Smaller Vial Equals Improved Potency

ApidraThe unofficial theory I’ve heard is: that which makes Apidra® work quicker (remember apidra is Pig Latin for rapid) also makes it more susceptible to “going bad” quicker. I think of it this way: its composition is broken down allowing it to do it’s job faster, but that broken-down state means that it’s closer to losing its potency.

I read this somewhere some time on some forum. It made sense to me so I tend to believe it. I don’t know if it’s accurate.

After using Apidra® for a while and having great success, I started to notice that toward the end of a 1000 u vial of insulin, numbers seemed to creep up a bit. To isolate this variable to be sure the higher BGs coincided with the age of the insulin vial takes data tracking and analysis. The work I did in this area was not extensive, but in general, I think the older the vial, the lesser the potency.

I did not see this with Novolog®. Once I took a vial out of the fridge I didn’t put it back. I continued this practice with Apidra®. I had heard Apidra® was more vulnerable to spoilage from heat. So at first I tried to keep the vials in the fridge between changes. That became cumbersome.

My dear friend, Cari, told me that she uses pen vials for her son’s insulin source (a fellow OmniPodder). This serves two purposes:

Apidra Pen1) It allows for flexibility if you need to give an injection. Say you have a pump delivery issue (and yes, ours are almost nonexistent at this point, but not completely eradicated) rather than needing to change a Pod or draw up a dose with a regular needle because perhaps it’s not exactly convenient to do so in the middle of a restaurant or when you’re on the pitcher’s mound, you are prepared with the ease and convenience of an insulin pen.

2) The amount of insulin you have unrefrigerated at any time is significantly less. The vials are 300 u rather than 1000 u. Instead of using one vial per month, we’re using one a week.

Poof! The monthly bg creep issue was eliminated. I no longer worry about the age of the insulin and whether it’s gone bad.

With so many variables to manage with diabetes, being able to eliminate one is a win! With two day site changes and smaller vials, we’re up to two! Win, win!!

Apidra® v. 140 | Sanofi-aventis

Apidra

It had been well over a year that I had been inquiring of Caleb’s endo about Apidra®. I consistently got two responses: (1) it’s the same as the other fast acting insulins and (2) there’s nothing wrong with Caleb’s management, so don’t mess with it.

I wasn’t convinced about point one, but I did accept point two.  Change plus diabetes often equates to hell on earth and I wasn’t too interested in inviting that in.  I wasn’t trying to change Caleb’s numbers, so buying into “if it ain’t broke don’t fix it” seemed reasonable.

But the problem is, it is broken.

His pancreas is broken and achieving acceptable blood sugars with a broken pancreas is a lot of work and I’ll take all the help I can get.

My gut told me Apidra® would help Caleb and after talking to a number of users, I firmly dug my heels in and instead of asking for an opinion, I simply asked for a sample.

Our Apidra® journey started a couple of months ago and so far I am enjoying the ride.

My sole reason for wanting Apidra® was to minimize the tail of insulin duration.  If I could minimize tail-chasing, I would be more than satisfied.

I cannot point to statistical specifics about how things have changed.  I just feel like it’s better. The changes have been subtle. But subtly better.

This is what I can tell you with certainty:

  • Caleb’s school nurse thinks it’s fantastic. She, more than me, sees a marked change in Caleb’s numbers.
  • I don’t talk to Caleb’s school nurse much anymore.  Caleb’s plan dictates that she call me with anything under 70 or over 200. We’ve gone more than two weeks without a call regarding blood sugars. TWO ENTIRE WEEKS! If we previously had gone two days without talking, I considered that a great success.
  • Caleb has fewer lows and I don’t find myself tail-chasing quite so much.

But this is what sealed the deal for me. We recently went to NYC to see Wintuk and went out to eat afterward.  I totally guessed at his carbs. My guess was 140 in total.

One hundred and forty carbs. All at once.

Caleb’s meals are typically fifty to eighty carbs.  One hundred and forty is almost certain to be a very bumpy ride at best. Consistency works with diabetes and doubling a meal bolus usually does not.

This is how it went:

Apidra v. 140 carbs

His blood sugar pre-meal was a nifty 105, it did not exceed 158 and there was no tail to chase afterward – he ended at a flat 109.  There was no big spike from the enormous amount of carbs he took in and no plummeting low afterward from a huge tail of insulin from a huge bolus.

Caleb has indulged similarly on other occasions and it was never this straight-forward.  Perhaps the planets were aligned this night and they will never be again. But my gut tells me that Apidra® is helping with Caleb’s D management.

I will leave you with this little tidbit:

http://twitter.com/#!/KxDxJ/status/14863935324815360