I could use some advice folks. Saw my endo today, and he had no problem switching me to a trial of Apidra. I'm currently pumping novolog. I have horrendous pp spikes, even if I pre-bolus, so I'm hoping the switch will moderate the spikes some. I'll start tomorrow, next set change. I understand I'll have to change sets every other day instead of every 3?
My novolog is set to 3.5 hrs duration... how much should I lower it? Start with 3 hrs? 2.5?
I think everyone is different, and you'll have to do some trial and error to see what's best for you. I don't find I need to pre bolus, but if I do, I don't do much past 15 minutes. The biggest difference for me was that I stopped having post-prandial lows. With novalog, if I adjusted my carb ratio to get me in range 2 hrs after I ate, I would ALWAYS go low at about 2.5-3 hrs post meal. In my body, Novolog always has this weird second peak between 2.5-3 hrs. Apidra works faster and doesn't seem to have that second peak for me.
Jrtpup, I have been on Apidra for over 5 years. I notice that for me,it starts to work about 20-25 minutea after injecting, if ou are in normal range. It corrects a high in about the same time as N=Humalog, which is th last insulin I use efore changing to Apidra.. I changed becaus my endo says it would be less cahnce for apodra to clog in the pump. I neve had that problem that I can recall, but I just went along with his recommendations. I used the sam amount of basal and still prebolus by 15-20 minutes Apidra lasts for me about 2.5-3 hours, depending on the time of day. I really do not see THAT much of a difference from the Humalog.My high pps are usually because I overeat and underbolus due to miscalculated carb counts, or am having a site issue. And I am finding I ablsolutely must change by no lster than the beginning of the third asnd I used to be able to go well into that third day before I changed out the set, with good absorption,but lately I am finding that the set sites are getting sore and lumpy, even a little inflamed with poor absorption after 2 1/2 says. Has the new Apidra changed its make-up? I never had these skin inflammation/iritation problems unti recently, when Apidra started coming in a blue, rather than a white box. Is there a new formulation? Maybe I will need to go back to humalog.
I like your new picture. I was just looking at it on your page, and at the pictures of your pups, and I had an aha moment what your name stands for. Jack Russell terrier pup?
OK, on to the subject at hand: Apidra insulin. I have my duration of action set at 4.5 hours. Gary Scheiner in Think Like a Pancreas says rapid-acting insulin-Humalog, Novalog and Apidra-starts 5-15 minutes, peaks 3/4-1.5 hours, and lasts 3-5 hours. John Walsh says in Pumping Insulin that it takes a minimum of 4 to 6 hours for all of the insulin action from a recent bolus to stop lowering the blood sugar. I try to pre-bolus 15 minutes before I eat.
Yes. I have Apidra in Navy blue boxes. This newer order expires in 4-14. That is is why I am asking. The ones that did NOT that do not appear to inflame my skin were due to expire, like yours in the white box, in 1-13. I felt some very slight irritation with the Quickset duration ( 3 full days) this time, but still a lttle redness around the site.. I will see how the Mio does with the Apidra in newer packaging. Maybe that is all that has changed.
Haven't really figured the Apidra out yet, for me. I seem to go up just a tad 1 hr pp, then spike some at 2 hours. Haven't made sense of it yet! My basals seem to be doing about what they were with novolog.
I was a bit lightheaded the first day, but seems to have gone.
To me fast is not always good. Some components of our food will take longer to digest. Thus if Apidra builds up quickly and fades out too fast you will see an uncovered spike later. This is why I prefer NovoLog. It is quick and at the same time it has a small tail to cover the remainig carbs after the 2 hour mark.
I think there's some "hedging" in the use of 3-4-4.5 hour times for duration. Most of the insulin has run it's course but I think that there may be some floating around too. I think that this is most prevalent at times when your metabolism slows down, particulrly at night, stringing tendrils of "action" beyond when the "duration" says it's done. I refer to this as the "tail" but, sometimes, the tail can wag the dog?
I switched to Apidra to try and smooth out the spikes I get an 1 hr. Novolog just isn't fast enough for me. So, I'm thinking maybe I need to do combo boluses with the Apidra.
Humalog worked fine if I ate <10 carbs - not what I'd call a huge spike - but more than that and I'd spike (unacceptably high, for me), then crash to where I'd intended to be. (I generally eat ~30 carbs a day).
This is going to be a longer learning/tweaking curve than I'd expected LOL Suggestions welcomed ;)
I currently use a MM pump and always have to choose between 3 and 4 hours. 3 hours is too aggressive for me and 4 hours is not aggressive enough. I use the term aggressive because the main function of the active insulin time in a pump is to determine how soon and how aggressively you correct post meal highs.
I've always thought 3.5 hours would be perfect for me. That's not possible with MM because of 1 hour increments. I will probably be switching to a Animas Ping soon because of the future integration with Dexcom. The ability to have 3.5 hours as my active insulin time will be a huge improvement for me.
BTW-I use Novolog. I've tried Apidra a few times and wasn't super impressed with how it worked for me. But I never stayed with it long enough to adjust my pump settings to make it work. It's not covered by my insurance plan so I didn't have a lot of motivation to stick with it. Lots of people love it, so sometimes I wonder if I'm missing something.
After thinking about it I came to the conclusion that Sue's more general description of 4-6 hours taken from Walsh will fit more people than mine. For me it is up to 4 hours but others might respond very differently. The greeting box of every newly diagnosed diabetic needing insulin should contain all the different brands to try. This together with a hand out what to look for when testing them: who is wagging who and where is the tail of this madness?
Not much I can really add to this discussion beyond the obvious (to us) fact that everyone’s response to any given medication is individual and (potentially) unique.
For instance, Humolog is highly effective for most people, but for me it hardly works at all – next best thing to a placebo. And I saw a comment here about Novolog being better for covering the slow-digesting parts of a meal; but that’s not true for me either. If a meal contains any significant amount of protein, Novolog wears off much too soon, and I spike. That’s why Regular is my bolus of choice; it takes longer to start, which requires more planning, but its longer duration covers the meal more effectively. I use Regular when I am in control of the timing and Novolog when I am away from home or need a fast correction.
I suspect that the only pattern that will be relevant to you will be your own, established through trial and error.
I like Aprida but it clogged in my pump tubing one time too many. It happens in the summer more than the winter and I used to switch back and forth between Novolog and Aprida. I just learned to bolus earlier with Novolog and with My cgm everything seems to be good.
If your basal rates are on the higher side you may find no clogging trouble, but mine are relatively low(.4-.6/hr) and when I exercise I suspend it for 2-3 hours. Aprida almost always clogs when it sits like that, but Novolog and Humalog never do.
The only thing I miss about Aprida is that it corrects highs fast. For me it was just too much trouble.
How has the Apidra been treating you? Caleb switched about 2 years ago from Novolog. We changes IC ratios and basals slightly (needed less with Apidra) but we didn't change his insulin duration. He's always been 2 hours. What I saw right away was that with bigger boluses, the tail of duration was shorter. I would have to watch beyond the 2 hour mark only for those bigger boluses and compensate with Novolog, but not with Apidra. So although the schedules duration didn't change, my approach to compensate manually for the "big bolus exception" did. We did find that after about 6 weeks of use that the Apidra broke down at 48 hours and Caleb would have highs. We now change his Pod every 2 days instead of 3. Not sure why it was smooth sailing initially.
Lorraine, it looks as if I'll be changing pretty much everything. Duration for me seems to be about 2 hours, though I'll keep testing. I'm currently retesting/changing my ISFs, which I haven't done in years. I:C ratios are next. I'm running at 80-90% basal.
I'm thrilled that I haven't had the huge spikes I used to get at 1 hour, though haven't challenged it yet with more than 15 carbs at a time. I did start to go up at the 2 hour mark a couple of times though, and needed to correct. I expect I'll have to do a big bolus correction at 2 hours as well, expecially for protein/fat.
I expected to have to change my sets every 2 days, but haven't had to. Maybe there's a 'honeymoon'.
