Novorapid to Humalog experience

[Subby]

I had a good visit to my endo yesterday, it all went well. Except one thing, I was hoping to trial Apidra, at the last minute she bailed on the idea for now and set up a trial of Humalog in the off chance it afforded better absorption/action for me.

I have a very delayed wait for Novorapid to work, usually 60 min passes before anything happens at all.

We both agreed it was a long shot that the extremely similar (I think she said one enzyme difference or something) Humalog would be different, but then again there are people for whom one works better than the other, so I agreed. Now I'm on it and it seems if anything slower. Certainly I'll keep my eye on it the next few days.

But it's been a while since I switched insulins. I wanted to ask those who might have moved between similar insulin if I should factor in some kind of adjustment period.

If the Humalog doesn't improve things, my plan is to log my pre-bolusing findings (ie, period of non-action) in isolation and see if some concentrate cold hard numbers might help my cause for trying Apidra.

[LancetChick]

Your endo seems to be totally disrespecting your intelligence and your wishes. To have to jump through hoops to try a different insulin is insane!

For me, Humalog and Novalog are somewhat different, but enough that I can see the difference immediately. Sounds like you have absorption issues..... do you have scar tissue build-up? Humalog takes 15 minutes to start working in me, and Novolog takes only 10.

[Subby]

Thanks for your vote of confidence that it's a simple and fair request. In the scheme of things this endo is overwhelmingly smart and reasonable. I think there was a specific reason she shied away from this.

You see, a few months ago, I was offered to go on Apridra by the "pump team", a bunch that she referred me to to get on the pump. On going through the hoops with them, they ended up refusing the Apidra on grounds I use too high amounts of insulin (Which caused me to think WTF? That's part of the reason I want to try it, to see I get better absorption and lower insulin needs). Anyway, THEY are nincompoops and history. (I was just talking about them in another thread).

The unfortunate thing that happened was at the time my endo said on the phone it was fine to go on Apidra, have a script, I said "don't worry" because I was going to get it through the pump team, then they folded on me because I didn't fit in the parameters of their "study" involving pumps and Apidra.

I think when I stupidly told her yesterday about being disqualified from the study, (honesty being the only course as far as it goes, and hard to know where it might be counter-productive) she might have thought she should look into it first... a problem being her hesitancy with the pump. And that Australia is a good few months/years behind US, so Apidra is less accepted here.

From what you say, this slower action is probably the way of it - Humalog strikes out. As for my absorption issues, seems to go beyond scar tissues. My absorption was terrible, a nightmare on MDI for 15 years, I never had typical absorption, even on fresh sites. Now with pumping and a constant site for three days the absorption is at least more consistent, but typically 2 - 4x longer onset than "typical". It's been one of the major headaches of my diabetic career. No doctor has an answer. All I can guess is my sub-q tissue is.... different, or that the fast and rapid insulins I've used so far are not fully effective for some reason.

I know some people find Apidra is no faster but hey it's surely worth a try.

I think with a friendly, informative fax to my endo about no absorption improvement next week, she should come around. But I really am at the tear your hair out stage with all these false starts and stalling.

[judi t]

What's interesting to me, Subby, is that I've never even considered 'absorption' when thinking about control of diabetes. This forum is a whole new world. I'm not sure I want to factor in another thing to concern myself about when I seem to be just getting my pumping act together. Again I say: eeeek.

I used to think I was so up-to-date in my diabetes management. The number of times I've told the opthalmologist or the GP, or whoever was asking that my control on MDI was 'as good as I could get it'. And I had never considered 'absorption', and even though I know what the word means, I don't know how I'd measure it.

Anyway, go the pump. After a month, it's great.

[Cloudedbrains]

When I went from one to the other I found I needed alot more humalog to get the same response I got with novorapid :(

[Subby]

What's interesting to me, Subby, is that I've never even considered 'absorption' when thinking about control of diabetes. This forum is a whole new world. I'm not sure I want to factor in another thing to concern myself about when I seem to be just getting my pumping act together. Again I say: eeeek.


Judi, if you are getting along ok without the concept in mind, take my advice and leave it that way. :) I seem to be quite unusual in the extent of these difficulties, for many people meals and insulin can be more easily correlated, or even the other way where their worries with absorption is being TOO quick! (which is just another universe, to my issues).

The main frustration I've had is that absorption problems can so easily be overlooked or minimised or blamed on other things (like dosage, timing mistakes, carb counting errors, lack of exercise, etc etc). I've had endos run me around the mulberry bush for years on the issue. Which is why I've started this ledger of pre bolus results to definitively keep the data exclusive - informative of the initial action of the insulin, food removed from the equation.


I used to think I was so up-to-date in my diabetes management. The number of times I've told the opthalmologist or the GP, or whoever was asking that my control on MDI was 'as good as I could get it'. And I had never considered 'absorption', and even though I know what the word means, I don't know how I'd measure it.

Anyway, go the pump. After a month, it's great.

Hey, you have had an infuriating, frustrating, obscured long term disease and you've obviously kept your self and your happiness around you. That you change your mind now (that you didn't/don't know it all) proves you really havn't fallen victim to the rather unique and grinding psychological demands it can place on us.

Happy to hear the pump keeps giving! I'm still blessing it 7 months on now.

When I went from one to the other I found I needed alot more humalog to get the same response I got with novorapid :(

I'm suspecting I'm on your side of the bridge. Today it seemed to lack what punch that Novorapid has for me. Also I've felt queasy quite a bit. Curiously though, I've felt a bit more alert. The observation will continue...

[Cloudedbrains]

Also I've felt queasy quite a bit. Curiously though, I've felt a bit more alert. The observation will continue...

I always feel sickly with humalog but I put it down to the amount I need to use in my injections, never thought it could just be the change :(

[Subby]

That's no good. I'll let you know if it continues for me. So any chance you can go back to Novorapid - it sounds the better option for you??

[Subby]

I'm still getting nausea on day 5 or so of Humalog. I would have expected it to go away by now if it was a symptom of transition. It gets pretty bad. I'll stick it out a few more days just to see if things change.

As for effectiveness, after a few days I think it is a little more effective than Novorapid for me - but not much, still get huge delays on normal boluses. Not enough for the nausea to be a tradeoff.

I'm thinking my issues might largely be insulin pooling under the skin when bolusing, causing onset delays regardless of insulin type, so for the moment I am experimenting with square boluses on my pump.

[Eddy]

I switched from lispro to aspart four months ago.

I find that aspart acts faster in me than lispro. Although onset time fortunately isn't a problem for me, I like being able to delay the injection, and to have more control in my mixes.

I did not like lispro. With it, I frequently would get a "pounding heart", where I felt like I'd been startled, was going hypo, or something along the "fight or flight" lines... even when my BG readings were fine. I also found the activity more variable, and more dependent on starting BG, than aspart.

I've not tried glulisine.

[Subby]

I did not like lispro. With it, I frequently would get a "pounding heart", where I felt like I'd been startled, was going hypo, or something along the "fight or flight" lines... even when my BG readings were fine. I also found the activity more variable, and more dependent on starting BG, than aspart.

That rings bells, the bit about fight or flight kind of responses with lispro. I have been feeling impatient/with a built up head of steam, and flying off the handle a bit these past few days - I'm usually pretty even keeled and patient. The kind of feeling I want to "do something" (like flight or fight) but I don't know what or why.

Ah, looking worse for the lispro. I was going to use the whole pack of insulin but I don't think that's wise. If thinks aren't better in two days I'll go back to Novorapid.

I will send the humalog to one of those diabetes aid agencies, at least it might do some good for someone else!

edit: then again: maybe I could do with some more catalyst/energy like this to get things done for a while, even if it's a bit edgy... I feel a bit "woken up" by it. And I've got things to do that I've been putting off... :( It's frustrating not to know what the "real me" would be feeling as far as the urge to push through, get things done etc... as far as I know the Novo inhibits my willpower hormones.

[Eddy]

I will send the humalog to one of those diabetes aid agencies, at least it might do some good for someone else!


It's certainly better than having out-of-control blood sugar, to be sure!

When I started on glargine and lispro (neither of which I want to go back to), I felt so much better that it's hard to describe. Instead of being in a "walking coma", feeling like death warmed up, I laughed... a lot. When a smile might have been appropriate, a laugh usually came out instead. When my blood sugar got into the 90s, most anything would make me crack up.

Given a choice between glargine/lispro and no treatment, I'd certainly prefer the former. I'm sure someone would be most happy to use the lispro instead of nothing.

[Chappo]

Subby,

Have you tried using a deeper infusion set or a 90 degree if you don't use one currently?

When i moved from 9mm back to 6mm (and i'm telling you, there's only 2 spots on my body that i can use a 9mm!) i noticed much lower absorption. The 9mm sets cause my Novorapid to work within 5-10 minutes. Now i've been using a couple of 6mm, that's been delayed to around 30 minutes.

If you're happy with an insulin, don't change, and definitely don't go through hoops for them just for a trial. I would say to try a few different infusion sets first ;)

[Subby]

Have you tried using a deeper infusion set or a 90 degree if you don't use one currently?

When i moved from 9mm back to 6mm (and i'm telling you, there's only 2 spots on my body that i can use a 9mm!) i noticed much lower absorption. The 9mm sets cause my Novorapid to work within 5-10 minutes. Now i've been using a couple of 6mm, that's been delayed to around 30 minutes.


I found a similar thing but further up the scale, the straight 9mm quicksets afforded me very bad onset and absorption overall. I now use the 18mm sils put in sharply. That's how I got to the stage I can actually expect the insulin to start working under 60-80 minutes, rather than possibly blow out to 120 or more. As with injections, getting deep definitely helps me, sadly doesn't solve.

[jennyz]

Your endo seems to be totally disrespecting your intelligence and your wishes. To have to jump through hoops to try a different insulin is insane!

For me, Humalog and Novalog are somewhat different, but enough that I can see the difference immediately.

I switched from Humalog to Novalog for about 5 minutes. When I took Novolog, I felt like I had injected adrenalin into my body- complete increase in heart rate, panicky,sweats, chills, nauseous..almost like low BS but I was fine..I ended up lying down and falling asleep and woke up with what felt like a bad hangover. I went back to Humalog the same day. Has anyone else had a similar experience?