not looking forward to changing the reservoir so often. I usually change my set every 3 1/2 days or so.
Heather, sounds like my earlier fear about taking too much insulin and going low before the food has a chance to work, or taking less than that, getting through the meal OK, and going high after. I doubt I’ll keep a vial of Apidra around strictly for highs, but it’s a good thought! And that short reservoir time… ugh.
I didn’t know Apidra had an official 48-hour time for pump cartridges. I guess I should start changing mine more frequently every time I change my sites. Might explain some of the blood sugar problems I’ve been having.
I don’t think it is official, I think it is just a problem some of us have. I could change the cartridge and leave the site in & have my BS go back to normal. It was really bad in the summer.
Scott, I have the same issue and have been thinking about asking for a trial of Apidra. Doesn’t matter if I pre-bolus, I still shoot up before coming back down to where I should be. I didn’t know about the short tail though - I guess you’d have to do a second bolus for a high protein/fat meal?
The product monograph section on pump use says, “Based on in vitro studies which have shown loss of the preservative metacresol and insulin degradation, Apidra in the reservoir should be changed at least every 48 hours.”
Thanks Heather. In the summer, I couldn’t even get 48 hours. I had to change it every 36 hours. I read other people had that same problem, especially when it is hot out. I don’t spend very little time outside, so that never made sense to me.
When I’m ready to try (when my current vial of Novalog is spent), I’ll definitely let you know! Though this short life of the insulin out of the refrigerator really concerns me. I think I may ask for a sample of Humalog; I think it peak a bit sooner than Novalog, although the tail is a bit longer. I think.
There is a group of Apidra users on this site …helpful ?? " Apidra UsersCreated by jimt1cgms"
I used Apidra …and am very unsure, if it was the insulin , that created an infection at my pump site …but darn , it happened and had to have it lanced by Doc …had other infections happening as well , as you can read at the Apidra group …very uncommon for me , so who knows about the timing .
PS I try to change my site ( Sure-T’s ) every 2 days ( 48 hours) and every 4 days ( 96 hours ) my NovoRapid reservoir and discard the bottle remains after 27 - 28 days .
