In the Fast Lane

This past week, my blood sugar control has been crappy, crappy, crappy. (See Wednesday’s post for a mood check). At first, I chalked it up to a typical short-lived SUS episode. But now I’m getting kind of pissy about it, because this seems to be a more permanent issue: could my insulin-to-carb ratio needs be changing yet again?!

Why doesn’t this $%#^@ disease ever go on autopilot, just for a month or two?

Wife_in_the_fast_lane_book_3 OK, I have to remind myself that everything else in my life is going extremely well — kids, marriage, camping on the coast last weekend, 11.4 Jewish holidays in the month of September, book club, upcoming trip to Disneyland, writing, writing, and more writing. Crazy-busy. All good. So I guess it’s like they used to say in Tales of the City: “You can have a hot lover, a hot job, and a hot apartment, but you can’t have all three at the same time.” As in: “You can have a hot personal life, a hot job, and smokin’ hot blood glucose control, but you can’t have all three at the same.” *Sigh*

So my endo and I are now talking FAST LANE. Meaning we both want me to try Apidra, the new super-fast-acting insulin analog from Sanofi-Aventis. We’ve heard good things about its effects on post-meal glucose levels — our great adversary in this lifelong fight for steady BG control.

I’m excited to try it, and even note that the company is offering $20 coupons off your copay for your first 5 Apidra prescriptions. But my endo has quite a drill in mind for me. She wants me to:

1) Wear my DexCom Seven continuous glucose monitor again for two weeks straight.

2) Get a Glycomark test at the outset of Week 1 to check my current postprandial levels.

3) Then carefully log everything I eat that week.

4) At the start of Week 2, I should load my pump with the Apidra.

5) Then I attempt to match the diet I ate the week before…

6) … and get a second Glycomark test at the end of Week 2 to assess whether my postprandials have really dropped, i.e. has the Apidra significantly knocked down my post-meal glucose levels?

7) Finally, the DexCom results will also show the difference.

Whew… I’m going to need to get out of the 3x AYSO soccer/ holiday-bonanza/ traveling/ multiple-presentation/ mile-a-minute FAST LANE in order to schedule a two-week period to “do my diabetes,” if you will. I’m planning on hitting it right after that Disneyland trip I mentioned above. Come on, who eats well there?

Meanwhile, there are even more new super-rapid-acting insulin products on the way. One is called ViaJect from Biodel Inc., a privately-held biopharma firm out of Danbury, CT. They’ve announced promising results from human trials, and claim that their product is potentially safer than today’s insulin analogs because it “more closely mimics the natural spike of first-phase insulin release in non-diabetics, possibly reducing the risk of hyperglycemia.” And it may cause less weight gain as well.

As the OC’s resident market critic Scott Strumello notes, it’s nice to know the Big Boys of the insulin arena will have some off-label competition. As long as the stuff is easy to get hold of. It’s tough making too many pit stops at the pharmacy and various doctors’ offices when you’re living in the FAST LANE, you know.

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16 Responses

  1. Jay
    Jay October 5, 2007 at 10:24 am | | Reply

    WOW…sorry to hear about the intense record keeping. It seems that when my Endo has me keep records of what I eat and what I’m bolusing that I always eat better and get WAY better control.

    Sometimes I’ll track my bg on a spreadsheet (nerd) for the heck of it. I’ll even run some descriptive stats and make a chart or two (super nerd).

  2. Donna
    Donna October 5, 2007 at 4:04 pm | | Reply

    Wow! I hadn’t heard about ViaJect until now. I like the sound of “may cause less weight gain”. I’ll have to read up on it. Thanks for mentioning it.

  3. aaron
    aaron October 5, 2007 at 5:06 pm | | Reply

    I switched from Humalog to Apidra. They aren’t identical, but they were close enough that I didn’t need to make any changes to my numbers. Don’t worry too much about it. My endo just gave me some samples and told me to try it out. It went well so I switched for the mere reason that I was getting free samples for awhile.

    Best of luck… I’ve never heard of the GlycoMarko. I’d like to hear about your experience with that.

  4. MoHo
    MoHo October 5, 2007 at 8:57 pm | | Reply

    I have been using Apidra for almost a year. It has the same time lag as Humalog, don’t expect any miracles because it doesn’t really make a difference.

  5. Amylia
    Amylia October 6, 2007 at 2:11 am | | Reply

    Wow. I’m tired just hearing about your list of to-do’s, but it’s all for the good stuff.

    Enjoy Disneyland. Don’t try to focus too much on the D while you’re there. Be a princess!

    Thanks for the tips on insulin. I had no idea there were all these new ones on the horizion.

  6. Tesney
    Tesney October 6, 2007 at 2:42 am | | Reply

    I saw a great improvement in post-meal BG’s with Apidra. Was on Humalog prior to Apidra and my A1C has gone from 8.3 to 7.2 since the switch.

    Not sure where MoHo’s info came from on the time lag, but my endo says Apidra is faster and I have to agree based on my personal experience.

  7. d2
    d2 October 6, 2007 at 8:01 am | | Reply

    I can relate to your challenges. I have been on Apidra for two plus years. My problem was the after meal time frame and the fact that basals did not cover the two hour after meal effect while using Novolog and a four hour duration. Still needed additional bosuls after meals and more monitoring of BG. Second, I use animas ir 1250. The set-up duration is at 3.00 for Apidra. Result was better after meal numbers.

  8. Elijah Meyer
    Elijah Meyer October 6, 2007 at 7:47 pm | | Reply

    After using Humalog for several years, I switched to Apidra when I started on the OmniPod. I found that while it worked fine for mealtime dosing when my readings were normal, it took forever to bring my sugar down when I had a high reading. At times this led to overlapping corrective doses, and five to six hours after the initial high reading, a menacingly low one. Not fun. This stopped happening immediately after I switched back to Humalog.

  9. Elijah Meyer
    Elijah Meyer October 6, 2007 at 8:10 pm | | Reply

    After using a Humalog pen for several years, I switched to Apidra when I began using the Omnipod. My endocrinologist recommended it, because it was less likely to clog, hence it was more pump-friendly.

    I’m surprised to learn that Apidra is being marketed as a “super-fast-acting” insulin, because in my experience, it was anything but. Typically, whenever I had a reading over 200, I would continue to have readings over 200 for four to six hours. Then, after several more tests (and several overlapping corrective doses), I’d have a dangerously low reading. Not fun.

    I’m back on Humalog now, and I’m a lot happier with it. Ironically, the Apidra DID clog my OmniPod several times, while Humalog never has.

  10. Elijah Meyer
    Elijah Meyer October 6, 2007 at 8:12 pm | | Reply

    Sorry for the double posting. My browser crashed, and I thought that first one had been lost. :)

  11. pumpmavin
    pumpmavin October 8, 2007 at 10:51 am | | Reply

    Sorry to hear about your struggles. One thing to consider, is the pump/pod delivering the insulin I ask for?

    So far, you seemed to either blame yourself (did I need a new carb ratio?) or the insulin (should I switch?) for the issues. While you may need to fine tune your settings, A ‘faster’ insulin is not likely to make a difference. Especially given what appears to be a tiny difference in speed between brands.

    So, you may want to consider the 3rd element of control: the delivery device.

    I have commented before (on your prior entry about SUS issues)on the host of delivery ralated issues that can cause high bg levels. Any of these can start the roller coaster ride of trying to get back into control.

    It could be a bubble in the pod or catheter that causes a gap in your insulin delivery.

    It could be an occlusion in the catheter that is causing delivery (occlusion alarms typically require 3 or more missed units before letting you know)

    It could be some other for of under delivery due to pod/pump failure

    It could be leaks around the catheter.

    Pumps anr pods are great when they work. But require trouble shooting as part of routine use.

    Pods are hard to trouble shoot when delivery is suspect (no way to remove it to test for delivery without scrapping it). If you give a traditional pump a shot, your options for trouble shooting the delivery issues increase (you can see the reservoir and look for bubbles, you can disconect and delivery a bolus to see if it is delivering, you can move to a new site without throwing away the insulin…)

    Traditional pumps have issues as well so do not take this as anti-pod, just anti-blind faith in a machine. Bottom line, do not assume you are getting the insulin you have programmed.

  12. Bernard Farrell
    Bernard Farrell October 8, 2007 at 5:39 pm | | Reply

    Amy

    Have you tried Symlin? I’m finding it really almost completely eliminates my post prandial rises. Not every time is perfect, but when it works it’s great. I’ve standardized on about 14 units of Symlin and some days I’m taking it three times. Based on some stats, my numbers are down from the averages that led to a 7.0 in July. So I’m now thinking I might actually hit 6.8 by the end of this month. And if so, that will be mostly due to more Symlin.

  13. Jules
    Jules October 9, 2007 at 7:32 am | | Reply

    When I have unexpected highs the first thing I suspect is the pump and for me that is the OmniPod. Usually the highs coincide within two areas. The first occurs on the third day of pump usage. I have learned to remove the pump and usually there is a small raised area under the skin right below the injection site. I assume this is insulin not being absorbed and I need a new site which almost always resolves the problem. The second area usually occurs on the 1st day when the alarm goes off. I have taken the pump apart and have almost always found a fairly large bubble in the reservoir. Unless I’m sick, I always assume a pump problem first.

  14. Dan Fahey
    Dan Fahey October 9, 2007 at 8:38 am | | Reply

    Sometimes we just get unexplained highs, and there’s really nothing we did to “cause” them. If so, the problem resolves itself quickly, and I don’t make adjustments.
    However, my experience is that sometimes my body settles into a period where it isn’t absorbing/utilizing the insulin so well, leading to higher BGs. If that persists, I have to increase dosing. Usually this settles back to more normal levels with time, and careful monitoring and adjustments.
    The only thing I can predict is that the absorption issue does resolve: how long it takes I can’t predict.

  15. Lisa
    Lisa October 9, 2007 at 1:29 pm | | Reply

    As a mother of a 9 year old with blood sugar fluctuations, we found that exercising with the ipod nano and nike plus for 2.5 miles every day and uploading into the ipodfitnesscenter.com helps keep blood sugar in check and the online fitness tracking keeps us accountable for the excercise. Maybe you should try it for your self and have your kids join in.

    http://www.ipodfitnesscenter.com

  16. lisa of newbury
    lisa of newbury December 27, 2007 at 3:02 am | | Reply

    i am so glad to have read what I have been experiencing. My reg doc knew i had been fighting with humalog because tooo many bottles of insulin were recieved inefffective, so he changed me to apidra. I read it was suppposed to be fast and I would need less as I have renal failure. I have never seen so many HIghs in my glucose monitor, and I cannot get my numbers down, My pump settings were tooo high from the humalog to apidra ratio so the first two weeks my husband had to revive me a couple of times with glucagon, now the numbers never make sense, I was beginning to wonder if waring it too close to the skin makes it go bad quicker than humalog did. I am so frustrated, I am awaiting a kidney transplant and have donor lined up but they want me in control and blood presssures to drop. With Apidra I am going to ruin my HBA1C for sure… And I don’t have an endo , I could not get one to seee me as it is the end of the year and they are boooked two months out. So the posts were soooooo helpful, in my experience this is the slowest reacting insulin ever, and in my pump it is useless, my basal rates at one unit per hour as for humalog, were too high, and cut them by half for apidra and they do nothing, keep them at one and I go into a major reaction. Is symlin an insulin also?

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