Apidra: The Smackdown

Oh Apidra, how I love and loathe thee.

About five weeks ago I switched Grace over from Novolog to Apidra in her OmniPod insulin pump. And things went swimmingly. Highs were coming down faster, we were not seeing a high postprandial spike, and it really seemed to work faster for Grace. I liked it. I saw less insulin being used more productively for her. I changed basals, I:C ratios and correction factors, and all was well. Honestly, all was well for about 3-4 weeks.

Until this happened.

And yesterday happened.

Quick synopsis - I realized that Grace may need to change her Pod every 48 hours, because of this issue with Apidra. It was literally conking out at 48 hours in the Pod. Not consistently and not every time, but it's like waiting for the floor to drop out from underneath you. It's like playing Tower of Terror with the pump. Honest, that's what it feels like to me!

This was not sitting well with Grace. She wanted the full three days out of her pump sites and who can blame her? The damn thing hurts when it goes in! I wanted that too, as we got a full three days, and sometimes a few bonus hrs, out of each Pod with Novolog. I told her of my new plan, that we would keep our eyes peeled at the 48 hour mark, and when the numbers started to skyrocket after 48 hours, we would change it. Maybe we would get three days out of a Pod, it had happened before with Apidra. That was our game plan, but really, why is watching your child like a hawk for every hour after the two day mark any kind of rational diabetes management, for anyone frankly?!

Sorry for the little sidetrack...

Which brings us to yesterday.

Grace woke up at a beautiful 125. The magic 48 hour mark was at 12:30 pm.
10:30 am classroom check - 210/190. Hmmmm, little high, suspicion begins.
11:45 am lunch check - 205. OK, well she should not have gone UP since the correction for the 190 happened an hour ago and she's had no food since breakfast
3:30 pm - 410. Crap. Recheck of 388. Double crap. Ketones of .3

I look into the logbook and it hits me. The bewitching hour of 48 hours is past, 3 hours past. That bewitching hour would have been at 12:30 pm today.

 It's almost like the Apidra turns to water in her pump after 48 hours.

We change her pump site, and I use the newly opened Apidra, the same vial that I filled this pump with. I attempt a valiant correction of 2 units through her pump, based on the 388 reading. I give her a shot of 1 unit in her arm, from the vial of Apidra, frankly, to prove the point and see if this is really how it goes.

I check 15 minutes later and she is 407. Four frickin oh seven. That is UP!
It's like trying to stop the freight train by sticking your foot out the train door and dragging it on the ground, oh, while wearing flip flops. Nothing good is going to come of it.

I pull Chuck in from outside and say, we need to convene the team here. What's our game plan?
We agree, check in over the next hour and if she has not lowered by at least 30 points, we pull the plug on this pump. We change her site, and we do it with Novolog.

Did I mention this was all happening at dinner time and Grace is starving. I will not let her eat. I give her a mozzarella cheesestick to hold her over. and a piece of chicken. Oh and two slices of ham. And Grace is crying. Cause it sucks to be 388 and climbing. I can SEE it in her, she is not herself.

The next reading? 429.
My friends, that is NOT 30 points lower.

The next reading? 402

The next reading? 399
This is one hour after the correction through the pump AND the arm dose.

Plan goes into action.

One Pod filled with Novolog. Dose of 1.0 unit through the new site. One dose of 1.0 unit given by injection in her arm.

Go to work Novolog, go to work.

30 minutes later... 293
1 hour later... 168
2 hours later... 74
3 hours later... 59
Suspend for 30 minutes and a juice and 2 tabs later... 101

So, now the question is - did some of the Apidra bring her down at all or is this all the Novolog? All I do know is that for close to 3 hours, Apidra did not budge her, at all. It's like it wasn't even being dosed to her. A few thoughts - was she climbing so high that I was just slowing down the high by the dose through the arm, but clearly it wasn't enough to move her down? Did the pump conk out and only the 1.0 unit of Apidra through injection work? Is heat affecting Apidra - her tummy site is a warm place for it. Or was this coming down from the high the work of the new pump filled with Novolog and the 1.0 unit of Novolog through her shot?

I have talked with others about Apidra in their OmniPod. Some are doing great, no problems at all. Some are experiencing the same issue as us - the 48 hour mark spells doom for Apidra in the Pod.

For now, I am out of the ring in the match with Apidra. It's back to Novolog for us for a little bit, until I have the courage to try Apidra again.