Apidra experiences

[Wurst]

I went for my 3 month check up yesterday. HBA1c was down from 9.7 to 5.3 largely due to a strict low carb diet and lost 3 stone with a lot of exercise. Only been using Basal (insumman) for the last 3 months.

Still having problems with the Dawn phenomenon. I can wake up with readings of < 5mmol and within an hour be 6.6 without breakfast.

As a result i was prescribed rapid insulin to take with breakfast. From what i've read about Apidra 1 unit can lower your BS by around 4 mmol ? Is this correct or am i hallucinating.
This would put me hypo territory as I currently low carb , for breakfast i eat very little, a lump of cheddar and perhaps some salami if i'm really hungry.
So it looks to me that i will have to eat a 'high carb' breakfast to avoid a hypo? I may well of been coerced by the doctor into giving up my low carb diet. Anyone else use Apidra ?

 

[phoenix]

What are your levels 2 hours after breakfast? Do you actually need to correct.? Might you avoid the DP if you ate immediately after waking?

When you use rapid to lower a high glucose levels it's called a correction.
The amount that each unit will lower your BG levels is very variable and depends on an individuals insulin sensitivity.
Normally, you calculate the correction factor by adding the total daily dose of insulin and dividing it by 100. Someone who is using 25 units a day might find that 1u t would drop their glucose levels by 4mmol/l Someone taking 100u in a day might find that 1u would only drop their levels by 1mmol/l .
http://www.dlife.com/diabetes/informati ... 0_Rule.pdf

1) the rule is based on someone using a basal/bolus regime ie insulin injected to cover all ('normal' carb meals). At the moment you are just taking basal and presumably have some insulin of your own so ???

2) We don't all fit the rule exactly. I almost fit 1u will drop my glucose level by between 3 and 4mmol/l depending on time of day etc. and take 25-27units a day.

3) My pump will adjust for a pre-meal reading of over 6mmol/l (I've set it for that) but at 6.6mmol/l that would only be a small fraction of a unit; not possible with a pen that delivers in whole unit doses. TBH, I'm quite good at carb counting but I doubt if I'm accurate enough to make the couple of 10ths of a unit of a correction at that level important in overall control

Sorry that leads me to say I don't know in your case. You could investigate the use of a 0.5 unit pen and just give half a unit.

 

[smidge]

Hi CBClarke!

I use Insuman Basal and Apidra. I am LADA and don't usually have much insulin resistance. (Although I do have a tad more in the morning than later). I also low-carb - around 50g per day. I am about 7 - 7.5 stone and 5 ft tall, so very small and 1 unit drops me by around 3m/mol on a correction (i.e. without food). However, it is pretty variable. One of the big factors you'll need to factor in is how much insuman is still active and at what stage is that (Insuman has a start at about 1 hour and a peak between 4 and 6 hours but it stays active for up to 12 hours - it's peak is quite aggressive and if it coincides with the Apidra it can drop you too low).

Anyway, changing the time of your Insuman or splitting the dose might help you control the fasting levels without using the Apidra. If you do need to use it, my advice would be get up, test inject Apidra and eat within 10 minutes. If you are having a no-carb brekkie, e.g. bacon&egg, use 1 unit only and see how it goes. If you want a few more carbs, try 50g raspberries, 75g plain yoghurt and 20g granola - that's about 15g carb, so you could inject at whatever your ratio is to cover that and add half a unit to correct. It will be a bit trial and error I'm afraid, but it can be done!

Smidge

 

[noblehead]

Still having problems with the Dawn phenomenon. I can wake up with readings of < 5mmol and within an hour be 6.6 without breakfast.

How soon after breakfast does your levels drop to your normal levels, I for one wouldn't worry about readings of 6.6 if that is as high as it gets.

1 unit of Novorapid (similar to Apidra...i.e fast acting) drops my bg by 3mmol/l

 

[Wurst]

Thanks for all the replies. This confirms my fears :-(. I take basal insumman at 10pm every night (i go to bed early).

Basically if i don't run (10 km) before breakfast I get BS rises up to 6.6 mmol. I'm around 5 mmol on waking, this rise happens with a low carb breakfast or without any food. Several months ago I was eating all bran for breakfast and was rising to 7.6 mmol. I haven't picked up the prescription yet but i'm fairly sure there won't be 1/2 unit measurement in the pen.
Around noon it drops back to about 5.8 regularly , then i lunch (low carb) and its on the rise again. Evenings i seem to get my insulin sensitivity back again and can even eat some delicious home made low carb chocolate cake without affecting my BS.

The idea of using Apidra was to enable me to get to my target level of 4.6 mmol more regularly as opposed to only in the evenings or after strenuous exercise.

 

[iHs]

Thanks for all the replies. This confirms my fears :-(. I take basal insumman at 10pm every night (i go to bed early).

Basically if i don't run (10 km) before breakfast I get BS rises up to 6.6 mmol. I'm around 5 mmol on waking, this rise happens with a low carb breakfast or without any food. Several months ago I was eating all bran for breakfast and was rising to 7.6 mmol. I haven't picked up the prescription yet but i'm fairly sure there won't be 1/2 unit measurement in the pen.
Around noon it drops back to about 5.8 regularly , then i lunch (low carb) and its on the rise again. Evenings i seem to get my insulin sensitivity back again and can even eat some delicious home made low carb chocolate cake without affecting my BS.

The idea of using Apidra was to enable me to get to my target level of 4.6 mmol more regularly as opposed to only in the evenings or after strenuous exercise.

Hi

Unfortunately Aventis haven't for some unknown reason produced insulin pens for their insulins in half unit increments but there is a way around all this by you getting just the insulin cartridges and putting them inside a Lilly pen that does deliver in half unit measures. If you do a search on the forum about this you will see that it is in actual fact fairly easy and straight forward to do... do a search though or pm me and I will tell you...... The Luxura Humapen HD is very good and will last you a life time. Using a pen that delivers in half units makes using basal/bolus much safer to use.......

 

[smidge]

Hey again!

Unfortunately Aventis haven't for some unknown reason produced insulin pens for their insulins in half unit increments but there is a way around all this by you getting just the insulin cartridges and putting them inside a Lilly pen that does deliver in half unit measures. If you do a search on the forum about this you will see that it is in actual fact fairly easy and straight forward to do... do a search though or pm me and I will tell you...... The Luxura Humapen HD is very good and will last you a life time. Using a pen that delivers in half units makes using basal/bolus much safer to use.......

Yes, I completely agree. I use the Lilly Luxura Humapen HD with the Apidra and it is excellent. Took a bit of pursuading the DSN that it would be safe, but she relented :lol: I'm a bit suspicious as to how good the Sanofi Aventis Clickstar pen is - this is the one they issue with both Insuman and Apidra. I use it for the Insuman and it seems to malfunction on the priming pretty often and I'm never sure I'm getting the full dose - especially as I take small doses. I've had the same problem with 2 different Clickstar pens, so I'd definitely try to get the Lilly one instead.

Smidge

 

[l0vaduck]

Alternatively you can get syringes that do half units.

I've read a couple of posts of people unhappy with readings in the 6's after meals - is this really such a big problem? I thought even non-diabetics had an increase in blood sugar after a meal?

 

[noblehead]

've read a couple of posts of people unhappy with readings in the 6's after meals - is this really such a big problem? I thought even non-diabetics had an increase in blood sugar after a meal?

I wouldn't think so as non-diabetics would see similar levels after eating, each to their own but 6's after eating looks perfectly fine to me

 

[Wurst]

Thanks again for all the suggestions. I went back to the doc's and asked for a pen to allow 0.5 unit injections. They gave me the lily pen but also humalog insulin to use with it saying Aprida is not comptabile with the pen.

How much does 1 unit of humalog typically lower blood sugar? If i understand correctly it's more potent than Apidra?

 

[Pneu]

I don't often say this (in fact I think this is a first!) but I think you are being a little over-zealous with your DP blood glucose. I have a similar issue to yourself whereby I suffer from quite a pronounced DP.. rather than messing around with a rapid you are probably better splitting your background and doing say 55/60% in the evening to cover the DP and then 45/40% in the morning. You might look at changing background to something like Insulatard that runs on a 12 hour effect curve to deal with the morning spikes..

To be frank however I think its a lot of fuss for very little gain.

 

[Wurst]

@ Pneu

To be frank however I think its a lot of fuss for very little gain.

The gain is normal (non-diabetic levels) blood sugar levels. My target is 4.6 mmol which will more acheivable with some rapid. A 2 mmol rise in the morning and with low carb diet needs addressing. Several posts/studies/books i've read indicate long term complications can arise with levels of ~ 5.5 mmol. Also more insulin may preserve my beta cells.

Anyone got a ball park figure for Humalog effects on B/S ?

 

[Pneu]

You are type I more than likely you have very limited beta cell function anyway..

I am all for normal blood glucose check out my own HbA1c's levels which I have maintained over a period of years.. something that experience will teach you is that you need to get a balance between blood glucose and life.. Studies indicate possible beta cell damage at 5.5 mmol/l+ this is correct but this is to beta cell function and not standard 'complications'.. most people on that front would agree that 7.8 mmol/l is the upper limit after which damage occurs to the body in general.

A rise to 6.6 mmol/l every now and then is not going to cause you any long term damage.. ALL non-diabetics get blood glucose outside of the 'normal' range now and then.. from illness, infection, etc...

Seriously I used to wake up at 4:30am to do a rapid injection to control my DP just as you want to do and I done that for nearly 18 months and noticed ZERO difference to the HbA1c's that I achieved. If you are that concerned over it then get a pump and then you can have adjustable basal profiles.. injecting 1 unit of rapid to control DP at the sort of tight control you are running now is a pointless exercise; especially seeing as you seem to be insulin sensitive.. you will more than likely end up giving yourself more morning Hypo's.

As I said previously given your sensitivity you will probably get more joy from changing your background profile and splitting insulin to control your DP than you will from injecting 1 unit of rapid at silly o'clock in the morning.