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[IP] Regular by Pump/ Humalog by Pen

Bob Burnett,

I have had similar, although not as serious, problems with Humalog when
I've used it in my pump.  My sugars would be erratic, originally after a
day or two, eventually on the same day as starting a new site.  Also I had
the hardness develop at my infusion sites. I did wonder at first if I was
allergic to this new (at the time) insulin.  In the end, I've concluded the
main problem was at the infusion site, whatever was going on.  However, I
always knew that the Humalog worked for me, since I could give it by
injection (a new site each time of course), and it worked beautifully.  I
finally switched back to Regular in my pump, over a year ago.  My infusion
sites cleared up quickly, and my sets have been lasting 5 to 7 days.  

One thing that I do differently from you though, and it has been very
successful for me:  I use the Regular in my pump for my basal, and usually
about half of my bolus requirements.  Then I bolus the remaining half with
Humalog in my pen, and also as you, use Humalog in my pen to bring high
sugars down.   I vary the ratio of H/R bolus depending on the food I eat
(glycemic index), the exercise I'm going to do, or have just done, or if I
am also trying to adjust for an upward or downward blood sugar trend.  I
noticed you rarely use more than 2 units of H.  That's normally my upper
limit as well, although more because a higher amount can send me low pretty
quickly.   I do a lot of outdoor exercising, (still back country skiing in
the mountains of B.C. Canada, and pretty soon will be mountain biking and
running).  I've developed a number of "rules" for me to handle the two
insulins.  When I used to use straight Regular in my pump my HbA1c's tended
to be in the mid 6's.  This new regime has brought me down into 5.6/5.7
over the last year, something I never thought possible.  I should mention
that I test frequently, especially before, during and after exercising.
Lately I've been testing 8 to 12 times daily.  When I've tried to reduce
this, even though I'm getting a bit better at predicting my sugars, I often
found myself with big highs or deep lows.  I no longer worry about trying
to reduce the testing, and just do what works for me.

The upside of the two insulins is the better control; the down side is the
two means of delivering the insulin.  Too bad there is such a problem for
some of us using Humalog in the pump.  By the way, since joining this group
a couple of months ago, I've learned lots, including the 5:1 mix of R/H.  I
tried it for a couple of weeks, and it was better than straight H. However
I do like the extra site life using Regular so have switched back.  Also
with separate insulins, I can turn down the R several hours before
exercising, and only bolus with the shorter acting H if required to handle
food or highs.  This leaves me with only small amounts of insulin in my
body and a low basal rate when I start the exercise.

 Another tip from this group that worked really well for me was the
Silhouette infusion set.  When I'm carrying a pack, the belly strap used to
rub my sof-set and would sometimes create an infection.  The lower profile
of the Sil doesn't seem to cause that problem now.  I haven't explored
other infusion sites yet, but that option is now open for me which I
couldn't do with the sof-set.

In Canada, we have switched to kilometers to measure our distances.  I
guess the acronym YMMV (Your Mileage May Vary), should change to YKMV for
us Canuks.  ..........Na,doesn't have the same ring to it!

Bob McQueen (an un-civil Mechanical Engineer)

>Fri, 16 Apr 1999 07:19:09 -0400
>From: Bob Burnett <email @ redacted>
>Subject: Re: [IP] Regular Insulin in Pump

>The quick answer is "I had no choice". I was getting no response from it; I
>often needed to change infusion sites at least twice a day, frequently
>three times a day; my sites were all very hard, as if muscle had developed
>under the surface; sites were usually bright pink, often red immediately
>after inserting new sets, especially after boluses; frequent rapid, racing

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