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Re: [IP] To H or not to H


There are a number of pumpers using Humalog with the endorsement of their
health care teams, even though it has not yet been approved by the FDA for
use in pumps. Lack of approval by the FDA seems to be more directly related
to the slow, cumbersome approval process than with the insulin's viability
in pumps. FWIW, it's interesting to note that the initial baseline data
collected by Eli Lilly for testing of Humalog was done with infusion pumps
(learning little "tid bits" like this is one reason I save package inserts
from drugs).

One advantage of starting pump therapy with Humalog seems to be the speed
of onset and short life span of this insulin. This can make some of the
initial adjustments (basal rates, boluses) easier to calculate and deal
with. This may also contribute to the "freedom of lifestyle" which the pump
vendors advocate as one of the benefits of pumping - you typically don't
need to bolus well in advance of meals and snacks as many of us do with
Regular (or Velosulin). Many users report more "spontaneity" with Humalog.

Some potential issues to be aware of re: Humalog:

1)  Many users need to change their infusion sites more frequently than
with Regular (often at least every 2 to 3 days, compared to 3 or more days
with Regular). This *can* be more expensive, or simply prove inconvenient.
No one seems to know why this is the case, but for many people, the
infusion sites seem to lose their effectiveness after two days. This is not
the case for everyone, though. Some users report no "early site loss" with
Humalog. This is a subject of endless discussion on these lists.

2)  Humalog appears to remain less "stable" at temperature extremes than
Regular. It freezes at a higher temperature than Regular, which means you
need to watch it when you transport it in one of those "insulin cooler"
packs, for example. Humalog seems to be really fussy about high
temperatures. This may not be a factor for you, depending on where you live
and what your lifestyle is.

3)  Since Humalog has a very rapid onset and short life span in your system
it is important to time your meal boluses properly. High fat, or slow
digesting foods might prove a challenge - the insulin will peak and then be
done, often well before the meal is finished breaking down. "Square wave"
or multiple, smaller boluses over time can help to deal with this.

There is a slightly higher risk of DKA with Humalog if your insulin supply
is interrupted. Again, this is due to the fact that it is gone from your
system so quickly. More frequent monitoring of your BG levels might be
necessary to guard against this.

4)  Some users have reported "sensitivity" to the Humalog. Lilly makes you
aware of this in their product literature and notes that this may be true
with any insulin. In my particular case, it appears that I am very
sensitive to Humalog. We are terming this an "allergy", though we do not
know of any definitive way to test this, other than discontinuing the use
of Humalog. This was barely perceptible when I started using it in my pump
in August '96, but eventually got to the point where I could not use it
anymore. I simply stopped using it after 18 months and am working on "re
tooling" my procedures for using Regular once again. Nothing lost,
hopefully a lot learned in the process.

Your current BG "swings" seem to be very typical of a regimen using NPH and
Regular twice a day ("Gee, I wonder when that morning NPH is going to team
up with my evening NPH and smack me in the head?" - Been there, done that
;-)). The post meal highs / pre meal lows are very typical of this regimen
- tricky to adjust.

Pumping should smooth much of this out for you, since the constant basal
supply of fast acting insulin is much more predictable than NPH. I also had
a history of "wild swings" (lessened considerably once I started pumping,
but still something I need to be aware of), which caused me to be a little
more cautious when switching to Humalog in my pump.

Since you are already using Humalog to bring down highs, you might do well
with it in your pump to start with. If it doesn't work, you can always try
Regular. Above all, remember that YMMV (Your Mileage May Vary), check with
your health care team frequently and holler if we can help.

Good luck with the pump.

Bob Burnett

mailto:email @ redacted
Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/