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Switching to Apidra

Discussion in 'Parents of Children with Type 1' started by rgcainmd, Sep 4, 2014.

  1. rgcainmd

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    We will be switching from Humalog to Apidra (do you pronounce it "A-pid-dra" or "A-pee-dra", just wondering?) in about two weeks or so. We already have a brand-new vial of Apidra in the fridge, but I'm a cheap-assed penny pincher and want to use up our small remaining Humalog supply before it ages out, hence the 2-week-ish delay. I decided to give Apidra a try because my daughter's post-prandial BG spikes soar into the mid-200s to low 300s a great deal of the time despite: 1) pre-bolusing (anywhere from 15 minutes to up to 1.75 hours before eating), 2) utilizing varying extended boluses, 3) avoiding pizza and other "non-D-friendly" foods, and 4) innumerable adjustments/combinations of adjustments made to her basal rates, DIA, ISF, I:Cs, targets/ranges. I have seen no pattern or temporal relationship between these sticky spikes (which are often resistant to even the angriest of repeated rage-boluses) and particular foods/ingredients, time of day, day of the week, amount of exercise, stress, weather, season, moon phase, fashion choice, etc.

    I'd be grateful for any advice/helpful hints from parents who have switched from Humalog (or any other fast-acting insulins) to Apidra. I know that Apidra and t:slim pumps do not play well together, but my daughter is a very happy OmniPod user so I've been able to cross this particular factor off the list. I'm pretty sure that I'll need to adjust the DIA on my daughter's pump for starters. What other (if any) pump settings did you end up needing to adjust after switching to Apidra, and in which direction? Do you prefer Apidra to the other fast-acting insulin(s) you had used previously? Why or why not? Did Apidra not work as well for your child, leading you to switch back to your "old" insulin or to try yet another fast-acting insulin? If so, why (and what did you try next)? I will go ahead and re-read old threads/posts on Apidra, but I'd still like to hear about more recent experiences and from those of you who may not have already posted about Apidra. I realize that YDMV and all, and what worked or did not work for you may not end up being what will work for us, but any information from parents who have traveled this road will be greatly appreciated.
     
  2. MomofSweetOne

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    No Apidra experience, but just wondering if you've been adjusting her I:C ratio along with the basal rate? We had to lower the I:C ratio quite a bit at the beginning of puberty but then it stayed the same. Also, what is the fat/protein content on the food she is eating? 4 years in and we spent the summer fighting horrific spikes from them. Many thanks to Joa for his posts on the topic because his method is taming the beast for us.
     
  3. Zivile

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    We didn't try Apidra, but for us switching from Humalog to Novorapid made big difference - after a week with same settings I was already chasing lows instead of highs. I am also curious about Apidra and I'm waiting for your posts about it - for myself at this moment from all readings I made conclusion that Apidra is quite tricky insulin. If you don't like it, I would recommend to try Novorapid (I guess it is called Novolog in your country) - less spikes for us, less bad sights (I noticed that for us Humalog crystallized in cannula), in my eyes - better potency. Good luck!
     
  4. missmakaliasmomma

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    Well, we use both Novolog and Apidra actually. I pronounce it "a pee dra". Every site change we change it up. I have a supply of both so you bet I'm gonna use them. My daughter uses a ping so I'm not sure how it is in OP but it's not all that different when it comes to insulin dosages. I don't change anything actually. Not DIA not basal, nothing.

    When we were doing MDI with Apidra, that was a little different. Because sometimes apidra drops the blood sugar fast, my daughter would look/ seem low when she wasn't, she just had a big drop in BG
     
  5. Michelle'sMom

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    Not exactly recent experience but my dd used Apidra for almost 3 yrs, until our insurance refused to cover it. Just my observation, but results/actions of Apidra seem to vary from user to user more than either Novolog or Humalog.

    We had to change everything across the board. Her DIA went from 4 hrs on Novolog to 2 hrs on Apidra. I:C didn't change as much as basal, but both increased.

    What we loved most was the fast in & out, after we learned how to work with it. We had to combo most meal boluses because the shorter DIA sometimes meant the bolus was done before digestion. We also had to shorten our prebolus time from 20-25 mins to 10-15. Her numbers were much smoother overall (we were fortunate to have a CGMS to see the differences). Her only complaint was the way she felt with fast drops, which I celebrated because she was having trouble feeling any lows/drops prior to the switch.

    She switched back to Novolog just over a yr ago.
     
  6. rgcainmd

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    Yep, in addition to increasing her basal rates, I've had to lower my daughter's I:C ratio a few times after her insulin needs increased dramatically. It felt like I was adjusting her basal rates a bazillion times a day during those first few days after her TDD doubled overnight (I'm not exaggerating how quickly this occurred). At first I felt certain that her site went bad, and I changed Pods. No difference, so I tried yet another Pod because I thought that maybe the cannula kinked on the second Pod. I continued to find it impossible to correct highs without using considerably more insulin than I had been using just the day before. But after throwing what at the time felt like a crapton of insulin at repeated highs that day, her BGs did come down. I finally realized that a bad Pod, a bad sites, or an impending virus did not explain why she was suddenly needing so much more insulin. This was the end of her honeymoon; at least 25 units of insulin per day was the way things were going to be from here on out. Quite frankly, I felt a sense of relief. On several occasions my daughter had talked about how she was dreading the end of her honeymoon. I asked her why she felt this way, but she couldn't come up with an answer. I suspect her dread had something to do with being afraid that needing more insulin somehow meant that her T1D was "getting worse." In a way, she was right. The majority of her remaining functional beta cells must have finally thrown in the towel over that 24-hour time period. But from a practical standpoint, all this means is that she now needs more insulin. She is still the same person she was the day before and she can still do all the things that she enjoys doing. When she realized this, all was well once again. As for me, I'm just happy that her anticipatory anxiety has come to an end.

    I never gave the whole fat/protein content idea a second thought when I first heard about it. I'll have to look into this and see if making some adjustments in light of this method would be helpful. Can you point me in the right direction to find Joa's posts on this topic? Thank you in advance.
     
  7. KHS22

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    My daughter switched from humalog to apridra a few weeks ago, and my husband followed her (in the Omnipod).

    We found almsot everything went down - basals, carb ratios, correction factors. In fact, her TDD decreased by over 25%. We had TONS of lows the firsts week or so. I know this isn't everyone's experience, but just know its a possibility.

    We have settled on a DIA of 2.5 hours - seems to be just about perfect for us. Definitely almost done working at 2 hours.

    LOVE it. Brings down highs so much quicker than Humalog for us (Like tonight - she was unexpectedly and inexplicibly 15.5. 1.5 hours later she is 5.2) On humalog we would have to correct highs multiple times, then she would crash.

    Good luck, hope you love it too!

    ETA: Her average sugar (based on CGM upload) went from 9.4 to 7.6 after the switch too!! Which i suppose is mostly because of less time in the highs! But can't beat that!

    My husband had the same reaaction, had to lower everything, mainly basal rates. His was less dramatic, about 10% TDD decrease. Also had lots of lows the first week...
     
  8. rgcainmd

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    I'm hoping that we have a similar experience and that Apidra shortens my daughter's prebolus time. It feels like I practically have to wake her up in the middle of the night to prebolus for breakfast, that's how long it's been taking lately (on the dwindling occasions when prebolusing actually makes a difference). Like most kids, when she's ready to eat she wants to eat now, not an hour or more later.

    I'm a bit anxious about trying Apidra because it sounds like this will be a fairly tricky endeavor.
     
  9. missmakaliasmomma

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    I was weary about apidra for awhile and it took me awhile to try it even though I had it too. It really wasn't tricky though. Every aspect of D took me awhile to warm up to if I was changing things. I can't even tell you how long it took me to decide on the pump, then we didn't even use it for almost a yr lol. Dexcom was another story. It's the only thing I've been soooo ready for and as soon as we got it in the mail, it went right in.
     
  10. Michelle'sMom

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    I'm grateful we had the Dex before the switch but as I said, response to Apidra seems to vary a lot more than other fast actings. It actually took 2 attempts at the switch. The first time, we started on a Friday. By Sun night I was waving a white flag. She was stuck high & nothing we did helped. We even tried corrections via syringe. I gave up & the first correction with Novolog broke the high. We waited a couple if weeks for spring break & gave it another try. I spent a lot of time reading others' experiences & asking a ton of questions. We made the switch again & saw the same stubborn highs, but I was better prepared & much more aggressive. By day 2 we had the basals close. By the time school started back, she had a nice smooth trend line. No more spikes to 300+ after breakfast. Those spikes were the reason our NP suggested Apidra in the first place.

    For us, Apidra was much less forgiving. With Novolog, I can run basals a bit higher to compensate for ratios that aren't quite right. With Apidra, if basal was too high it sent BGs into a mess. A lot of users have no issues. Hopefully you'll be among them.
     
  11. rgcainmd

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    I so appreciate everyone's input and advice. I feel much more confident about making changes after coming to this Forum; you all have become my safety net and I am truly grateful for this.

    School just started two days ago, so all of a sudden basals are too high across the board. Overnights have been going well; thank G_d for this piece of consistency. DD had a few minor lows and one major low yesterday (she got a little shaky and it took more carbs than usual to raise her BG). She surprised me by going into her pump's settings and reducing all of her basal rates by .05. I didn't even realize that she knew how to do this!

    I think I'll start Apidra a week from tomorrow, early that Saturday morning so I have the weekend to straighten out the major problems. Hopefully this will be enough time to make sure she isn't going dangerously low repeatedly. I'm planning to decrease the DIA and lower all her basals to start with. And I'll be ready to use a lot more extended boluses to deal with the rapid onset of action and shorter duration of action if necessary. I'll probably prebolus by only 10 minutes to start with. I need to be mindful of not changing too many things too quickly by increments that may be too large. My usual approach to almost everything in life is to identify the problem, quickly devise a solution with a backup plan, and then immediately go full force to fix the problem right now. T1D is teaching me to change my approach to a more measured, thoughtful, and patient one. I guess this is a good thing, but it is a big challenge for me.

    I will keep you posted with a boringly detailed play-by-play that hopefully will be of use to someone at some point in time.
     
  12. Megnyc

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    I found that apidra had a strange tail for me. So I would have a fast drop around 30 minutes after a dose, then a slow drop for about 2 hours and then another fast drop just when I would assume the insulin was done. I think it actually had a longer/less consistent DIA for me than humalog. I actually really liked it (I would manipulate basal rates and use uncovered carbs to deal with the tail) but I can't use it anymore due to my insurance which only covers humalog. I still keep some around for the times I want to bring a 500 mg/dl down really quickly. I have heard of other people having that weird tail (but I think it is pretty unusual) to but since you have a dex you should be able to catch any issues quickly.

    ETA: I also found it to be a bit more sensitive to heat than humalog. If you travel anywhere really hot you might want to consider keeping the vial in the fridge or at least a room with air conditioning. It might turn cloudy if it gets too hot.
     
  13. missmakaliasmomma

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    I think there's more varying opinions on apidra because isn't it the only one of its particular kind? Like humalog and novolog are very similar but apidra is different in its composition
     

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