@Rob5 Can you share with us what the Lyumjev onset time & duration are vs other rapid acting analogs (Humalog, NovoLog or Fiasp)?
I really wish Heath Canada would get their act together and approve insulins like Lyumjev (and Afrezza) in a more timely fashion.
I contacted Lilly regarding a Canadian release date for Lyumjev and was told they have no plans to sell into our market, likely due to the excessive bureaucracy
For me, Lyumjev and Fiasp are just about as fast. Both are considerably faster than Novolog or Humalog, although Humalog seems to be slightly faster for me to start working than Novolog.
One major difference is that I definitely have to pre-bolus for meals with Novolog & Humalog, but not with Fiasp, and even more so not with Lyumjev. And I find myself using extended boluses far more with Lyumjev than with any of the others.
I use Control-IQ on my Tandem t:slim X2 pump, and one difference I believe I experience between Fiasp and Lyumjev is that when/if I go low BG and CIQ turns off insulin delivery, my BG appears to recover faster on Lyumjev than with Fiasp. That implies to me that Lyumjev has a shorter active duration.
Also, again using Control-IQ, when I get up in the morning, my BG averages 109 with Lyumjev, compared to around 124 for both Fiasp and Novolog.
So overall, for my use in my pump, Lyumjev seems to be better. However, since there ain’t no such thing as a free lunch (TANSTAAFL), I do experience pain at my cannula site with Lyumjev. For the record, I use Tandem AutoSoft 90 XC infusion sets. The pain isn’t severe, just annoying, but I don’t know if there are any long-term dangers from it.
So, I’ll give Lyumjev a grade of B+. If Medicare gives me a go for Part B coverage, I’ll upgrade that to an A-, taking points off for site pain.
Great review @Rob5 
Curious how Lyumjev causes site pain / irritation, just as many of us found with Fiasp (which is a completely different formulation).
For the record, I found the Fiasp onset was 10-15 minutes, peaking in just under 60 minutes and with a total duration of about 3.5 hours
I’m envious of those of you who have access to Lyumjev
@Rob5 How do you get FIASP under Medicare Part B? My ENDO couldn’t find FIASP name in the drug list on the computer screen. The computer drug list has Novolog and Humalog only. He doesn’t know how to get FIASP, because it is not in the drug list. Please advise. Thanks.
I use Walgreens, and they have had to get their Medicare person involved every month. As a result, I have to allow about 5 days to get the Rx filled. And I always request it on a Monday and visit or call them every two days so they have plenty of time for various incompetents to be reminded how to do their job.
My advice is to have the Endo write (or send) the scrip, then go to the pharmacy in person and explain to them exactly what you want. Make sure they understand it is Part B, not Part D. I have gotten Part B to pay for Fiasp for two years now. I’m in the process of doing the same for Lyumjev now. It gets old having to do their work for them, but you gotta do what you gotta do.
Rob
Thanks. Use ENDO’s paper prescription and go to the Pharmarcy, as we did in the past when the electronic prescription system was not available. I will get the paper prescription from ENDO in my next office visit.
Please post the result of getting Lyumjev under Medicare Part B later.
Thank you for posting your experience for the comparison between Fiasp and Lyumjev.
Paytone, I agree RE: the viscosity of Fiasp with Niacin. Fiasp (injected) has been wholly unreliable as far as effectiveness. Also, it causes injection site irritation and inflammation. I haven’t had this occur in my 40yrs as a T1D.
I’m hoping Treprostinil and sodium citrate in Lyumjev 1) Don’t cause the site reactions and 2) Allows me to use it in my X2.
I have to get my Lyumjev under Medicare part D because it’s not approved for pump use in the U.S. yet. (I’m not saying I DON’T use it in my pump though). They (Walgreen’s) won’t put it through durable med for that reason. They assume I’m not using it in my pump since that’s not FDA approved here yet.
Are you saying that, with insistence, your pharmacy IS paying under Part B as if approved for pump use?
I’ve been dickering with Walgreens & Medicare on Part B coverage for a couple months now. Since Walgreens told me that it wasn’t covered, I submitted a redetermination request with Medicare (actually one of their contractors) giving them all the info I have on the topic. They were supposed to get back to me within 60 days.
Believe it or not, on the 58th day, a very friendly, nice, and helpful lady called me on the phone. She told me that what was needed was for my doctor to call the Medicare provider phone number - (866) 238-9650 - and provide a “medical necessity” for my use of Lyumjev over Novolog or Humalog.
I just saw the doc yesterday, and agreed to do so. But of course, there hasn’t been enough time for anything to have happened yet. I will post my ongoing adventures in this as they happen.
And, I was told by Lilly (the manufacturer) that Lyumjev was approved for pump use. I made that statement, along with Lilly’s statement that Lyumjev was priced the same as Humalog, in my redetermination request.
One of the things my doc said he will point out in making Lyumjev a medical necessity is that my A1c went from 6.6-6.7 for over four years down to 6.1 for the last three months, with use of Lyumjev being the only change in my diabetes protocol. My endo has been providing me with sample vials of Lyumjev for the last quarter so I can try it out, since I keep detailed records and do statistical analysis of my results.
Stay tuned!
Rob
Thanks for how to pronounce it. I changed insurance at the beginning of the year (2021) and the Fiasp I had been using is not on the formulary for my new coverage. My doc sent a script to the pharmacy for Lyumjev which is on my new plan. I haven’t gotten it yet, but expect to pick it up within a week.
Thanks to all that have posted regarding this insulin.
I just got some Lyumjev pens in the mail. I’ve only done 2-3 injections so far, but it’s noticeably faster than Humalog. It’s not as fast as Afrezza, but maybe more reliable.
The Control IQ technology paired with a faster insulin seems pretty appealing to me. I’ve been on MDI and Afrezza for awhile now, but the Control IQ technology paired with a faster insulin has made me reconsider getting a pump.
Do you have any pain when you do an injection?
There were a few reasons I switched off a pump; scar tissue was a big one. I think I develop scar tissue more easily than other people. I haven’t had pain at Lyumjev injections sites yet, but not sure if that means anything about what I would experience at an infusion site.
Also, my doctor seems less familiar with Tandem products, but he said that the pump doesn’t correct lower/higher once you’re “in range.” I’m confused by that because I’ve read that it targets 110 mg/dL. Do these adjustments only happen in sleep mode? What am I missing? Thanks!!
Since I’m on a pump, I no longer do injections so I can’t answer whether they are painful. My flu shots are completely painless when I get them.
When I turn on Control-IQ, it changes the target BG to 110 (it is changed back to my setting if I turn it off). CIQ then does its thing to keep BG at 110. The primary differences I know between the three activity settings are:
A lot of people on this forum use the sleep activity all the time, to have a tighter control of BG. I set a sleep schedule to be on from 7 PM to 7 AM. That works for me.
I am very fortunate in that my doc lets me do whatever I want with my diabetes care, so long as my results are good - and they have been for 20+ years. So I make small adjustments in my pump programs fairly frequently to tune the pump.
Rob
So if you’re running high at night and are in sleep mode, you must rely on alarms & manual boluses to bring your bg levels back to 110? I doubt I’d use sleep mode when sleeping then.
Do you feel that this is more necessary with tandem’s CIQ than other pumps?
Also, thanks for answering. Appreciate hearing your experience.
No, if you are high, CIQ will bring your BG down by raising the basal. Not doing a correction bolus in sleep mode is a safety feature. Your BG will come down, but slower than it would with a correction bolus. As an example, if I go to bed with my BG at 250, by the time I wake up in the morning, it will be between 108 and 112, using CIQ.
For me, my required basal rate in the evening until bedtime is around 2.8 units/hour, but between midnight and 6 AM, it is only 0.7 units/hour. If I let Control-IQ do a correction bolus, especially if it does so around 10PM, I go very low, since the effects of the correction will carry over past midnight. So I have it go into sleep mode at 7 PM so it won’t do corrections close to bedtime. I do my own corrections manually after 7 PM.
Another alternative that I haven’t done - yet - is to set up a time slot in my program starting at 7 PM that has a very high number for the correction ratio. That would result in CIQ giving lower correction boluses.
It’s all a matter of experimentation with both your pump program and Control-IQ. But make any program changes very small each time. A small change probably won’t hurt you, while a big one might. So I change correction ratios by only 1 point at a time, and basal rates by only 0.2 units each time until I know what the result will be.
Rob
That’s what we’re all here for on the forum.
Rob
You gave a great summary, but it isn’t quite accurate, so your description doesn’t show what some of us consider the “too little, too late” aspect of Control-IQ. The default “no activity” mode is more hands off than your description suggests. It’s completely inactive between 112-160, where you’re left to your own devices. It doesn’t raise your basal until you’re likely to pass the 160 mark, but does reduce it anytime you’re trending below 112.
That’s why sleep mode is such a great alternative for those of us looking for tighter control, because it’s action range is much tighter. It increases basal as soon as you’re trending over 120, and still reduces basal at the 112 lower limit.
So yes, there’s no correction bolus when sleep is engaged, but unless you completely forget to bolus for a meal altogether, the increased basal at that lower limit nearly eliminates the need for a correction bolus in the first place. But it definitely requires some settings tweaks to make it work. I highly suspect it’s less to do with “hacking the system”, as many have suggested, and more to do with the fact a system that is nearly always adjusting your insulin based on your settings highlights the shortcomings in those settings that were previously working out for you alright.
Thanks for the clarification on sleep mode. The idea of no/rare alarms while sleeping is what made the CIQ system most appealing to me. Due to hormone cycles, I have to make basal changes regularly throughout the month (approx ±25% basal but timing and amount varies from month to month), and I base those decisions off of upward/downward trends that I see during the night. Trends which, of course, can be accompanied by alarms during the night.
I can’t imagine going to bed high without giving a manual correction bolus, so the sleep mode described would likely fit my needs well at night.
Hopefully it would track the additional/reduced units given so that I could still easily make basal changes during my hormonal cycle.
The t:slim X2 let’s you set up quite a few different basal profiles that you can easily switch between. I used to have one called “broken” for that time, 'cause that’s what my husband calls me! LOL
With Control-IQ, though, I use far fewer profiles, though. I only have three now. My usual I’ve, and ones that are 50% higher and lower than my normal. It’s really all I need. The reduced one is great for if I’m running a fever that eats up my BG or high activity times. And the increased one is great for hormonal days, general sick days, steroid shots, holiday grazing, and any other time my BG is being stubborn. Since I run sleep mode constantly, Control-IQ will use whatever it needs of the insulin I’ve made available to the system and suspend what I don’t need.
But yes. If you upload your pump to the t:connect portal, via mobile app or by connecting to a computer, it’s pretty easy to see what was actually delivered when. That info is directly on the pump, too, but more difficult to see/understand there. You’ve got to scroll through the pump history that way.
Are you still using Lyumjev in your Tandem X2?
If so, how has the skin tissue reactions been?
Reason I ask is I had to ditch Lyumjev in my Omnipod and go back to Humalog becasue my tissue couldn´t handle it. Wish I could find a way for my body to handle it better.