Omnipod with Humalog

Diabetes Technology Insulin Pumps
#1

Hi everyone,

I recently had to switch from Novolog to Humalog due to insurance preferring Humalog. Since then I have noticed that somewhere in the last 12 hours of the pod expiring, my numbers continue to rise. Most of the time, this happens overnight, but I have had a few pods where their last 12 hours are throughout the day and it still happens. Originally I was fixing this by replacing my pod (which did correct the issue), but more recently I have temp basal’d 20% higher and that keeps it more level.

I have tried keeping the vial in the fridge continuously and that did not seem to help. During this time, if I take a correction bolus, it helps my blood-sugar not rise anymore, but it does not lower me back down. Originally I thought maybe I had just grossly miscalculated food I had eaten, but then I started realizing it keeps happening when I hadn’t eaten within 4 hours+ of the numbers going up. I have a dexcom, so that’s how I can keep a close eye on what’s happening.

I have been doing some research on why I haven’t noticed it before with Novolog and am now experiencing it with Humalog. I came across the fact that Novolog is “rated” up to 98.6 degrees, while Humalog says to be stored at 86 degrees or below. It makes sense to me that if Humalog is only good up to 86 degrees, and my body is obviously near 98.6, that it could spoil the insulin. Could that really happen in only 3 days, though? I have also thought about not lying on the pod at nights, but its sometimes hard to remember that.

Has anyone else experienced this sort of thing with their Omnipod combined with Humalog? Does anyone have any other suggestions that could help the insulin stop losing potency? I really don’t want to spend double the money on Novolog, but I will if I have to.

Thanks,
Jake

#2

Yes, I have noticed that NovoLog seems more stable through 3 days than Humalog.

You should be able to get your endo to make one of two requests to resolve this.

  1. Either state that Humalog does not work for you, that you need NovoLog.

  2. Or get your prescription changed to allows pod swaps every 2 days instead of every three days.

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#3

I’ve been using Humalog and the Omnipod for years and have never noticed this before. I always wear my pods for the maximum time of 80 hours as well. If Novolog works better for you though maybe get one of their Copay cards that will pay up to $100 dollars to get your script down closer to $25. I always try to use diabetic supply companies prescription savings programs whenever I can.

Good luck!!

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#4

I’m going through this with my HMO’s pharmacy, Optum. I have a severe Humalog allergy and some committee is sitting deciding if I should be allowed to have my insulin on Tier II. I have, and I know others who have had, problems with Humalog needing to be used in higher doses, and for me it was increasingly higher. It’s not uncommon. The insulins do not act the same for everyone. Unfortunately, getting a prior auth doesn’t work for all either.

#5

I had similar problems when I used the Omnipod system but I was using Apidra. When I switched back to my tubed pump and tried some other cannula styles, I concluded that it was not the insulin but the quality of the site combined with the cannula style I used that caused unexplained hyperglycemia.

#6

We use Apidra, and noticed that with Humalog! We love how fast Apidra works on son’s body, I feel we can manage it better.

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#7

I haven’t, personally, noticed that. I never refrigerate my Humalog. But, I have had a number of pump failures from poor absorption, lately, that I think are due to poor site rotation. If you aren’t getting a formal pump failure (with an error code that they can look up for you), then perhaps the insulin is suspect. I called them with an opposite concern - that the insulin in the Pod might be getting too cold and leading to failure. They were able to read the codes and said that wasn’t it. But, they suggested that as the insulin gets colder, it gets thicker, which might contribute to crappy absorption. I think that’s what they were saying, anyway. Call 'em up and ask!

#8

Sorry for not replying sooner, my wife and I just had our first baby at the end of December, so we’re still getting the hang of things (and lacking sleep).

Thanks for everyone’s replies! Unfortunately Novolog is now a plan exclusion under UHC (at least for me) so I’d have to pay full price. I do have the option to appeal, which I may do.

I had never thought of the site being the issue since its only on the third day of the pod. Because I wear my dexcom and omnipod solely on my abdomen, my site rotation is limited.

Last night I had a 12-hour reminder on my pod replacement, which went off at 7pm and I did a temp basal 20% higher and stayed stable throughout the night. This morning I moved my my pod to my leg. We’ll see if that helps on the third day. I’ll be sure to post back.

Thanks again,
Jake

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#9

I have had to do several appeals with UHC on types of insulin. Those appeals were very easy compared to some of the others.

You can record the “day 3” issues for a few weeks and provide documentation for the appeal. I had to “use” crappy no-name insulin for 30 days and then explain how it did not work as well as the other insulin, and the appeal when through with no problem. And that was with UHC.

It helps to have an endo on board with you. If you explain the difference you are seeing with Humalog and NovoLog on day 3, your endo should be able to help with the appeal. If not, maybe consider getting an endo with a bit more “fight” in him.

There are a bunch of threads on TuD about day 3 issues if you want to read about them. There are a bunch of these types of threads.

Here are two:

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#10

Yeah, if I do an appeal I don’t think it’ll be too hard, especially since I used to use this insulin under my old prescription plan. I just need to decide if its worth the difference in cost to go through the appeal process.

After switching to my leg I did not experience the highs on the 3rd day like I had with my abdomen. So I am going to continue to use my legs for a while to allow my abdomen to heal. After a few weeks, I will switch back to my abdomen and see how it goes. In the future I will try to rotate sites more often.

Jake

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#11

I was able to go to one vial of Novolog per month under their prescription discount program. It came to $25 per vial and is good for one to two years under that program. My appeal is still heading to some grievance board…I have a back stash of vials so even though I prefer getting two bottles, one a month will suffice for this price. The price on Tier III at my plan was $99 per vial.

#12

That’s interesting. I just started using my previously unused thighs, and I find the third-day problem occurs far, far more often than on my overused abdomen. Just goes to show how different we all are!

#13

I’ve absolutely experience the same issue, however I have my pod set to remind me to change 8 hours in advance before it expires. I imnedietely change it if I’m due for a change at all that day in the morning as well. This has seemed to help tremendously or just simply setting a temp basil. I love how easy it is to use the percentages on the pod and set it to automatically go back to normal rates.