August 14, 2008

Why I LOVE Apidra

Apidra is the brand name of yet another fast acting insulin. Its generic name is "insulin glulisine" and that is the name you will see it referred to in medical research studies.

I had been doing quite well with Novolog, but was curious to try Apidra as I had heard it was even faster and more physiological in the way it acted than Novolog. So at my last endocrinologist appointment I asked the doctor about it and she offered me a free sample.

The sample came in the form of a cartridge which had to be inserted in the Opticlick pen. At first I did not think I was going to like it. The Opticlick pen is reusable and is more bulky than the disposable Novolog pens I was used to. It comes in a case that looks like an eyeglass case and barely fits in my purse.

The Opticlick pen also features some electronics that keep track of the dose and the instructions say that if you put it in the fridge that will ruin the pen. Since I have always kept my pens in the fridge to preserve the potency of the insulin and we were headed into summer--the time of year when I traditionally cook a pen or two just walking around with it in my purse on a hot day--I figured my Apidra trial would be short.

Was I wrong! The Apidra cartridge I opened on April 11 dispensed its last unit last week.

The extra long life was due to two factors. The first is that I was eating extremely low carb 2 of the past 4 months at the urging of my surgeon, and when I eat less than ten grams of carbs per meal I only need to use my Levemir.

The other reason was that the Opticlick pen only requires that you shoot one unit to prime the pen, rather than the two units you have to shoot to prime the Novolog pen. When your usual dose is two units, as mine is, having to waste two units every time you take a shot makes the insulin disappear pretty quickly. (My carb insulin ratio right now when I am also injecting Levemir is 1 unit to 20 grams of carbs.)

The last few units of Apidra I injected were just as powerful as the ones I shot the first day I tried it. When I opened a new cartridge I was able to keep using the identical dose to cover the same amount of carbs, which is proof that there was no gradual fade with the previous cartridge. And that was true despite the fact that the Opticlick pen has been sitting in an un-airconditioned kitchen cabinet for the past 4 months--when it hasn't been traveling to restaurants on hot summer days in my purse.

This stuff is ROBUST!

But that's only the beginning of why I love this insulin. The other reason is its activity curve. Now please note, various insulins may perform differently in different people's bodies, so my results might not be your results. But my experience with Apidra is that if I inject it right before my first bite it covers fast carbs perfectly.

What do I mean by perfectly? I mean that if I cover an ear of fresh picked sweet corn with 1 unit right before my first bite, at 1 hour I am at 104 mg/dl and I'm back in the 90s at 2 hours. Since at 2 hours it has just about stopped working, I do not see delayed hypos when I get those good numbers at one hour.

The only potential downside with this kind of activity curve is that if you are eating really slow carbs you may have to split your doses for the meal and inject a second dose at 1 or 2 hours after eating. Otherwise the insulin may peak before your food is digested. I have mainly seen this happen with a slice of pizza eaten with the whole crust and a enchiladas/bean dinner.

But it's a lot better to have to give yourself a booster shot at one hour than to reach that one hour with your blood sugar unacceptably high, or to have to wait for a half an hour after you inject before you can start eating.

I had been concerned because I'd read that if something happens to the Opticlick pen the only place you can get a new one is from the endocrinologist. They aren't sold at pharmacies. But so far this hasn't been a problem. My pen is still working well.

What I really love about the pen is that it has an LCD display that retains the number of units you have injected. So if you are scatterbrained like I am, and inject without giving the dose quite as much attention as you should have, you can look at the pen and for a few minutes it still displays what dose you injected. That's very helpful.

It turns out that the company that makes Apidra (which is the same company that makes Lantus)is going to be selling Apidra in the Solostar disposable pen. They already have switched to selling Apidra in Solostar pens in Europe. That will make Apidra more competitive with Novolog and Humalog which both come in disposable pens. No one can tell me when this will actually happen, but supposedly it is scheduled for sometime in 2008.

I have tried the Solostar pen as my doctor gave me a Lantus Solostar sample last fall when they came out. It is pretty much identical to the Novolog pens and does not track the dose used. Unfortunately, the Solostar requires you to use 2 units to prime the pen, unlike the Opticlick which only uses one. This means the pens will not be lasting anywhere near as long for me. When I am not low carbing my Novolog pens usually last six weeks to two months--if I don't cook them first, a big IF.

I'm told a lot of pump users use Apidra, which given how stable and fast acting it is makes a lot of sense. But if you inject fast acting insulin and are still seeing highs at one hour, you might want to ask your doctor about trying this newer insulin and seeing how it works for you.

If you do test it, start with a low dose and expect it to work faster than the insulins you are used to.

4 comments:

k2 said...

Apidra is great! Personally, I keep switching betwn Apidra & Novalog and have an RX for both.
Novalog is better in the heat (higher bake rate than most fast acting by 1 or 2 degrees) and I do a lot of watersports & outdoor activities in the summer.
But like you said, Apidra is very ROBUST and extremely fast acting.
I'm not sure of the bake rate, as I just started with it. I need to look it up & will let you know.
My CDE gave me a boat load of Apidra samples (3 months worth) last month when I got my cortisone injection & was going through insulin like water! Once again,
I was impressed on how quickly it worked on my elevated blood sugars (thank u cortisine,) bringing them closer to normal very quickly.
I plan on using them for the rest of the summer, heat wave or not!
k2

Khürt said...

Jenny,
I was told that once the Novolog leaves the fridge I have 30 days to use it. Since I work in an office I take my insulin with me and it sits at room temperature most of the day.

My carb insulin ratio is 1 to 6 so even if I shoot 2 units to prime the pen I never complete the pen before the 30 day period.

I have very good control with Novolog and Levemir ( 18 units daily ). Will Apidra benefit me?

Jenny said...

Khürt,

The 30 days is all that Novo-Nordisk or any of the other insulin companies will guarantee their insulins for.

Quite a few people have been able to keep their insulins going for another month without obvious fade though usually if you use a vial for a long time when you open a new vial you may find that it is a bit stronger than the old stuff.

My Levemir which I get in 100 ml vials starts to weaken after about 6 weeks, which is a shame because I use so little.

But I have used quite a few Novolg pens until the last drop was gone.

So in practice this means many of us keep using the same pen or vial until we start noticing unexpected highs. Then it is time to get a new one.

Jonah said...

I use Novolog and I have very slow digestion and don't see meal spikes even on my CGMS. But I use a NovoPenJr, which means only a half unit to prime, because it doses in half units. I'm glad you are liking Apidra.

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