After trying for the last hour to download Diasend in order to upload Adam's Omnipod to figure out his mess of BGs, I've decided I give up and will ask for advice here! Adam has been on Apidra for the past 4 years, and UHC just decided that they don't feel like paying for it anymore, so we were forced to switch to Humalog (yes, I appealed and lost). Endo assures me Humalog is just the same, in the past week since we have switched, Adam has had a ton of lows. Like in the 30s. Of course, it could be lots of things, (growth, maybe he's getting sick??) but my question to you all is - what would you tweak first - basals or IC? I suppose I could email his endo, but again, he seems to think that Humalog is exactly the same. Thanks in advance!
I don't know, but I was going to ask about the difference in Apidra. Is it faster than Humalog? The graphs I have seen show Lispro and Humalog to be virtually identical ON AVERAGE. One thing I was thinking was that since the liver may break down unused insulin over several hours, the liver might not be as good at breaking down Apidra if it has been seeing Humalog or vice versa. And who knows. People probably just absorb and break down different chemicals differently. Are his lows within 4 hours of a meal or are they more than 4 hours later? That's all I've got. If I saw lows arriving 4 hours out I assumed it was probably basal.
I can only tell you our experience. I flat out don't like Humalog for my dd. She was almost constantly low while on it, & yes it was during a switch from Apidra. Humalog was slower to work & had a much longer tail. We started by lowering basals across the board. When she still went low after the next meal, we hit the I:C. Dd's endo also believes that all fast acting analogs are interchangeable. Not for my dd.
Thanks for sharing your experience. I love our endo....but they just don't live with T1D every day, so sometimes they don't "get" it!
That's exactly right! I think we always have to keep in mind that while they may have years of experience in treating T1, & years of education, when it comes down to it they know what they've been taught. It's easy to forget the individuality, especially when all those studies & texts disagree with what they hear/see from those in the trenches.
we had a wild ride from Novolog to Apidra when it was approved for ped use. We did start using Humolog. And from my talks over the last 10 years most people say that Humolog has the longest peak and strongest tail of the 3. I would reduce basal first and then try to see the trees thru the forest. If you reduce basal enough you can start to see where bolus insulin stops being useful. what is your current DIA/IOB setting in your pump? did you change it for Humolog?
Apidra is considerably faster than Humalog or Novolog, both of which have longer "tails" of residual activity. When switching insulins you're best always to start by making sure baseless are ok (use overnight numbers to guide you there), and then start working on carb ratios and correction factors. Good luck!
