Insulin change

what an odd day at the doc’s. the nurse practitioner i’ve been seeing is leaving and i was just told i won’t be seeing the new PA after all. apparently my situation is too complicated and i’m officially brittle now. so the NP and endo consulted with me today since i’m being turned over to him entirely for my next visit. and the decision was made to change my insulin from novolog. the debate was whether to change me to u500 R or to apidra.

u500 R was because apparently they’ve just noticed [after years of seeing my pump settings] that my ISF is 1:15. used to be 1:18 when i was diagnosed but it’s changed back and forth over time, likely due to weight fluctuations. so the NP thought maybe it would help if i took fewer actual units per day.

but the gastroparesis is a concern for both me and the endo - taking R might reduce my daily dose but since i’m prone to sudden drops, i’d be risking playing catch up for up to 8 hours.

so apidra it is.

they were out of sample vials so they hooked me up with a couple of pens. since i’ve been stable for over an hour and haven’t eaten all day, i just took one single unit and now i’m going to poke myself in the finger every few minutes to see how it acts on me.

apidra and the pump. this should be interesting.

I use Apidra in the pump & also have gastroparesis. I love Apidra! I think it is great for gastroparesis because it gets out of your system faster than the other insulins so it makes stacking easier. I hope that you like it!

good to know. that’s part of the problem. if i take insulin now and the food doesn’t stay with me then i’m basically in trouble for 3.5 hours.
endo said eat the food, wait until the glucose starts to rise and then take the apidra as a square wave. do you ever do that? and if so how does it work?
the hardest part for me is that my gastroparesis is semi intermittent. it’s always slow, but sometimes it’s only slow with solids and sometimes it’s even slow with liquids. and there are days even glucose tablets or water won’t stay down.

I usually take some bolus prior to eating and watch when my BS starts going up & then take some more. I can never remember which is square wave and which is dual wave, is the square wave zero up front & all of it spread over a time period? I am doing that with the protein & fat portion but I bolus for the carbs up front.

kelly, i’ve never heard of a dual wave bolus so i can’t help you.
i tend to bolus for corrections up front and then for the food, spread over a longer period.
however, right now i am concerned that the apidra the doc gave me is not working at all. i was at 122 and took one unit to see what would happen. it went up to 176 in half an hour. well, that could be a fluke, even though i hadn’t eaten in 7 hours. my liver has been known to do that.
i was ACTUALLY HUNGRY!!! so i had a little rice and took the apidra with it, right away. when i’m hungry it means my stomach is working right now. and my glucose is acting like i haven’t taken any insulin at all, is up to 235. good thing i got off work early today for the appointment and am not trying to do this at work

Doesn’t that feel good to actually be hungry! It doesn’t sound like the Apidra is working. I know I had to adjust things a little when I switched to Apidra - I needed a little more than Humalog, but I was on MDI. Have you changed the duration on your pump? I have mine set for 2.5 hours with the Apidra.

yes, i changed it to 2.5 hours also on the recommendation of my doc, because i was at 3.5 with novolog.
yep, 249 now and i haven’t even finished my glass of milk. something is definitely wrong. i’ll wait it out though and see what happens. they gave me two apidra pens to draw from so i can always take a shot from the other pen after this exceeds duration to see if that insulin is working.
i’d better not need much more. my pharmacy already pulled a jerk move and switched my prescription to 60 days instead of 90 so they could get more copays out of me because they thought i was taking too much.
the problem seems to also related to a maternal family history of type 2 and a paternal history of type 1. i’m caught in the middle and got all the autoimmune and chronic diseases that run on both sides.
so i’ve been type 1 but seem to be developing resistance like a type 2 over the last year.

I hope you figure it out. Is the other pen a different lot number? I don’t think you will need a huge amount more but probably a little more. That happened to a friend of mine also when she switched to Apidra and also happened to her husband. Nice pharmacy! I hate when they do stuff like that.

oh thanks, i’m so tired i would have forgotten to check the lot. yes, it’s different and neither is expired. they didn’t give me any pen needles but i had some leftover from when i tried the lantus pen. i used both the pen and i drew some out of the pen into a pump cartridge. so i’d have to use the other pen to inject that way anyway or draw some into a normal syringe.
man, the stuff we have to keep around for situations like this. for diabetics, it’s good to be a medical supply hoarder because you never know what you will need.