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Starting Pump in November - Apidra now or later?

Discussion in 'Parents of Children with Type 1' started by ashtensmom, Sep 13, 2011.

  1. ashtensmom

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    DD is going to start pumping beginning of November. We have spoke to our CDE about Apidra and she told us it is available if we choose to use it. However I wonder if starting Apidra "AND" the pump together is the best scenario, as far as having too BIG an adjustment/change. Should we stick with Humalog (which is what she uses now) and get comfortable with pumping first and then think about switching to Apidra when all issues with the pump is sorted out?
     
  2. Jordansmom

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    If we were doing it again, we'd start Apidra during pump start. Pump start and and adjusting to Apidra can both be starting from scratch with basal rates and ratios. Usually your endo requires a huge amount of testing and logging to figure out pump settings. Often they ask you to limit snacking and choose easy meals to figure out for a week or two when you start the pump. All of those things are very beneficial to figuring out how Apidra is going to work for your child as well.

    We had our pump start upheaval. Then just as we figured everything out (about a month later) started Apidra and started from scratch. It was a long drawn out stressful time with lots of extra tests.

    However, some people don't see a huge change with Apidra and find the transition easier than we did.
     
  3. hawkeyegirl

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    I agree with Jordansmom. Pump start usually involves across the board dosage changes anyway, so I'd think it would be a good time to start Apidra, which also seems to require a lot of changes for many people.
     
  4. ashtensmom

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    Are there any side effects with apidra? I have heard that it doesn't do well with heat. Is there any other down side to apidra. And is it really better than humalog?
     
  5. Mom2Kathy

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    Yes - the vial should be tossed when it's been outside the fridge for 25 days. I won't use it in the pump if it's been out for 23 days or more.

    I try my best to keep the vial at room temperature as well. I think it is more sensitive to heat than other insulins. I've not had a problem keeping it "cool." For us, the pros of Apidra outweigh the cons.
     
  6. momofone

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    What would the pros be of Apidra? Sorry, we're still on outdated Rapid and NPH but hoping to start pumping in December during winter break.
     
  7. ashtensmom

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    Well I can only comment from what I read and not from experience, but the reasons we are considering apidra is because it has no preservatives, decreases post meal spikes (thereby providing a more stable bg rather than up and down all the time), and out of your system by 2 hours so you can correct a high bg without worrying about stacking insulin and causing a low. Expert users please chime in if there are other benefits, or if I am incorrect in above benefits.

    I wonder about what to do with high fat foods like pizza, etc. Since it is out of your system by 2 hours will you go very high at 3 or 4 hours after eating pizza? Do you accommodate this by an extended bolus/and can you extend a bolus to give the second half at 3 or 4 hours? Sorry I am not pump-wise yet.

    Also, what happens when you disconnect to shower (1 hour). Do you approach disconnecting differently when on apidra then you would with humalog/NR?
     
  8. JackyH

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    Everyone does this slightly differently. Something that works perfectly for one kid doesn't work at all for another. The way we deal with pizza and hamburgers hasn't really changed between Humalog and Apidra (or NPH/H for that matter) - we just bolus for about 70% of the carbs at supper and then bolus the full carbs again about 4 hours later. About 90% of the time it works perfectly but I don't recommend it as I never get much sleep on those nights - unfortunately for us it's the only way to stop the delayed spike in it's tracks. Trial and error and making lots of notes is the only way to go. I would note in my log book what I did, what actually happened and what I should try the next time. ?It took a while before we stumbled on the right combination (which ended up being the way we dealt with it on shots - go figure)!

    Disconnecting for a shower has no effect really unless she's in the shower forever - we are usually only disconnected for 10 minutes or so (unless he forgets to reconnect of course:eek:)
     
  9. ashtensmom

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    Hmmm, 8 years old and a girl to boot... it takes almost forever:rolleyes: I would say it takes a good 1/2 hour from start to finish and time to lotion up. Are you still okay to disconnect up to 1 hour while on apidra?

    So from your reply I guess the extended bolus doesn't let you do the combo bolus that far after the first, huh. Do you know how many hours you can stretch a combo bolus?
     
  10. JackyH

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    I'm lucky if he even breaks out the shampoo in the shower!! Our basal is so low at the moment it doesn't really matter if we were disconnected for 3 hours but if we were in our 2u per hour basal phase I would just bolus the missed basal after he reconnects.

    You can combo bolus but you give up front immediately and the rest is spread out over the number of hours you set. I've tried every combo with Oscar but have never found the magic combination or I've had to cancel the combo for whatever reason i.e. Site change, bath night, or he wants to eat again. I've just always found it too restrictive. You cannot tell it to give 2u now and 2u in four hours. It would be a nice feature but I can see why they wouldn't want to do this too - it's not exactly safe and you need brass balls (or a CGM) to bolus again when BG is in range and, in theory, there is no food on board. I don't know about the Ping combo but the VEO dual or square waves can be spread over a max of 8 hours. The dual is so much up front and the rest over the next few hours - the square is the set amount over whatever number of hours.
     
  11. ashtensmom

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    That's a lot of helpful info Jacky, thanks. It sounds like whatever combo, dual, square one decides to experiment with it's a heck of a better route than NPH! I am naturally nervous about pump start and adjustment but excited for Ashley too. We won't have to plan our day around meal times anymore. I am hoping by starting at age 8, she will be used to it and it won't be a body image issue when she hits her teen years.
     

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