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Location: Minneapolis, Minnesota, United States

Diagnosed with Type 1 diabetes in April of 1980. I recognize the incredible mental struggle of living with diabetes. I hope to share my struggles, my successes, and everything in between.

Tuesday, April 17, 2007

Unsteady Ground

The water is about knee-deep in most places. Brown and murky, I'm not able to see the terrain of the riverbed. But I know that it is absolutely littered with debris. Rocks. Downed trees. Holes and pits.

I know this because I've been stumbling along - slamming my feet and legs into things, if I'm lucky the edges are not too sharp or jagged.

Jarring my knees and spine with unexpected drops into holes or off of small ledges. Then tripping back up when the landscape levels off.

Or stepping halfway onto a rounded rock, slippery with the muck and growth. My foot seems to accelerate off the rock as it slips down the surface, pulling me forward into the next obstacle.

I'm not allowed to slow down - it's just simply not allowed!

Try as I might to slow down, the current of life is pushing and pulling me along. I can not be hesitant or careful with my steps. I march forward fully expecting the ground to be solid and stable beneath my feet. Unable to slow down and tentatively feel out the terrain below my next step.

I muster up my confidence and continue to move on. Sure that I'll find my rhythm and routine any step now.

Walking full speed in knee deep, obstacle ridden, brown murky waters. That is what it has been like for me experimenting with Novolog.

I usually pump Humalog insulin. I have for as long as I can remember (does anyone remember when it was first made available?). I had an opportunity to get my hands on a bottle of Novolog, and wanted to try it. For no good reason really. The Humalog was/is working fine (for the most part). It seems a little slow for me at times, but not enough to make me want to get rid of it.

From what I can tell, the Humalog vs. Novolog use is just as individual as we are. For some people one works better than the other, and for other people they can't tell any difference. Some folks have had to switch because of insurance arrangements. Others prefer one over the other.

For me, the out of pocket cost is the same. I have noticed that for meal boluses, the Novolog seems to kick in faster, which I kind of like. Same for correction boluses. I rocket down like some kind of bungee jump ride that doesn't bounce back up. They don't seem to stop when I've reached my target - they keep going and dragging my BG down with them! Resulting in lows, which I'm prone to over treat. I haven't had the time to really dig in and test with it though.

For the most part it has made me unsure of my ratios and calculations. These same ratios and calculations that I have been using for years. It has made me less confident of my moves when I'm bolusing for a meal or for a correction. A little gun shy maybe.

But then I pay for it when I reduce the recommended doses.

I am 100% sure that, given enough time, I could figure it out (we are good at figuring things out). But, without a good reason to change right now, I will probably just add this knowledge to my toolbox and put it away for a while.

Granted, it may not be the best time to make a decision. Somewhat shaky about things and anxious to get back to my clear and shallow swimming pool - clear water and a flat and stable concrete bottom.

I'm also in a position where I don't need to make a decision. If I choose to re-evaluate again in the future, I'll have a better idea what I'm getting into and can maybe better set my expectations. I am deciding not to decide right now.

It sure has been an interesting few days!

14 Comments:

Blogger George said...

I really appreciate you posting about your experiences like this. I have never even thought about checking out Novolog until now.

Thanks Man.

10:12 AM  
Blogger Johnboy said...

Scott, I felt as unsteady when I tried Apidra. Seemed to work great for a while, then not so great at all.

I finally just chucked the last half of the vial and went back to my usual.

Sounds like you might eventually get down to fewer units with Novolog should you have the time or inclination to fool with it.

But, if it ain't broke and you ain't got time...

10:41 AM  
Blogger Nicole P said...

Scott -

I'm one of those that's a big Novolog fan - but I also understand the comfort of the norm - the thing that gives you what you expect.

I really thought at first you got flooded out in the storms. I'm such a dope.

Nicole

11:40 AM  
Blogger Scott said...

You are correct in that its as individual as we are. Personally, I absolutely HATED Novolog ... I found it was so incredibly slow that my numbers did not come down for 4 hours at least, and even more irritating, I found it lasted for about 6-7 hours after dosing, too.

Having tried Humalog, I can say for me it worked very, very predictably, peaking with the same level at hours 1-2, then no tailing activity at all. I find Apidra somewhere in the middle. We should keep in mind that insulin analogs are neither human, nor insulin, but man-made creations, and as one of my blog posters noted:

"Basically we're talking about a protein with hormonal activity and you should recognize that a much bigger protein molecule with just a single amino acid out of place causes sickle-cell anemia. In a small molecule protein/hormone like insulin, playing around with amino acid structure is tantamount to courting disaster relative to cancer, immunologic responses, and many of the things we are beginning to see in diabetics who have now been taking synthetic insulins for more than 20 years. Even the European Medical Agency has cautioned about the possible cancer-causing effects of many of the new analog insulin-like products, including Lantus, NovoRapid, and Apidra. The fact remains - no one has done long-term studies to either verify or vilify the answer to this question."

For people develop immunologic responses to insulin analogs, it means they work predictably for a while, then they stop working in a predictable manner. For them, regular switching between brands seems to do the trick, but it makes it a pain to come up with ratios until you get ratios for each brand down.

12:11 PM  
Blogger Heidi said...

Living in Denmark, the home-country of Novo Nordisk (the company that produces Novolog), the only option in terms of fast-acting insulin analogues is NovoRapid (the Danish name for Novolog). I have no experience with Humalog or Apidra so I cannot comment on that. However, when adding NovoRapid to my MDI regimen years ago, I noticed that 1 U of NovoRapid dropped me significantly more than 1 U of Actrapid (Regular), which was my fast-acting insulin of choice back then. NovoRapid seems more agressive, at least when the BG is in or around target range. With high BG's it seems to be more unpredictable in its effect - sometimes it works like a charm and other times it doesn't seem to work at all. Therefore I still turn to Actrapid when experiencing high BG's (> 15 [270]) that doesn't seem to respond to corrections with NovoRapid.

Anyway, Scott, you are right that people respond differently to different pharmaceuticals, and while trying out new insulins/brands of insulins might sometimes be necessary or desirable, it is usually hard work to make it work like you are used to. And so I agree with you and the comments from other readers, why fix it if it ain’t broke?

Good luck returning to the calm and predictable swimming pool ;-)

12:31 PM  
Anonymous Scott M said...

Well, at least you tried. Who knows, it could have gone in the other direction and been great for you. And you are right, with time you would adjust, but without great need... I agree with your decision to stick with what works.
My Novolog pens work good for me right now but when I switch to a pump I wonder if Humalog would be preferred.

3:39 PM  
Anonymous Theresa said...

Hi Scott,

I switched from Humalog to Novolog a couple of months ago due to insurance reasons. I really miss Humalog. I can see from all the other posts that it is different for everyone. I don’t use a pump so I use Lantus and Novolog injections. I find that with Novolog I need to take 1 or 2 extra units for particular meals and foods compared to Humalog. I also find that if my bg is high, I need more Novolog than Humalog and it takes longer to bring it down. For me, the duration of Novolog seems shorter than Humalog. I’m starting to figure it all out, but I like Humalog better than Novolog. Later this year I can switch to a new insurance plan and I might do that so that I can go back to using Humalog.

Good luck and keep us posted on how it continues to work out for you.

5:32 PM  
Anonymous Anonymous said...

This is Val at drjekyllandmrslow.blogspot.com - won't accept my password for some reason so that's why I'm anonymous


I just loved your image of slogging through the stream, bumping against stuff. I can relate - that's what every day seems like for me. I started on Novolog 3 years ago and switched to Apidra last fall and have yet to see anything predictable with either, though peaks don't seem quite as sharp with Apidra.

Maybe at my next endo visit I'll ask for a sample of Humalog to see if it's any different - never realized there could be such a drastic difference between them...

8:00 PM  
Blogger Drea said...

I switched from pumping humalog to pumping novorapid (canada's version of novolog) - it was a seamless transition, no major issues....you are right it is very individual....or maybe I did not pay that close attention to my body :)

9:39 PM  
Blogger Chrissie in Belgium said...

Scott, i have only used Humalog so I appreciate reading about the differences between Novolog and Humalog. I never knew that these two insulins affected people so differently! Since humalog is working fine I see no reason to futs with it. I didn't know that for some people Novolog can work faster than humalog. I had previously read the eopposite. I am still laughing about you stunt in the bathroom!

5:31 AM  
Blogger Kendra said...

I love your blog, Scott - both the entries and the thoughtful comments your readers leave. I didn't know that there was a significant difference between Humalog and Novolog. I was on Lantus and Humalog for my first two years as a diabetic. When I switched to the pump my endo automatically switched me to Novolog, saying that it would would be less likely to clog up in the pump tubing. I guess I should've clued in then!

I haven't noticed a change in my response vs Humalog, because the pump is such a huge improvement over the injections that I think it trumped any weird differences between the insulins I might have seen otherwise. I'm very curious now though, that's for sure...at any rate, I hope your navigation in the riverbed gets easier - or that you can return safely to the "easy" stream you knew before ;)

5:44 AM  
Blogger Bams said...

HI Scott,
Thanks for your words of encouragement earlier this month. I hope you find a balance with the insulin. Personally I switched from Humalog to Novolog just after starting the pump in 2005 and loved the change.
Good luck figuring out what works best! Enjoy the nice "warm" weather we are getting now if nothing else!
Take Care,
Amber

8:55 AM  
Blogger The Patient Connection said...

Research Blog on Diabetes and Lifestyle


We at The Patient Connection are currently running a research blog or online discussion on the subject of diabetes and the lifestyle of diabetics

In particular we are interested in your experience of genetic counseling or those of family members

We would love it if you could share your story or just post useful resources for fellow sufferers.

If you would like to join us please go to

http://www.thepatientconnections.com/blog.asp?uid=33

Thanks and remember your opinion counts

Best wishes

Belinda
The Patient Connection
Belinda.shale@thepatientconnections.com

3:08 AM  
Blogger julia said...

I like your description. I'm not sure if that's an insulin description or just life in general, but either way, it's excellent.

Hang in there - things sound a little chaotic for you right now.

6:34 PM  

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