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Saturday, November 26, 2011

The Switch-A-Roo: Novolog Day 2,297 / Apidra Day 1

Have I mentioned recently how utterly impossible blood sugars have been over here?


If this is a growth spurt, it is the MUTHA of all growth spurts.  The past 2 weeks have been a blur of high blood sugars.

Correct - Spike - Correct - Spike.

Lather.  Rinse.  Repeat.

I think something happens to my brain when we're in a rut like this.  It's hard to concentrate, and I find myself lost in a sea of numbers, trying to differentiate between times and basals and ratios and carbs and on and on and on.

Don't get me wrong.  I HATE LOWS.  But I can fix a low lickety split.  Highs like this?  I feel like I'm being pelted with snowballs from every angle, and all I can do is run for cover behind a tree, trying my best to shield both of us - and every organ in her body - from a fate of doom.

For awhile now, I've been following some DOC Peeps who have been using Apidra.  I scored a bottle to trial, but was waiting until the winter break from school so I could hover.

Until Thanksgiving night.

Something happened.  She was 350 around 9 pm, and I fell off my rocker.  That was it.  I couldn't stand it any longer.  Sure, it was Thanksgiving, but she hadn't really eaten out of the ordinary ... if anything, she had eaten LESS than usual.  Her numbers shouldn't have been so stinkin' wonky.  Period.

We yanked her old site, filled the pump with Apidra, perused Facebook for a little feedback about Duration of Insulin Action times, inserted a new Dexcom sensor, and hit the ground running.

Ready or we come.

Disclaimer:  Switching up your/your child's lifeline right before going to sleep by using an insulin she's never been exposed to when you know that Dead In Bed Syndrome is a very real threat, and recent stats suggest that 1 in 20 people with Type 1 Diabetes die from hypoglycemia is not something I would ever recommend doing.  It's a dumb idea, so don't do it.  You should ALWAYS consult your/your child's diabetes healthcare provider before making any changes to your/your child's insulin regiment.  Period.

That being said, while the rest of the world was making plans for Black Friday, I was monitoring blood sugars closely through the night.

I'm cautiously optimistic, but it does appear that she spent more time between 80-150 when comparing these 2 consecutive 24 hour periods.

A few observations:

  • That LOW stretch at the beginning of the Apidra screen really never dropped below 78 by fingerprick.  (As I mentioned, this was a new Dex sensor, and our experience has been that it takes Dex about 6 hours to settle in, before being consistently accurate.)
  • Apparently she had quite the breakfast spike on on Apidra, Day 1!!!!  This has actually been a normal occurrence over the past couple of weeks.  On the Novolog screen, the breakfast spike wasn't nearly as bad, but that has been the exception lately.  I'm giving Apidra a few more days, and then will start re-instituting the Superbolus next weekend, if I can't get a handle on it soon.
  • I've heard rumors about Apidra losing it's effectiveness around the 48 hour mark when used in an insulin pump.  We haven't reached that time yet, but I'm holding my breath and praying for the best.
  • My kid is amazing.  She's been a real trooper, and I'm incredibly proud of how cooperative she's been with the extra finger pokes, site changes, and Dex insertions since this madness started.  She was upset when the decision was made to insert a new sensor the other night, but Mr. Rose sat her down and explained why we felt it was necessary.  None of this is easy for her, but she smiles anyway.

FYI -- This morning's breakfast spike only made it to 300.  

Maybe we're getting somewhere?

More on our APIDRA experience...
The day we started.
The experience.
The trial end.
The 6 week review!
The verdict.

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  1. Yay for Apidra! Hope it goes well.

    We find that breakfast is the only meal that still requires a pre-bolus. And for my kiddo, it can vary on the time to pre-bolus based on the food he eats. Cereal is at least 20-30 minutes.

    Good luck on this new journey!

  2. We had the same experience with Apidra - it seemed to kick in faster but felt lighter-weight (didn't push back against the breakfast spike as much as Novolog). Hope it works out! Everyone's wired so differently...

  3. Yay for Apidra! We find bfast needs a 20 to 30 min pre bolus if over 120, under only 10 to 15 min, and you made even see an arrow down but the food will catch up and its beautiful!

    We never had an issues with sites lasting we change every 3 but could go longer I'm sure.

    Basals and ICs did change but it was worth it. J used to hit 250 atleast with every meal, now with a pre bolus bfast maybe 180, and with lunch and dinner usually only spikes 40 pts and that's it without a pre bolus.

    I hope it as good to you as it is to us! Happy holidays, love ya!

  4. Always appreciate to read about these insulin experiences. When we asked my dr and nurse about apidra, they said there's not any difference from what they've seen. But, you read so many different takes on Apidra. Thanks for sharing your early results.

  5. Good Luck! We are liking Apidra...not loving, but it does seem to be treating Bean better.
    Our 'issue' is the still the breakfast spike. Getting better with an aggressive temp basal, but on those mornings when I forget, she pays for it. :(
    Will be staying tuned to see how things go...and what tips I can try! :)

  6. I am an Apidra user and the only thing I had used previously was Humalog. The things I like about Apidra is that it seems to attack a high quicker and that it doesn't have a tail causing lows hours and hours later.

    I haven't noticed anything about it not lasting as long in my pump. I typically fill it with about four days of insulin and it works for me the whole time. YDMV.

  7. Duration of Insulin Action was 4.5 to 5 hours for us on Novolog; it's 3 to 3.5 hours with Apidra. Most have shorter duration. I can start correcting a high (overriding the pump if BS is too high at the two-hour mark) with Apidra. Corrections for highs work much faster. But food complicates this, depending on type of food eaten. Apidra is not as good a match as Novolog for certain foods; but the same could be said for Regular and Novolog (Regular supposed to be good for Pizza). We needed more insulin initially (vaguely remember about 25 percent more, spread among basals and bolus insulin) with Apidra. After a month or two, this stabilized and we now use approximately the same TDD as with Novolog. Careful of site failure or if site isn't working well... blood sugars climb extremely high, very rapidly. We usually get 3 days out of a site. Occasionally, the site will fail overnight on day 2.5. We now know if you get high blood sugars 2.5 days after a site change to change out the site; things will not improve. I like Apidra much better. Her A1cs have not improved however; still the same for us. A1cs have always been pretty good; I was led to expect they would improve further. For us, not the case.

  8. Wendy I am amazed at your tenacity to tackle this head on over a holiday, it will be well worth it if it goes just right though won't it?! When we have times like this I just keeping something has got to break through, anything, I hope for you the switch to Apidra makes a dramatically good change none of our babes need to feel so cruddy because of d. Keep us updated as I've been keen on trying that insulin for Isaac too due to his big after meal spikes.

  9. Can't wait to hear more about your experience with Apidra! We just got a new script from Charlotte's endo and we'll be starting it once we finish her last vial of Novolog (we just opened it earlier this week). I've heard such great things about it so I'm eager to get her started...just can't bare to waste the Novolog though


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While I'm happy to share our experiences with what works, and what doesn't work, for the management of Type 1 Diabetes and Celiac Disease in our house, please do not mistake anything you read here for medical advice. Decisions regarding your/your child's health care should be made only with the assistance of your medical care team. Use any information from this blog at your own risk.