Seeking Opinions about Using Humalog, Novolog, or Apidra in the Pump

Diabetes Technology Insulin Pumps
1

Hi there,

I'm diagnosed with type 1, but I've been using Humulin-R in my pump (the U-500 strength) for the past four years. I suppose you could say I had "double diabetes" until I had bariatric surgery two weeks ago as I had significant resistance to the insulin I was pumping (and injecting prior to getting on the pump). I am no longer in need of the concentrated insulin and am seeing my endocrinologist next Friday to discuss switching to one of the fast acting mealtime insulins (Humalog, Novolog, or Apidra).

Right now I'm only filling my 3ml reservoirs about 1/2 full and wind up with more than 1/2 of what I put in left in the reservoir when I change three days later. My CDE thinks it's time to change over to U-100 insulin and I certainly agree and know there will be significant benefits to using it. I'm experiencing a lot of lows right now and find I'm testing practically hourly at this point (I don't have a CGM to help me see trends to eliminate some of that frequent testing).

My question is this: do any of you have a preference for any of the three types of insulin I might switch over to using?

I'm seeking opinions/reviews if you've got any!

2

Novolog® is probably the best all-around pump insulin when looking at all of the factors including stability in the reservoir, they are all U100 so there ability to lower your BG so many points per unit is the same. I pump Humalog®, but if BCBS would still pay for Novolog® I would still be using it..JMHO

3

The answer to the question, as with most things related to diabetes, is "it depends".

Each physiology is unique. In theory, any U-100 insulin should lower blood glucose by the same amount. In practice, it doesn't always work that way. Regular insulin and the fast acting analogs are all U-100, but they don't always affect blood sugar identically. The fast analogs tend to lower BG more, something the manufacturers don't tell you. This has been documented extensively by Bernstein and others, and I have verified it empirically myself. One unit of regular will lower me about 40 points. One unit of Novolog or Apidra will lower me about 60. I've measured this repeatedly and it's highly consistent. On the other hand, one unit of Humalog won't do anything at all for me; it might just as well be a placebo.

That said, Apidra tends to be the most touchy in a pump. For one thing, it's more temperature-sensitive than the other two. For another, some pumps' plumbing just has more difficulty maintaining a smooth even flow with Apidra, while others don't seem to have a problem. So the specific pump is yet another variable.

As is typically the case with diabetes, the only way to really know the answer is to determine it empirically. What works perfectly for one person may not work well at all for another, and vice versa.

4

I've experimented with all three in my Omnipod. I agree with David - Apidra seems to be the most sensitive. I found it lost it's efficacy in my pump by day 2. Novolog maintained it's efficacy for the full 3 day Ominipod lifecycle, but was prone to occlusions. Humalog is stable and has not caused occlusions for me at all.

5

. . . and there you go. Only way to know for sure what works is to try different things. Someone (not me) said "If you want to treat diabetes by the book, you need a different book for each diabetic."

6

Exactly. :-)

7

I like Humalog, I have never had a problem with it.

8

I use novolog, it has been very stable for me. I have been pumping for over a year now and so far no occlusions. I will load the full amount in my tslim and run till empty. For me that is about 7-10 days depending on how carb heavy I go. Have never had it go off in that time frame.

9

Thank you all so very much! I appreciate your input. I was pretty sure that the answer would be that we're all different and have different needs and requirements, so it may take some experimenting to find my right insulin choice.

I have been on Humalog in the past, but it did not work at all well for me (but that was probably due to the insulin resistance thing). It's likely that's changed now.

I am very curious about Novolog because of the extended period of time it's approved to stay in that reservoir (I use a Medtronic 7 series Paradigm pump). I've been seen by three endocrinologists now and the first two both had me on Humalog (before the Humulin R was started). I'm not sure which insulin she'll prescribe to me, but I'd like to go in feeling knowledgeable and ready to discuss the two I'm considering (I was never sure about Apidra due to that instability factor -- I visited their website the other day and read that the insulin in a pump must be changed every two days and thought that there better be a very good reason to love that sort of insulin if I'm going to change every other day).

I'm hoping what will happen is that I'll have a chance to ask which she prefers to prescribe and why -- and then ask why not the other one. My insurance covers all three insulins, so that's not a factor in my decision.

I'm really excited about switching to U-100 insulin again now that my sensitivity is so vastly improved! It's been nerve-wracking to cope with all of the lows I've been having and I worry every time I bolus that I'm miscalculating the number of carbs and giving myself that concentrated insulin and, oh dear, it's just a scary thought to me that I'd drop too low to correct it. I live alone, so I don't have anyone to look after me should that happen. My insurance does not cover a CGM. I've been testing about hourly right now to keep tabs on where my BG level is at. My fingers are killing me! I'm actually starting to flinch a little when I go to poke myself with the lancing device -- I haven't done that since about two days after I first started having to test! I've got glucose gel packets absolutely everywhere in my apartment -- beside my bed, at my desk, at my chair side table in the living room, in my bathroom, in the kitchen. I'm never more than a couple steps from those things right now. It's sneaky, hypoglycemia, I never notice it anymore and am often shocked to see a low number on my meter. My neighbors may think I'm a little batty and possibly using drugs. I keep exclaiming, "wow! I'm HIGH?!" Then it's a glucose gel down the hatch for me.

Thank you again for all of your input. I do appreciate it so much! :)

10

I have had no luck with Apidra. I've been pumping Novolog for about 14 years and have never had a problem. Humalog gave me site issues, although I injected it fine for years. Best wishes and let us know how everything goes.

Susan

11

Second that. I fill my Animas 200 ml cartridges of Humalog and they last a whole week, no problem. Oh, and I've pumped U100 R as well. Works fine, but slower to kick in and a slightly longer effective period.

12

Ha! I just realized there is a huge typo in my reply to you all. I meant to say I'm going around saying I'm *not* high?! I'm so used to saying I *am* high that I think I just automatically typed in what I used to say so frequently.

I can't wait for Friday morning to arrive so I can go to my endocrinology appointment. I can't believe I'm excited to be going and not scared to death that I'll be lectured about my high a1c and all of the highs I have when they download my pump data.

I was disappointed the other day by my endocrinologist. I misplaced my lab slip and called to ask that someone call in the required tests (an a1c and some other routine blood work) and a nurse called to say she spoke with my doctor and my doctor said that it wasn't necessary to have any lab work at this visit as she had a fairly recent a1c and other tests in my file. I wanted to know how it's changed since that last draw! So I was a little bummed that I don't have to go to the lab. Now I have to wait awhile for my next a1c to be drawn. It's so weird to feel happy about something like finding out my a1c and to not feel dread at the prospect of finding out what it happens to be.

It's almost like Friday is some special holiday or something! I'm like a kid waiting to find out if Santa came or not. I'm so ridiculously excited about changing to a different insulin that I'll be very let down if she says no for some reason. Friday morning at 8:45 is when I get to finally talk to the person who can change my prescription and help me reprogram my pump to suit U-100 strength insulin. I could do it myself if I had a calculator on me to multiply everything programmed in by five. I think I'll let a pro do it this time, though.

I just can't wait. It's amazing to finally have decent sensitivity to insulin. My numbers are looking so good (other than the lows and one silly high of 201 that I can't explain). Also I was able to bring that high down quicker than ever in my life with only a tiny amount of insulin (I think it was 0.2 units of U-500 and for me this is unheard of to bring my level down).

It's very strange to suddenly be very interested in managing the diabetes again. I've been very burned out for quite a long time trying desperately to cope with always being high. Now it seems to doable. It's quite exciting to me!

13

What a happy day! I was finally switched from U-500 Humulin-R to Novolog early this afternoon! I'm so stinking excited about this it's ridiculous!

The NP at my endo's office said it is definitely time to make the switch (I was pumping so little of the Humulin-R by this morning that it was just silly to continue with it).

This is a dream! No more running in a bolus (or blousing) half an hour before eating. And with having had weight loss surgery I never knew if I'd be able to actually consume the number of carbs I told the pump I was going to eat. I was sometimes running in half as much as I planned to try to eat just so I wouldn't have a catastrophic low later on if I couldn't eat my entire meal. And if I did eat the whole thing I'd bolus for more AFTER I ate the food -- not the optimal way to use Regular.

I was having one or two lows a day, sometimes more frequently, and they were getting to be very difficult to treat -- I'd take a 15 carb glucose gel pouch and drop again an hour later; I just can't always manage to follow up with a little "real" food to keep me level since the surgery.

My endo NP and I decided together to be very conservative with my basal rates, carb ratio, and correction factor. I'm expected to run slightly high for the next few days until I can see my CDE next week and discuss what we want to do to change the settings.

I've never run rapid acting insulin in the pump! I've pumped for about 4 1/2 years now and it was always the U-500 Regular. I used rapid acting via MDI before that, so I'm not entirely new to this type of insulin. But never in my insulin pump.

I had such a wonderful time at that appointment. I got some goodies -- a couple of Mio infusion sets to try out (I think I can more successfully place that type of site at my back hip and back of my upper arms to give my abdomen a break), a prescription for one box of Mios and one box of Silhouettes with each shipment, brand new script for more glucagon (that isn't expired like my old kits are -- time for them to become practice kits that my family members can mix up and pretend to inject), a back up Bayer Contour meter (the kind that talks to my pump if I want it to), a full vial of Novolog, the partially used vial that I filled my reservoir with in the office -- I'm ridiculously excited about all of this!

When my NP came in, she had Humalog in her hand and started to talk about it. I asked her, "what about Novolog?" She seemed surprised that I wanted to talk, but excited, too, to know that I've been doing some research and talked with you all about my options here. I told her I've heard it's more stable in the pump and she told me that's what she's heard as well. She was more than willing to allow me to lead the way in what I wanted to be infusing. She checked that I have Lantus (my butter compartment is filled with Lantus and Novolog now) and told me that I might as well get rid of the Humulin-R I have remaining as I don't come anywhere near to what she considers the level of use of Novolog to ever go back on that insulin. She said it's pretty dangerous to keep that stuff around -- I'm not likely to confuse that huge vial with the slimmer Novolog vials, but you never know what I might think in the middle of the night if I'm high and needing to take an injection because the pump might be acting up.

I will not admit to you how much Humulin-R U-500 I was once capable of injecting to correct a high and the hours I'd stay awake waiting and waiting and waiting for it to come back down -- often injecting more of that concentrated insulin! If I did that today I'd be a goner for sure.

I got my lab slip for my A1C and other tests for my next visit with her in about six weeks. I read something interesting on it. It stated my condition and the ICD-9 code for it. Next to those it read, "type 1 (juvenile) diabetes; not specified as uncontrolled; with complications. NOT SPECIFIED AS UNCONTROLLED. It has been YEARS, literally, since anyone could say that about me and the diabetes. It was always NOT controlled on the lab slips. I'm bouncing around right now. I'm ready to dance around my apartment just thinking about how happy I feel because of it. I'm still having occasional blips of something high-like (I had a 170 for no apparent reason that other night) and I dip low quite often (usually around a 50), but for the most part I'm staying in pretty good range. I am still testing about hourly and anytime I feel "off." I never thought I"d see the day when I said 170 was high. Used to be 170 was a good day for me.

I bugged all of my family members, friends, neighbors even, and on Facebook, too, about how happy today has made me.

Plus Rite-Aid in my town was selling Level Life Glucose Gel packets for just over a dollar a piece. They only had nine of them left, but I snapped them all up!

I don't know if it is absolutely silly to be this happy about diabetes. In general it is something I just deal with and I do my best to take care of myself. I don't feel depressed about it or angry about it very often. I feel like I can handle it now. I know there will be rough spots, but it's like I now have a little control of the situation. And that's wonderful.

Thank you for all of your input about the insulin types out there. :)

14

I'm glad this is working out for you. I would hope that you will see further improvement over the long term as well. Do stay in touch.

15

I have used Novolog for 15+ years in pumps, without issues. When I first started using pumps, I used Humalog, but switched to Novolog when my doctor heard reports about infusion set clogging due to crystallization. (Clinical tests by NIH were inconclusive.)

I tried Apidra for about a week; it wasn't as predictable as Novolog, so I continued with Novolog.

You mentioned glucose -- I used Relion Glucose tablets from Walmart, $3.98 for a bottle of 50 tablets, each with 4 grams of carb. For BG below 70, I take 4 tablets. The tablets are the lowest cost, most predictable method I've found to treat hypoglycemia.

16

Apidra is the fastest-acting. I can bolus mid-meal so I don't end up having to eat the whole meal just because I bolused for the whole meal.