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28 Responses

  1. Type1
    Type1 February 11, 2013 at 4:45 am | | Reply

    Most insulins today have a phosphate buffer to prevent occlusion.

    Apidra does not, while Novolog and Humalog do.

    Way back in the day, when pumping was not so mainstream, pumpers would have to use a special formulation of regular, called “buffered regular”, which was a phosphate-buffered insulin, to prevent occlusions.

    The problem associated with occlusions is that the insulin actually crystallizes. Insulin buffered with phosphate prevents this from happening.

    1. Cesar
      Cesar November 26, 2013 at 11:37 am | | Reply

      For what its worth… I currently use a Medtronic MiniMed pump and have been using Apidra for over a year and have not had one occlusion incident so far. I change my infusion set every three days pretty consistently but have even gone to four days on rare instances.

  2. Lloyd M
    Lloyd M February 11, 2013 at 7:15 am | | Reply

    I think it takes a set of circumstances for there to be a problem using Apidra in a pump. I’ve used Apidra in my cozmo for about 3 years, I get one occlusion per year, if that.
    I am type 2, I have a higher basal rate than most type 1′s would have. That may make a difference.
    I live in a cold climate, that may or may not make a difference.
    I don’t use a t-slim. That may or may not make a difference.

    I think that like most things diabetics deal with, trial and error is involved.
    Apidra works much faster than Humalog and Novolog for most diabetics, if you digest food quickly this can be a big advantage.

    It’s worth a try

    -Lloyd

  3. Dan
    Dan February 11, 2013 at 7:47 am | | Reply

    I found this to be an interesting read. My best success has been with a two day rotation. The site has no blood leaks when the inset is removed and there is minimal visual damage at the prior inset site and no issue with occulsions. My issues have come from bends with the internal inset location. The rise in glucose after a new change is a clear signal that there is a bend. Another factor is related to the ability of the inset tobe in a “locked” position”. Meaning there is no play at the inset site due to an up and down motion based upon body movement. Being re-stuck at the inset site can hurt. As always have a great day.
    Dab

  4. Scott S
    Scott S February 11, 2013 at 8:34 am | | Reply

    I have used Apidra with the Animas One Touch ping for a couple of years with no occlusions. I change the site every 3 days.

  5. Shana F
    Shana F February 11, 2013 at 8:52 am | | Reply

    We have tried all 3 insulins in my daughters Animas Ping pump. We prefer Apidra. It’s faster acting and it seems to work so much better for her. We change her site about every 3 to 4 days. She had what seemed to be endless highs with Novalog and Humalog stings terribly bad every time we bolus. We’ve yet to have an occlusion (knock on wood)!!

    I would encourage people to try all the insulin options to see what works best for them.

  6. Sarah
    Sarah February 11, 2013 at 9:17 am | | Reply

    I’ve actually been using Apidra in my t:slim for over a month without issues and I change out sites every 3days :)

  7. DCScribe
    DCScribe February 11, 2013 at 9:42 am | | Reply

    I have been pumping for 15 years using MM and Silhouettes and either Novolog or Humalog the entire time. I can’t comment on Apidra since I’ve never used it.
    I can comment on site rotation.
    I have never abided by the 3-day rule. I use each site for 7 days on average. I have never had a problem and my a1c’s have never been above 6.5 (often lower.)
    And while there have been “studies” suggesting dire consequences for exceeding three days, it’s also true that most, if not all, of those analyses are suspect. The one cited in the story above, for example, was underwritten by Unomedical. That company sells Silhouettes and other infusion site so there’s a blazing conflict of interest to factor into any conclusion. The shorter the duration, the greater the sales.
    And sure, the work may be valid. But I covered the tobacco wars years ago when supposedly independent researchers insisted nicotine was not a drug. Some even asserted it wasn’t addictive.
    That’s a big of a false parallel, of course. But the caution is not. Read these studies with skepticism.
    Make your own decision based on your own results and history. It’s possible that screwy numbers are the result of something else – bad decisions on food, for example, and not site rotation. Yet rotation is an “easy” and satisfying fix.

    1. Ray Sands
      Ray Sands October 7, 2013 at 6:00 pm | | Reply

      I do pretty much the same routine as you. My Aic are a little higher but that is not my comment.

      When using Apidra, if I use what was my customary method before switching to Apidra, I take 20~ units over 60 minutes.

      This method results in NO insulin action.

      If I take 20~ units as a normal bolus (about 3 minutes?) Apidra works fine.

      Any other pumpers have this situation with the extended bolus?

  8. Lorraine
    Lorraine February 11, 2013 at 10:17 am | | Reply

    Caleb’s been using Apidra in his Pods since 2010 and since using it has changed his Pod every other day. Been meaning to post about this experience ever since. Maybe this will be the inspiration to do so…

  9. Kevin
    Kevin February 11, 2013 at 1:13 pm | | Reply

    I have had nothing but occlusions with Apidra in my Cozmo. I finally had to switch back to Novolog because I would get occlusions on day one of Apidra during the summer with everything swapped out (insulin cartridge, tubing, infusion site.) Only the rare occlusions with Novolog and those all seem to be infusion site related on the rare occasion they happen.

  10. Bernard Farrell
    Bernard Farrell February 11, 2013 at 10:42 pm | | Reply

    Thanks for a great article Allison.

    I switched from Humalog to Apidra several years ago because I’d heard that it worked better for some folks. I noticed no difference in speed or duration from Humalog. At that stage I was using a Deltec Cozmo and changed sites every 3 days. If I forgot and went to 4 days I did see worse control on that last day.

    Once i started on the t:slim I saw occlusions many times. Sometimes 3 in one week. Tandem changed the pump in case that was the cause. But I didn’t hear about the 48-hour approval for Apidra until I spoke with someone senior at Tandem. It was in the package insert for Apidra, but who reads those? Until my first shipment of Humalog arrived I went to 2-day site changes and the occlusions disappeared.

    I have since switched back to Humalog and my occlusion problems completely disappeared. I didn’t change my settings from Apidra, YDMV. Note that I set my insulin duration to 5.75 hours. For me it may in fact be slightly longer.

    I do wish Tandem support had brought the 48 hour Apidra ‘limitation’ to my attention earlier, but that was in the earlier days of t:slim support. I imagine this is the first question they ask folks who see occlusion alarms these days.

  11. Michael Robinton
    Michael Robinton February 13, 2013 at 2:54 pm | | Reply

    In the 1990′s before either Novolog or Apidra were approved “at all”, it was fairly easy to collect data on (let’s call it) infusion site failure, rather than occlusion. At the time, the only insulin-anaolg available was Humalog. First lets define the symptoms. Rise of bg’s after 24-48 hours. Bolus of more insulin does not help. Moving the site does help. For infusion sets such at the “tender” or “silhouette” where the infusion cannula can be seen, occasional redness around the cannula. Insulin Pumpers self reported data on this for several years and came to the conclusion that between 5%-6% of pump users had a sensitivity to Humalog but not regular human insulin. With the advent of Novolog, collecting this data became more difficult because pump users would switch brands and the problem would disappear. Since that time there has been enough anecdotal reporting to strongly indicate (in my opinion) that the sensitivity to insulin-analog is general in nature and is probably 5-6% of pumpers for ALL insulin-analogs, however any individual person is usually only sensitive to one of these molecules. This is somewhat to be expected since the three fast-acting insulin-analogs (Humalog, Novlog, Apidra) all have slightly different molecular structures.

    So, with respect to the findings reported in the article, I assert that they are meaningless because the sample size is way to small. A study with a dozen individuals would be badly skewed by having a single individual member with a sensitivity to the particular insulin-analog product. I am not saying that this problem does not exist, quite the opposite. For years I have said that this phenomena does exist. The problem is that no study with a large enough sample size has been conducted to properly characterize what is going on. To do so would require a study with at least 500 participants for EACH insulin-analog product PLUS a control group of the same size. That would provide a statistical meaningful outcome.

    Michael Robinton
    Executive Director
    Insulin Pumpers.
    Visit us at: http://www.insulin-pumpers.org/

  12. Mara
    Mara February 15, 2013 at 11:28 pm | | Reply

    Thanks for the post. I think it is important to get this info out there. Though, I switched my daughter to Apidra last week and I couldn’t be happier. We are starting to pump next week and I was fully aware of the fact we would have to do change sites every 48 hours (thanks to the DOC). It is still worth it. Apridra works so much faster and keeps my daughter’s blood sugar so much steadier. Great results in 1 week. She was on Humalog which was taking up to 5.5 hours to finish working. I am still so happy we found apidra.

  13. Stella
    Stella February 18, 2013 at 7:05 am | | Reply

    I have been using Apidra in my MM Paradigm for over a year now. I switched to Apidra because my endo said it should help with the scar tissue buildup. I have had no problem with occlusion, but I never keep mine in for longer than 3-4 days.

  14. Allison
    Allison February 19, 2013 at 5:41 am | | Reply

    Like Stella, I’ve been using Apidra in my MM Paradigm for a few years and have NEVER had a problem. No occlusion, ever. In fact in my 15 years of pumping I don’t think I’ve ever had a problem with occlusion. I also change my site about every 3-4 days. I think that, as Mr. Robinton said, the sample size is too small. However there are quite a few people here who are corroborating the results, so maybe we are wrong!

  15. Julia
    Julia February 20, 2013 at 9:47 am | | Reply

    Yes, we have noticed some very high blood sugars since using Apidra the past few years…. that is offset by the speed in which corrections take place. We can get a high blood sugar down much quicker with Apidra. Apidra often lasts three days in her pump and often will fail at 2.5 days. We deal with it. Because the duration of Novolog is close to five hours and the duration of Apidra is 3.5 hours… for her. Most people have a four hour duration with Novolog and Humalog. If you should have a site failire, you will go much higher much faster but we knew that going in. We love Apidra. Use MM Revel pump though. If we had a 4 hour duration with Novolog there we would still have tried Apidra. The faster the insulin the sooner it is out of your system, the better, for bolus purposes for sure.

  16. Jane
    Jane February 27, 2013 at 1:18 am | | Reply

    Going to have my pump fitted today … Eek all a bit scary !

  17. Jen
    Jen April 20, 2013 at 1:09 am | | Reply

    Sarah, which brand/style tubing/infusion sets do you use? I’m a frustrated t:slim user trying to get Apidra to work because its the only fast acting insulin my body responds to. I get occlusions in 30-33 hrs like clockwork. I use cleos. Also wondering: Is shorter tubing supposed to decrease likelihood of occlusion (anyone)? Thank you!

  18. hannah
    hannah May 2, 2013 at 6:29 am | | Reply

    i’ve used apidra for past few months and actually find i’ve had less highs and no occlusions compared to novorapid

  19. Julia
    Julia May 2, 2013 at 11:58 am | | Reply

    When I went to an Onmipod pump from Medtronic, my diabetic educator told me that Apidra had fewer occlusion issues due to no zinc, so I tried it. I had distasterous results! Not disasterous due to occlusions, but because Apidra is extremely temperature sensitive and would quit working after day 2. I have since spoken to numerous diabetic educators about the subject. All of them reported bad issues with Apidra due to temperature sensitivity and said that was the reason for the 2 days FDA approval. I wne back to Humalog and have not had any issues since.

  20. Jen
    Jen May 3, 2013 at 11:46 pm | | Reply

    Been using the paradigm on Apidra in 90 degree weather this week with no issues. At least with the paradigm, Apidra is not a problem. Been getting 4 days out of it and great control. It’s too bad the t:slim can’t produce the same result (at least, for me).

  21. seth
    seth May 20, 2013 at 4:12 pm | | Reply

    I have a Medtronic. My endo switched me from Humalog to Apidra a few years ago citing occlusions as the reason even though I’d never had one. On Apidra I get an occlusion at least once a month, often more frequently. Guess I’ll ask my new endo about switching back to Humalog.

  22. Krista
    Krista May 21, 2013 at 9:37 am | | Reply

    I have a Medtronic Revel pump and I have used Apidra since it first came on the market. I have never had an occlusion, but I am OCD about changing my infusion set every 3 days.

  23. Jen Jen
    Jen Jen July 5, 2013 at 8:08 pm | | Reply

    I tried Apidra by chance, almost seven years ago. Doc had samples, gave me seven bottles, did better than Humalog and Novolog. I live in FL, so temperature is an issue. But I’ve never had an issue with it and Apidra. Apidra is actually the best analog for me. It’s been a fight trying to get it back, too(suffering with Novolog right now). I’ve used Apidra in an Animas 1250 and a 2020, no problems. Now I have a MM Revel, it’s done fine in it, too. I hate the MM though, I feel like the pump is unreliable. No alarms when I should have due to kinks and such, and they will not do a switch out for me(under warranty until Jan 2016). I want to try a t:slim, even with the Apidra issues.

  24. Jen
    Jen July 5, 2013 at 9:56 pm | | Reply

    I ended up returning my t:slim and am now pumpless. Don’t want Medtronic insurance issues jeopardizing my dexcom sensor refills. Although I’m doing worse without the pump. Sometimes battling insurance and all the less than ideal decision making is just too much for me. Will look into animas perhaps when I have the energy again for this issue! Very much appreciate this site and all of you!

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    markhenry350.soup.io November 16, 2013 at 5:48 pm | | Reply

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  26. claudia
    claudia August 20, 2014 at 3:44 pm | | Reply

    I have been on Medtronics pump and Apidra for 4 years without any occlusion, some spikes when starting a new quick set (change my set every 3 days and reservoir every 4 days average) I have switched to sure T set everything is going very well . I would love to try the slim pump but will wait to have more feedback on the use with Apidra. I will choose the pump based on how will work with Apidra :)

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