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