Nova & Apidra

[bennyg70]

I dont feel im getting on that well with apridra since switching. I find it unpredictable, and sometimes just like injecting blooming water. If I eat something with a little fat in it then Ill have good bloods post 2 hours, but then raises after.. And it does absolutley nothing for me if I eat a high fat meal where I know Im going to spike 3 or 4 hours later. The hypos can be pretty nasty. Especially if I eat at say 7 or 8 (A meal out) and the spike may happen when im asleep, its very hard to time an apidra injection which gets into my system quickly and out within 6 hours.

However, Its good for corrections, and good for sweet snacks such as cookies & high gi foods such as baked potatoes etc.

So , Im going to give both a try. I have about 10 pens of nova in the fridge, and apidra on prescription.

What are your thoughts? Do you think Im safe to do this? I want to give it a try before approaching my DSN to get both on prescrption.

 

[Northerner]

Well, we can't give advice on such things, but if it was me in your situation and I had gathered enough information about when it was appropriate to use one or the other, then I might give it a try. But then you may end up in a situation not knowing which you prefer overall. Would it be possible to adjust the timing of your apidra for fatty meals e.g. injecting after eating? I know some people do use 3 insulins, so it's not unheard of 🙂

 

[bennyg70]

Well, we can't give advice on such things, but if it was me in your situation and I had gathered enough information about when it was appropriate to use one or the other, then I might give it a try. But then you may end up in a situation not knowing which you prefer overall. Would it be possible to adjust the timing of your apidra for fatty meals e.g. injecting after eating? I know some people do use 3 insulins, so it's not unheard of 🙂

Ive tried allsorts with the apidra, but its unpredictable to me. Somedays it seems to be quickly released and some slow. Somedays it seems to last 4 hours, some 2. At least with my nova there were definate patterns, and Id just got to the point when I thought I had it cracked. And they told me give apidra a try you can always changed back..... I wish I hadnt of really. I feel Ive lost months of testing and information! and back to square one a little.

Its good to hear I wouldnt be the first though.. Ill give it a go and see how I do.

 

[Northerner]

It does seem silly to put you on a different insulin when the one you were using was starting to work well for you!

 

[bennyg70]

She was a new DSN, and during my first appt things were a bit up and down, it was during here that she tried the apidra selling pitch and said wed look at it next time. In the space of time between that appt and next I made some changes... Ie slashed my lantus and a few other things and really started to get things right.. I think I even went 4 days withs no Lows, and nothing above 10mmol (Moajority 4 - 8mmol) that was leading up to the appt. So upon the next appt although I was doing well I think shed got it in ehr head to get me on apidra (I recall her saying that they prefer their patients on it in this area). So I thought, well, Ill give it a go and see what happens....

 

[Northerner]

And now you know! 🙂 I'm sure it will be useful feedback for her. I think it's a bit strange to prefer people to be on one particular type of insulin - easier for them maybe, but it's not her diabetes, it's yours! 🙂

 

[everydayupsanddowns]

If you've tried it and are getting worse/less reliable results I can;t see she would have much problem switching you back.

For me running two rapid insulins side-by-side would be too much of a brainache keeping track of what does what, which I would need when and juggling timings etc of dose splits.

Which moves me neatly on to...

Have you done much experimentation with split doses with those high fat/large meals while on Apidra? (ie a proportion up front and the balance 1-2 (or more) hours lateer). I need to do this on NovoRapid and suspect I would need to even more on Apidra given its reputation for being faster in and faster out.

 

[bennyg70]

Hi Mike,

Ive tried it but I jut find with the lack of tail I cant get the timing right, like id begun too on novarapid. I think in reality I would keep apidra there for odd occasions and highs that needed correcting quickly. And the nova for main use / everyday use..

Ill give it a go over XMAS and see how I get on!

 

[novorapidboi26]

When and how often do you have highs that need correcting quickly........?

Not too often I would imagine.....🙂

 

[Robster65]

I do have issues with the fixed profiles of insulins vs the unpredictable, varied profile of food.

As you say, apidra designed for high GI and Novo and Humalog designed for med GI. Low GI needs a split, which may suit apidra better since the 2nd dose might not overlap so much with the 1st.

This is one reason I fancy a pump, but sadly, not a NICE criterion.

I would be tempted to go back to what seemed to be working despite what they prefer. Is there any rational reason why they prefer it?

Rob

 

[fencesitter]

I think Gary Schein in 'Think like a pancreas' argues in favour of different insulins for different situations. Maybe if you get the point where you understand very deeply how various combos of food/insulin types work, it would be a good way to go, but must require quite a bit of study

 

[everydayupsanddowns]

I would be tempted to go back to what seemed to be working despite what they prefer. Is there any rational reason why they prefer it?

Rob

Maybe they just like the Apidra rep better 🙄

 

[Robster65]

Maybe they just like the Apidra rep better 🙄

haha. I did wonder that too! 😉

Rob

 

[bennyg70]

haha. I did wonder that too! 😉

Rob

I do have issues with the fixed profiles of insulins vs the unpredictable, varied profile of food.

As you say, apidra designed for high GI and Novo and Humalog designed for med GI. Low GI needs a split, which may suit apidra better since the 2nd dose might not overlap so much with the 1st.

This is one reason I fancy a pump, but sadly, not a NICE criterion.

I would be tempted to go back to what seemed to be working despite what they prefer. Is there any rational reason why they prefer it?

Rob

I did get the feeling that it was the one they were instructed to promote, maybe they get it cheaper or something... I dont know how it all works..! But the approach was in the same way they wanted me to use a certain metre..! Although the selling points she used... In system quicker, out of system sooner, reducing spikes, and hypos 4 hours after food, did sound appealing. Unfortunatley I havnt found this to be the case in most circumstances.

I want my Nova rapid back!!

NRB.. Probably more than youd think, and less than I give myself credit for..

 

[everydayupsanddowns]

I did get the feeling that it was the one they were instructed to promote, maybe they get it cheaper or something...

According to BNF the cartridges pretty much identical ?28.30 for Apidra, ?28.31 for NovoRapid. The Novo disposable pens are a tiny bit more expensive (up to ?32 per pack of 5 while Apidra is ?28ish) But it's not really enough of a difference to steer the decision I would suggest.

If they were encouraging you to go back to hypodermic syringes and Actrapid I'd could see the savings mounting up (?7.50 per 3ml vial) - but they don't make cartridges for that anymore 🙄

 

[bennyg70]

I do use the disposable pens, But in my opinion that could be considered one heck of a saving.. ?60 per year for me x however many diabetics under her care.. I dont know the figures, but possibly not a figure to be sniffed at! Could fit a few extra insulin pumps into the budget!

Like I say I dont know enough about it, And Im surprised that I onlly cost them ?384 per year in fast acting insulin, I thought It would have been so much higher.

I must cost them a fortune in test strips though!

 

[Northerner]

I do use the disposable pens, But in my opinion that could be considered one heck of a saving.. ?60 per year for me x however many diabetics under her care.. I dont know the figures, but possibly not a figure to be sniffed at! Could fit a few extra insulin pumps into the budget!

Like I say I dont know enough about it, And Im surprised that I onlly cost them ?384 per year in fast acting insulin, I thought It would have been so much higher.

I must cost them a fortune in test strips though!

Most test strips cost the NHS about ?15-?16 for 50 🙂

 

[trophywench]

Perhaps ..... Ms DSN has found most of her patients to be carboholics, so if you are stuffing down a shedload of fast acting carb and virtually zilcho fat !!!! - then yes Apidra could indeed be a lot better, then of course if you eat fast carbs between meals and jab for it, the short tail would help with 'anti dose stacking' wouldn't it?

Have you see this Benny?

http://www.diabetes-support.org.uk/info/?page_id=408

Find that quite helpful when I need it.