Apidra or Novolog

JediSkipdogg · #1 (**permalink**) 03-26-2007, 08:07 AM

So now that I'm finally out of the two vials my doctor's office gave me (the first free thing they ever have

) I have come to some conclusions.

Apidra takes forever to kick in. I almost felt like I was back on R waiting for the action to even start making a change. However, once it starts, boy, does it ever start. It kicks like a donkey (I assume they kick hard.) It then seems to be out of my system in about 3 hours max, whereas Novolog took about 5.

Now, my question is which do I go with? If I choose Apidra, I almost think I'd always have to give the bolus 15 minutes prior to eating. Then every bolus would have to be an extended bolus. Today is a fine example. Had my normal breakfast, then at 90 minutes I check and I'm running 71 (this is with a 124 pre-meal.) I decide to take a gamble and just figure something out. I test again at 4 hours and I'm back to 100. I've noticed this numerous times before. It appears that since I have a slow digestion the insulin is working faster than my digestion does. And that was with a simple bowl of cereal (no milk.)

Also, the other day while playing golf, I didn't calculate my first meal of the day right and was running 462 about 5 holes into it. I correct and almost exactly 1 hour (63 minutes) later I'm 271. That's a 3.03 mg/dl drop per minute. I know some may come from the exercise (although not much since we rode carts) but that's still a huge drop. Although something I've NEVER seen with Novolog. It takes 2 hours for me to see a result like that.

So...do I stay with Novolog (which by the way is 50% cheaper on copay levels) or do I switch to Apidra? I just feel like comboing everything is going to get old fast (yeah yeah Cyborg...I know you do it all the time, lol)...and without my CGMS yet, it's going to be hard at first.

Lloyd · #2 (**permalink**) 03-26-2007, 08:22 AM

Quote:

Originally Posted by JediSkipdogg

Apidra takes forever to kick in. I almost felt like I was back on R waiting for the action to even start making a change. However, once it starts, boy, does it ever start. It kicks like a donkey (I assume they kick hard.) It then seems to be out of my system in about 3 hours max, whereas Novolog took about 5.

The instructions say to take it 15 minutes prior to 20 minutes after you start eating when pumping.
I usually take it 10 minutes before, but I have taken it as long as 20 or so minutes after and had no problems at all.

I guess this is another "everybody is different" case. It works for me. I don't like the 48 hrs in the pump limit though.

-Lloyd

JediSkipdogg · #3 (**permalink**) 03-26-2007, 08:33 AM

Quote:

Originally Posted by Lloyd

The instructions say to take it 15 minutes prior to 20 minutes after you start eating when pumping.
I usually take it 10 minutes before, but I have taken it as long as 20 or so minutes after and had no problems at all.

I generally take insulin immediately before but sometimes even right after. The difference is wit Novolog I see it start to work within 15 minutes. With Apidra, at 30 minutes I saw a slight change which I could accrue to the meter reading variations and not my BG changing.

Quote:

Originally Posted by Lloyd

I don't like the 48 hrs in the pump limit though.

All three (Humalog, Novolog, and Apidra) say that if you read the papers in their boxes. I was amazed to read that and since it applied to all 3, I just ignored it. Which kinda makes you wonder, why it took Apidra to come out before it was ever caught, and even then, nobody really does it.

I guess the biggest thing I don't want is the twice as much copay. But...if I can gain better control it may be worth it. Well, at least bring my highs down faster. I guess if I hada CGMS now it may be different and maybe I'm just going for to much at once, lol.

Lloyd · #4 (**permalink**) 03-26-2007, 08:48 AM

Quote:

Originally Posted by JediSkipdogg

I generally take insulin immediately before but sometimes even right after. The difference is wit Novolog I see it start to work within 15 minutes. With Apidra, at 30 minutes I saw a slight change which I could accrue to the meter reading variations and not my BG changing.

I guess the biggest thing I don't want is the twice as much copay.

1) Does it really matter how fast it acts as long as you are in good shape after 90 minutes?

IMHO reducing the time you have insulin on board makes control easier, and is more important.

2)Insurance wise, my insulin is grouped with my pills, since I have 13 prescriptions, I hit the out of pocket limit every year, so insulin isn't the problem. I don't want to have to by extra pump cartridges though, I pay for them out of pocket. I am considering using the cartridges twice.

-Lloyd

David · #5 (**permalink**) 03-26-2007, 08:57 AM

I loved the Apidra samples my endo gave me. It always kicked in and cleared out quickly. Goes to show how different we can be. Insurance is the only thing holding me back from switching over.

"takes forever", "comboing everything" the expense and maybe "kicks like a donkey" all sound like disadvantages. What real advantages did Apidra have for you? Its speed when correcting and clearing out, right? Do you have many lows from Novolog's slower clearing? How often do you need to make corrections like that? IMO, unless you're having to make that type of correction frequently, on balance, it looks like you're better off staying with Novolog for now.

Good luck with whichever you decide

David

Funnygrl · #6 (**permalink**) 03-26-2007, 09:17 AM

I would stick with Novolog.

JediSkipdogg · #7 (**permalink**) 03-26-2007, 09:19 AM

Quote:

Originally Posted by David

"takes forever", "comboing everything" the expense and maybe "kicks like a donkey" all sound like disadvantages. What real advantages did Apidra have for you? Its speed when correcting and clearing out, right? Do you have many lows from Novolog's slower clearing? How often do you need to make corrections like that? IMO, unless you're having to make that type of correction frequently, on balance, it looks like you're better off staying with Novolog for now.

I definitely did not have many lows with Novolog. I've had at least 3 times more on Apidra, and it all seems due to it reacting faster than the food. I say that because I'll test, correct, and then when my Novolog would have normally been over I'll be sky high since the correction technically wasn't needed.

The problem I have with Novolog is that I stay high for a long time. I eat food and due to my slow digestion (I call it slow, never really been medically diagnosed as slow) the food lasts for a long time and I'll linger around 200 for 2-3 hours before coming back down. And that's with a regular standard bolus.

jen_slc · #8 (**permalink**) 03-26-2007, 07:19 PM

Quote:

Originally Posted by JediSkipdogg

I definitely did not have many lows with Novolog. I've had at least 3 times more on Apidra, and it all seems due to it reacting faster than the food. I say that because I'll test, correct, and then when my Novolog would have normally been over I'll be sky high since the correction technically wasn't needed.

The problem I have with Novolog is that I stay high for a long time. I eat food and due to my slow digestion (I call it slow, never really been medically diagnosed as slow) the food lasts for a long time and I'll linger around 200 for 2-3 hours before coming back down. And that's with a regular standard bolus.

This is why I love Apidra, my post-meal readings look great, and I could never get them close to my target on Novolog.

Funny how it takes a while to kick in for you, Jedi. We are all different! For me it kicks in within 5 mins and HARD! unless I'm well over 100 before a meal, I shoot up afterwards, otherwise I hypo during dinner, lol!

It seems that you like the fast action of Apidra bringing you down from a high and keeping your post-meal readings down, but that the time it takes to kick in is bothersome. It depends on how much weight each of these pros and cons carries for you. If the post-meal & correction action is something you really like, maybe try the Apidra for a bit longer and take it 15 min before meals (annoying, I know). The lows do get old very quickly, I know how that feels - I definitely have more of them since switching, and I'm still tweaking my doses to get it right, I think I'm average 1/day at least. If you feel more stable on Novolog, maybe stick with that and try to work at those post-meal readings. I know that's hard though.

I am paying more for Apidra because, although it has some drawbacks, like all insulins, the pros outweigh the cons for me. I struggled with the decision, but I figured, hey, if I'm really not happy with Apidra, I can always go back! And you can do that with whatever decision you choose.

Cyborg · #9 (**permalink**) 03-26-2007, 07:58 PM

I only tried the Apidra because I thought it would kick in faster than the Novolog. For me, that did not occur. No one ever told me I had to bolus 15 minutes before I eat. I already do that most of the time with Novolog, so for me it seemed the Novolog worked better and I stuck with it.

JasonJayhawk · #10 (**permalink**) 03-26-2007, 10:27 PM

I've never tested 15 or 30-minutes into eating. I've only used Novolog.

It would be interesting doing a CGMS comparision between the two insulins. I'm sure it's a YMMV, but personally, if you know the profile of Novolog, and Apidra has no incentive yet (such as a mail-in-rebate), stick with what you know and what costs less ... that's my opinion, though!

JediSkipdogg · #11 (**permalink**) 03-27-2007, 05:06 AM

Snide remark coming up....

Quote:

Originally Posted by JasonJayhawk

Apidra has no incentive yet (such as a mail-in-rebate),

Tell me what insulin has EVER had a mail in rebate? I've seen them on meters (heck, they love them on meters), test strips (certain companies, very few though) but NEVER insulin. Stupid drug companies.

Cyborg · #12 (**permalink**) 03-27-2007, 05:17 AM

My endo told me that if I liked the Apidra to let them know because they had some coupons I could have...

JasonJayhawk · #13 (**permalink**) 03-27-2007, 11:46 AM

Quote:

Originally Posted by JediSkipdogg

Snide remark coming up....

Tell me what insulin has EVER had a mail in rebate? I've seen them on meters (heck, they love them on meters), test strips (certain companies, very few though) but NEVER insulin. Stupid drug companies.

In April 2004, I received a free box of Novolog Flexpens from NovoNordisk for filling out an application and bringing it to my pharmacy -- that was a $120 value.

In May 2004, I filled out a $40-mail-in-rebate for Novolog Flexpens. I did the same in July when they offered a $20 mail-in-rebate yet again. And in the same month, I did a mail-in-rebate for $5 for buying a box of Novopens. (This was all when I was uninsured, so it really helped out).

Off and on again, I've seen Novo offering a $20 rebate for 70/30 Flexpen users.

I was just as surprised as you about them!

Someone in the Freebies for You-and-me forum mentions that they had a rebate for Humalog appear on their website--but nobody has been able to find it again.

JediSkipdogg · #14 (**permalink**) 03-27-2007, 12:01 PM

Ok, I should have been more specific....rebates on vials not pens. I think I've seen the pen ones and for some reason they want to give those away at times (at least the pen they do) yet the vials just seem near impossible to get discounted.

JasonJayhawk · #15 (**permalink**) 03-27-2007, 12:22 PM

Quote:

Originally Posted by JediSkipdogg

Ok, I should have been more specific....rebates on vials not pens.

Hee hee, actually, at the time I received the free box of pens, it was good for either one vial (1000units), one box of pen refills, or one box of FlexPens. I chose the route that was the most expensive (because I lacked insurance) -- the vials were at least $40 cheaper.

I have to admit, I haven't seen it offered again since 2004.

One would think that Apidra would have to do some $$$ marketing to get more people interested. That would be in their best interest!