Apidra v Novolog

I'm always saying that we (the parents of type I children) shouldn't make the mistake of becoming complacent when it comes to the methods that we use to manage our children's type I.  I put my money where my mouth is last week and tried the insulin Apidra in place of the Novolog that Arden has been using since day one of her diagnosis. This is what I've learned after twelve days of using Apidra...

Our experience with Novolog was mostly good but I always thought that there was room for improvement.  I knew what Novolog was going to give me and there was comfort in that, however the spiking and dips were just too severe at times. 

Let me stop for a second to say this: I am not a doctor, in fact if you ask my wife I may be a moron. You should not take any of what I'm saying as medical advice and as a matter of fact, none of the steps that I took to come to my conclusion were scientific in any way. That aside, I know what I know, saw what I saw and I believe that you'd do well to speak to your endocrinologist and bring up what you've read here.  I think that you'll be happy that you did.

Back to it...

Arden uses Novolog in her OmniPod insulin pump.  After a bolus the insulin seems to begin working in around 20 minutes and it picks up momentum (like a freight train), peaking between the 1hr 45min mark and the 2hr mark. The trouble with the Novolog is that it sometimes drags Arden down over the third hour in a significant way.   

Every time Arden eats we pre-bolus, eat, watch the BGs spike or gradually rise, then watch them level off, later the BG drop occurs and then the gradual decline over the third hour finishes the ride. This all makes eating a meal a three + hour process and since there are three meals a day, well you can do the math. Even worse, if I miscalculate the carbs, more insulin may be needed and you can't bolus with any certainty until the three hours has elapsed. You all know the feeling - do I live with the high a little longer or bolus and catch the low later? There is nothing fun about this...

By it's nature Novolog also makes a pre-bedtime correction a very scary proposition because you can't be 100% sure that the third hour of the bolus (most call it the 'tail' of the insulin) is going to happen, and if it does happen - will it be severe, gradual, take the user too low... it's a mess I tell ya.

Now of course man made insulin isn't perfect and Novolog is very good and I am grateful for it but in my opinion the Apidra has a slight edge over it in two ways. Here is how...

First, Apidra is gradual. I can watch Arden's BGs on her DexCom 7+ CGMand the Apidra is smoother then Novolog. After a properly pre-bloused meal Arden's BG rises gradually, not sharply like with Novolog and the decline is the same. Her CGM line now looks more like a rolling hill then a mountain range at meal time.

Second, there's little to no tail and Arden is experiencing a much shorter insulin action time with Apidra (two hours) vs. Novolog (three hours). Apidra seems to be finished doing it's business in two hours and if there is a decline in the third hour it's so gradual that the DexCom can't report it as an arrow diagonal down.  The CGM maintains a horizontal arrow as the number drifts lower but generally the Apidra seems to be finished after two hours. She may get lower in the third hour but the decline is not dramatic and therefore not scary and easier to manage if necessary.

Switching from Novolog to Apidra was fairly painless but it did take a few days to make adjustments to basal rates and insulin to carb ratios in Arden's pump.  The process was made easier with the DexCom but would have been possible without it.  It's important to remember that everyone may not respond the same as Arden did but I think that it's important to keep our minds open and not get stuck in today's methods in regards to our children's therapies. Over time treatments will change and I believe that changing with them, when changing is warranted, is important.

I had a close friend when I was younger that was diagnosed at age 18. Back then meters were huge and humolog was the insulin de jour. My friend would get up in the morning, decide how active the day would or wouldn't be and then approximate how much insulin he needed. He injected, ate and went about his day.  He would have lunch when he felt light-headed and inject at dinner. He didn't count carbs, test or even visit an endo with any frequency.  By today's standards he was barely taking care of himself. However, 20 years ago he was doing what he was supposed to based on the best medical advice available to him. He didn't fall behind because he didn't care, it's just human nature to find something that works and stay with it.  I say to resist that urge, pay attention to advancements and after careful consideration take a chance when something looks interesting. I wouldn't change for the sake of changing but please learn the lesson that my friend's story teaches. When he finally tried Multiple Daily Injections two years ago the therapy almost killed him. It was too different and he was too set in old ways. One Saturday he stopped at a store to buy a book before lunch, as he did every Saturday.  At some point he pre-bolused for lunch while he shopped just as he'd always done and then drove for two hours in his car before crashing it into a tree - all because he took his shot too soon before lunch. He has no memory of the two hours, the last thing he recalls is leaving the book store and saying goodbye to the guy behind the counter. Something that simple almost ended him. Treatment had passed him by... Now he is scared of the "new" and will never experience the stress relieving goodness of the OmniPod or the security of the Dex. His care is frozen in time and his inability to adjust may very well cost him at some point. I can't imagine what is to come in diabetes management but I'm sad that my friend will never experience it.

Not being complacent won't just benefit our children, it will also keep the people and companies that we all rely on focused on innovation. We absolutely love Arden's OmniPod and her DexCom 7+ but those products have to continue to improve if they want to keep us as customers.  We shouldn't become complacent and we shouldn't accept complacency from the products that we count on to keep our children alive and healthy.

Having allegiance to an insulin is actually silly right? I mean I only use Novolog because a doctor gave it to us. I never looked into it, I was too stunned at the time. Moving forward, no one ever told me that there were choices, I only have the internet and the Diabetes Online Community to thank for my awareness about Apidra. When I asked my NP about it (and this is important) she hadn't seen any data to suggest that switching was warranted but she still supported my trying. Please don't let your doctors limit your choices, you may only be using Novolog because the reps from Novo Nordisk have better deli platters then the girls from Sanofi-Aventis.

Final thought - If Arden's NP is reading this (and I know that you are) please get your script pad out because we are switching insulin. Switching wasn't exactly fun and I'll admit that I had to rev myself up to go through basal testing but that little bit of effort and a tiny bit of patience bore some nice rewards. No fast spikes, no fast falls, shorter insulin action time and a steadier fasting BG. Also, I didn't get a chance to speak about it but Arden's overnight CGM line is excitingly flat.

See ya Novolog, it's nothing personal... I have to keep up - for my daughter.

Be well, you and your children are all in my thoughts!

Read the follow up to this post, 'Apidra Blog ptII' here.

The stuff at the end - I already said that I’m not nearly a medical person. I’m just a guy that takes care of a little girl with type I... I just happen to have an opinion, a keyboard and an idea about how to post a website. Please do your research, speak to others and then go over everything that you’ve learned with your healthcare professional. Please also know that this site is not supported by any ads, hand outs or pressure from any pharmaceutical company or device maker. I’m just trying to spread good information to the people that need it the most, as best as I can.

---

**

The following are archived comments from this post. You can post new comments below.

Joel

Apidra is not keeping up with technology for those that choose MDI.  

They, unlike Novolog, do not offer a pen that allows for 1/2 unit dosing.  The ability to give a 1/2 unit dose is a big deal for those on MDI.  

They are lacking in the technology area for sure.

Wednesday, February 2, 2011 - 12:17 PM

Penny

Hi Scott,

I just tried to comment on your blog about Novolog vs Apidra, but I cannot leave a comment. I can get to the comment section and complete it all, but clicking on comments does nothing.

So, here is my comment:

Thank you for this information! I do appreciate it and I swear, will NOT take it as medical advice!!! I spoke with Lorraine over at This is Caleb about Apidra a few months ago when she tried it with Caleb and there, in my frig, sits a bottle of Apidra, scripted from our endo at DuPont. We are still using Novolog in her OmniPod, but I am tempted to go ahead and try it. I do want to try it when I am around to watch whats happening - Spring Break to be exact, cause having a girl active at school with a new insulin will not be fun times for all.

I'm interested in the insulin action. We get a spike, not very large, but enough to sometimes cause a crash from the long actingness of Novolog. I'm also liking the finishing in two hours, for Arden at least, in a shorter amount of time. We have so much of a tail of Novolog at times, we end up with IOB for a high correction, coming down within perfect range within an hour, but overshooting our target, resulting in a low. These at bedtime, as you said, well, they suck. 

Thanks again, I appreciate you sharing your experience. Glad it is going well for Arden and for you too.

Thanks so much!

Penny

Wednesday, February 2, 2011 - 01:03 PM

Scott

If comments won't work please try deleting your cookies... That sounds funny!

Sorry, thanks!

Wednesday, February 2, 2011 - 01:05 PM

Stacey D.

I've heard so many people that get better results with Apidra.  I, unfortunately, am not one of them.  I tried it twice some time ago and although I didn't get to catalog every detail as well as you did (wish I had!), I believe it was the shorter action time that just didn't work well for me.  It was a bit disappointing too.  But I'm glad you got good results and found something to improve Arden's bg, even if just a little bit =)

Thursday, February 3, 2011 - 04:00 PM

Anna

Hi.  We have an almost 3 yr old daughter w/Type 1.  We use Dex and Pod (just started) and found your blog when searching for info on Apidra.  A FB D mom friend suggested it.  Thanks for your input!

Wednesday, March 9, 2011 - 01:24 PM

hockeymom

Thanks for sharing your experience.  We are just starting our 2nd week on Apidra and ran high the first week--made some basal adjustments today and will see how that goes before making carb ratio adjustments.  Waiting to get our new sensor transmitter--would LOVE to see some of those flat lines you describe.  Have had too many seizures on Novolog so hope for some more stability and sleep at  night!

Saturday, May 14, 2011 - 10:07 PM

Scott

Hockeymom,

It took me a few weeks to get it all together. I wish you luck! Please let me know how you make out.

Scott

Wednesday, May 18, 2011 - 11:15 PM

Update

on 2011-09-26 13:29 by Scott Benner

Read the follow up to this post, 'Apidra Blog ptII' here.

Spontaneous reboot

Arden’s PDM has been spontaneously rebooting for the last few days.  Sometimes it happens when I press the home button and sometimes it happens when no one is touching it.  The long and the short of it is... it’s broke.

I just called Insulet (makers of the OmniPod), I held for a few minutes and then explained my situation much in the way I did in the previous paragraph. (I think that it’s important to note that the CSR doesn’t know that this is my website and that I’m not compensated by Insulet or anyone else for sharing my thoughts about the OmniPod or any other D related stuff that you see on this site).  She put me on hold for 30 seconds and when she got back she told me that a new PDM would be overnighted to me immediately.

I want to note that I’ve never had a tense exchange with an Omni rep, never.  I have had moments when I was upset that I guess could have escalated when I didn’t like what I was hearing but that’s just never happened.  I’ve heard from time to time on the interwebs about folks having issues with Omni reps but I’ve never had anything but good experiences.

* I’m having issues with comments on the site that I’m working to fix.  Some people may not experience them.

My Freestyle test strip test

Standard blog disclaimer... I’m not a doctor and listening to me when you make decisions about your or anyone else's diabetes is just plain not a good idea. That said, these new test strips work fine in your OmniPod PDM (at least the PDM we have - color PDM).

Like all of you, I was caught off guard when I opened a new box of test strips to find that they weren’t what I was expecting.  I immediately made some calls and found out that I would have to track down the old strips if I wanted them. Then I asked myself the following...

“Self”, I said. “Would Freestyle make test strips that wouldn’t work in my OmniPod PDM?” and myself answered, “not likely since they have a business relationship with Insulet”.

Then I asked myself, “what is the FDA doing with the strips to test them” and I answered myself by saying, “probably comparing them to the old strips and making sure that they work”.  

Then I took a few minutes to congratulate myself for being so smart and myself agreed.  I proceeded to do my own FDA style home testing over a two day period.  Here are my results:

11/22 - 9:48pm

Old-211

New-200

11/23 - 7:30am

Old-117

New-112

11/23 - 8:15am

Old-150

New-155

CGM-158

11/23 - 7:35pm

Old-85

New-72

CGM-65

11/24 - 8:00am

Old-170

New-176

CGM-169

11/24 - 1:50pm

Old-217

New-218

CGM-191

These numbers coupled with my astute deductions were more then enough for me to trust the new strips. I saved one vial of the old style ‘just in case’ and moved on to the new style around the 1st of December, 2010 and have not looked back.  Be sure to set the coding on your PDM to match the vial!

If you think back to when your child was diagnosed, the nurse at the hospital used a huge meter (about the size of a brick) to test your child’s BGs.  I’ll never forget the moment when the nurse took our first free meter from it’s box and had me test Arden. The nurse tested Arden with the ten-thousand dollar meter that the hospital uses and then I tested with the twenty dollar meter they gave us. The numbers were sixty points different, SIXTY!  I said, “which one is correct?” and the nurse told me that her’s was probably more accurate but not to worry because I couldn’t afford the one she had and it wasn’t portable anyway but “don’t worry because this is the meter that you’ll be using every day” - as if that made up for it not being accurate!

My point is this, we don’t really know what our kid’s BG is.  If ten meters tested Arden from the same drop of blood, we’d probably get 7 different readings and who is to say that the three that agreed would even be correct.  This entire thing is a crap shoot.

Arden was 69 the other day, it was hours after her last bolus and her DexCom line had been steady around 100 forever, (though it was drifting lower) but she felt fine.  Was she 69, 49, 89?   How the hell can I know?  She felt fine, she was steady, I dosed her last meal accurately, what am I going to do?

Final verdict: I say use the new strips. They require way less blood and in a day or so when nothing goes wrong, you’ll trust them just as you did the old style. In the end, this is all about trust. You’ll be a veteran of this by the time the FDA gets off their asses and gives the thumbs up.

**

The following are archived comments from this post. You can post new comments below.

Penny

Hey there - I read your blog, but not much of a commenter. We live in the same area, I'm in Philly. My gal, Grace, is 8 and dx'd two years ago. We are a Pod using family. I got these new strips from our refill at CVS and refused them, cause of the Insulet advice about them. Problem is I am on our last 4 vials of 'old' Freestyle. I will need to use the new Freestyle ZipWik strips soon as I cannot get the old ones. I spoke with Lorraine over at 'This is Caleb' and she is using them without problems too. So, along with your thoughts (and I know, you are not a doctor and don't play one on TV!) that I will just go ahead and use the new strips when we refill in a month.
Thanks for your thoughts about them and the test - appreciate it!

Wednesday, January 26, 2011 - 07:25 PM

Leighann of D-Mom Blog

Even two readings with the SAME meter with the SAME drop of blood can be widely different.

I think the important thing is using the same meter and the same strips consistently.

We have also been using the new strips with no problems that we have noticed. 

When I spoke with Abbott when we got our first nine boxes of the new ones the rep happily sent me a FreeStyle meter to use until FDA approval (which I didn't want to use because isn't the whole point of the integrated meter that it's one less step). I had done a bit of an experiment using the old and new strips in the PDM and the new strips seemed to give a little lower number. The rep said that the new strips are more accurate and that could be why. Who knows.

The point being, we have been using the new strips for months. Months! We've gone through 900 of them and are on our next round of 900 (we fill 90 days at a time).

And I firmly believe that the only reason Q began testing her own blood sugar is because the new ones use so little blood and the little nub is an easy target to hit.

Thank you for stepping up and coming out and saying you use the new strips in the PDM. I appreciate it! (Because lots of people are FREAKing out about it.)

Wednesday, January 26, 2011 - 07:50 PM

Leslie

Thank you!  We are new to Podding but not pumping or diabetes, and this whole strip thing is driving me nuts. I am not a doctor either but I do pretend to be a damn good endocrinologist and pancreas. I found that Abbott will trade in new strips for old strips at 500 a pop. I find comfort knowing that I can get a 100 or so to keep on hand if something seems funny, but I think we are going to go ahead with using the new style strips. As we are so new to podding, I haven't had the PDM for that long, but all my tests have been similar to yours, very close numbers, some even the same. Thank you for posting and will definitely become a regular reader after finding you today. 
Leslie

Thursday, February 3, 2011 - 12:20 PM

Scott

So glad that you found us Leslie! Welcome and thank you for reading! Best of luck, I think you're going to be fine with those new strips. Let me know how it goes... If you every have any OmniPod question, drop me a line.

Friday, February 4, 2011 - 07:27 PM

Update on 2012-01-07 18:27 by Scott Benner

The test strips were finally cleared by the FDA on January 6, 2012. I wrote about their clearance and the FDA's incompetence here.

News you can use

Arden was recently the focus of the ‘Covering your Health’ segment that ran on KIMT news.  As you know, we try our best to bring awareness and transparency to type I diabetes and we were thrilled to have the chance to speak about Arden’s OmniPod insulin pump.  

I feel particularly lucky to have the chance to tell other diabetics how much the OmniPod has helped us.  If just one child finds the OmniPod and feels the relief that Arden has experienced then we have done a world of good.  

Please take a moment to watch the piece (above), if you have any question about the OmniPod please feel free to leave them in the comment section or send me an email.  I’ll do my best to answer your questions.

Proud to pod

Pick up today’s Trentonian to read all about Arden.  Great thanks to Sulaiman, the writer of the piece for all of the time and attention that he gave to our story.

The article is also online at this link.  If you like it, please take a moment to hit the FaceBook like button, ReTweet on Twitter or comment on the article at the Trentonian site, below at Arden’s Day - or do them all!

I can’t say enough great things about the Arden’s OmniPod, the freedom that it’s tubeless design gives to her or my experience with their customer service.  I don’t make statements like this on the site very often but, “If you or your child is in need of an insulin pump, you just must give the OmniPod a long look”.  You’ll be happy you did!

Lots of people are sharing the link on FaceBook today, thank you to all of you for being such wonderful supporters! Remember, it’s all about transparency and raising awareness.  Your support and help spreading the word makes Arden’s message that much stronger.  Have a great day!  One day when a cure is found, you will all have a place in saying, “I helped to cure type I diabetes”, I just know it...

If you’d like to make a tax deductible donation to Arden’s 2010 JDRF Walk, you can use this link 

http://walk.jdrf.org/index.cfm?fuseaction=extranet.personalpage&confirmid=87699113