Considering Apidra

[Subby]

I'm considering requesting a trial of Apidra. I never heard of this insulin until a few comments made around here. Here is why I think it may be useful for me, does it seem reasonable to take to my doctor?

- I've used novorapid for many years, and since starting the pump. It has always taken long times - commonly 2 hours, and up to 4 hours to kick in for me. This lag time has improved on the pump but I still get caught in a huge upward spin if it decides for whatever factor, to hold off on action for an hour or so.

- I suffer from "tail end" hypos very often. The 5 - 7 hour mark I almost invariably get a drop from the novorapid, even if it did not adequately cover the carbs for the first 4 hours.

Notes, I have determined this is generally NOT from my basal rate. It is also a general constant from a great variety of infusion sites as well, variety of GI levels of carbs, variety of carb amounts and doses! The curve just does not seem to fit my carb response and energy release. I know there are many factors, I am pursuing them all, I am thinking faster action such as Apidra may help, though.

What do you think? I may need to put up a good argument for the doctor to allow this trial. It sounds like it should be compatible with th pump, yes? Anyone know if it is available in Australia? I'd love some feedback from users of Apidra.

[Gary_W]

Hi Subby,

Whilst I'm having response time issues with it at the moment, I don't think it's the Apidra at fault. For that reason, I'll tell you how it worked when I first went on it.

It typically started to kick in within 10 mins. 70% gone after 2 hours, all gone after 4. If you are eating a large carb meal which is pretty much all low GI, you might need an orange juice chaser to stop the Apidra getting ahead of the insulin. Also, I would imagine you'll be using the dual wave feature as the pizza etc of this world is not doable with Apirdra without a double shot IMO (even more so than Novo due to Novo having a bit more of a tail).

It really helped with my post-meal spikes and also meant less hypos at the 4 hour mark. In me, those last two hours of the response seem to be a little weird as it apprears to back off a little between hours 2-3 then have a last good fight just before 4. But that could just be that all the food has gone rather than the insulin ramping up.

No idea whether or not you can get it in Aus, but I'm sure some of the pumpers on here use it. There have also been a couple of posts on here from people who tried it and it worked slower than Novorapid, which just proves the point of us all being different...

Gary

[mike-munich]

I'm one of the guys that are pumping Apidra. I used it with my MDI's before, but it's also perfect (for me) in the pump.

It kicks in really fast, and as mentioned above, is almost gone after 4 hours.

As for the availability in Australia: I'd check with Sanofi-Aventis, the mfgr., and see if you can get it there.

Here is the US website for Apridra, maybe you'll find something useful on there: Apidra® Fast, Flexible Mealtime Insulin for Blood Sugar Control (http://www.apidra.com/)

Good luck ! Cheers,

Mike

[ant hill]

I've used novorapid for many years, and since starting the pump. It has always taken long times - commonly 2 hours, and up to 4 hours to kick in for me. This lag time has improved on the pump but I still get caught in a huge upward spin if it decides for whatever factor, to hold off on action for an hour or so.
Yeah this Novoslow as many of us know it can last a long time like 5 hours or so and then again to what you are doing too like mowing the lawn or something physical and it's lunchtime so you count the carbs and see 5.5 / 99 so within 20 minuets it will swing in to action!! and that's no joke! but if you be at the computer and then time for lunch then you would be waiting forever for a onset of the insulin to work.
Gee if we have had a insulin to work as fast as the food to react then we would have better results would we. ;)

What do you think? I may need to put up a good argument for the doctor to allow this trial. It sounds like it should be compatible with th pump, yes? Anyone know if it is available in Australia? I'd love some feedback from users of Apidra.
I think that you would have no problems on getting the insulin but the manufacturer say it's fast well I think that would be of some argument to say just on how fast it really is. Still have a go at this and post of your results. :)

[JJM335]

Just to echo what Gary said:

I switched to Apidra from Novorapid (for use in MDI with Lantus). I found that the Apidra cuts in much quicker than Novorapid (which as far as I was concerned should be called NovoSlow!). This really helps with post-meal spikes in particular where the meals are relatively smalland get into the system quickly e.g. a sandwich at lunch. Dinner is my main and biggest meal and can therefore digest a bit slower. I routinely split my Apidra with about 2/3 upfront and the rest after about 45 mins. This stops the early dip and then rise. For mega-meals e.g. full-on Chinese, I sometimes do a 3rd shot of a couple of units at the end of the meal.

A second major advantage of Apidra is that it seems to be all gone by about 3.5 h. I used to get hit by the Novorapid tail all the time - although I still have problems with hypos due to the Lantus, I rarely if ever have an Apidra hypo and if so it's usually an overt miscalculation.

Joel

[Subby]

Thanks for all the very useful comments! It does sound interesting the mixed results with speed factor, I suppose there is only one way to find out how it likes my body. If I get speed increase like you JJM335 it could be very useful. If something else happens, oh well.

It appears it is in australia, so now I will get onto my endo. Expect a report in a few weeks, hopefully.

[ant hill]

It appears it is in australia, so now I will get onto my endo. Expect a report in a few weeks, hopefully.

Good on ya Subby. Let us know of your findings. :D

[jen_slc]

Apidra kicks in much faster than either Novolog or Humalog did with me. I have noticed though, due to its faster action and clearance, any meal I eat out in a restaurant (and usually containing a lot more fat that I normally eat) Apidra does not deal well with. But you are pumping, so that shouldn't be an issue for you. :)

[JJM335]

Apidra kicks in much faster than either Novolog or Humalog did with me. I have noticed though, due to its faster action and clearance, any meal I eat out in a restaurant (and usually containing a lot more fat that I normally eat) Apidra does not deal well with. But you are pumping, so that shouldn't be an issue for you. :)

Jen:

Apidra can run out of legs on slow digesting meals, but it's no big deal to split your shot into two or even three and space them out over 45 min intervals. I routinely do this and it works pretty well.

[mike-munich]

Jen:

Apidra can run out of legs on slow digesting meals, but it's no big deal to split your shot into two or even three and space them out over 45 min intervals. I routinely do this and it works pretty well.

Yes, it's ideal with the different bolus profiles in the Cozmo pump. I usually do it during longer meals. 50% immediately, the other half spread out over 45 minutes.

[Subby]

Thanks for your comments guys, I have been getting into dual wave boluses for fatty foods just lately, they have great promise! I think I will be a pro at them by the time I get onto the Apidra :)

[JediSurfer]

Works well if you know how to dual wave and don't mind the extra injections. My control improved greatly after starting using Apidra about 8 months ago. still tend to find that there is a bit of a tail end for me. Not sure if it work in everyone this way but sometimes the tail end still still hits me 5-6 hours after injected.
Its also great for correction doses due to its fast acting. Occasionally if I do go high for whatever reason I don't have to spend as much time feeling ill and the numbers come back to "normal" in a better time range.
Its by no means perfect but greater "control" is achievable. I found this insulin to be the best I have used in 30 years of diabetes.

hope it goes well for you.

[jen_slc]

Jen:

Apidra can run out of legs on slow digesting meals, but it's no big deal to split your shot into two or even three and space them out over 45 min intervals. I routinely do this and it works pretty well.Yes, I've tried this without much luck, but I'm continuing to work on it. Even with these issues, I still find Apidra to be the best of the three rapid insulins.

[Lloyd]

I pumped Apidra until I was forced to switch to Novolog by my insurance company.

Apidra is much faster.

I require 21% more novolog than I did Apidra.

[Subby]

Got an invitation today from my pump endo to join in an Apidra trial with pumps here in Melbourne, I am so happy about this as so far my other doctors and endos are very cautious around the pump and I didn't see convincing a dr into trying it, it was looking like waiting around for a year or so until it became "acceptable" or "normal" kind of practise. I'll keep you posted on how it works for me.

[HelenM]

I started on a pump 3 days ago, I'm using Apidra which was quite a surprise. For others using Apidra, what active insulin time so they use on their pump? ( we didn't get that advanced on my course)
Yesterday (not a normal day because in hospital) I used 21 units of Apidra as opposed to an average of 31 of lantus and Novorapid combined on MDI

[Eddy]

Apidra can run out of legs on slow digesting meals, but it's no big deal to split your shot into two or even three and space them out over 45 min intervals. I routinely do this and it works pretty well.



Yes, I've tried this without much luck, but I'm continuing to work on it. Even with these issues, I still find Apidra to be the best of the three rapid insulins.


Or you could be a rebel and mix insulins. :D

It all depends what one wants. The split-bolus approach is analogous to NPH-basal: insulin activity rises and falls, according to individual peaks. That does not appeal to me. If I need slower onset and longer duration, I use stuff with slower onset and longer duration. :)

Note that I've never tried Apidra, and cannot comment on its mixability. With Lilly's and Novo's offerings, though, "it works for me!"