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Re: [IP] Regular by Pump/ Humalog by Pen

Bob McQueen responded to my experience with Humalog:

>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

For me, the tissue hardening was a separate issue from the rash and rapid
heartbeat / pulse, though they both got very troublesome at about the same
time. I suspect the tissue hardened over time, just getting to the point
where I couldn't continue using H. I'm pretty sure the rapid pulse happened
right from the outset, but I shrugged it off as simply a "different
feeling" with the new insulin. I've heard some describe being able to "feel
the Humalog kicking in", or a "rush" after bolusing and wonder if this is
similar to what I experienced. Toward the end, this rapid pulse thing got
pretty interesting, much more pronounced - a number of times my heartbeat
felt like I had just run up a couple flights of stairs. This would happen
after boluses as well as between meals, was not related to rapid rise /
fall of BG levels. The fast pulse (tachycardia?) part of the total Humalog
experience, combined with the rash, is what we termed an allergic reaction.
The tissue hardening was just another variable to juggle. It was strange
and a bit scary at times.

I've heard from at least one medical professional that "the sine qua non
for insulin allergies is itching AT the infusion site" - a loose
interpretation would be "if it ain't itching, you're not allergic". Other
doctors I've spoken to differ on this, feel that you can be allergic
without itching. I'm not sure if I had itching at the sites with Humalog.
If I did, it was not the kind of thing that drove me nuts, since I don't
have separate notes on it. I can state I have not had anything like this
with Velosulin, using the same sets, site prep technique, etc. as I had
with the Humalog.

>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

I've tried this with mixed (no pun intended) results. More often than not,
it's worked well, but there have been a number of times that some of the
old symptoms returned - noticeably a very rapid pulse. There has been at
least one occasion where I developed a deep rash on my upper chest after a
4 unit dose of Humalog from the pen. I don't do this any more.

>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

I've achieved A1cs of 6.1 (my lowest) on both Humalog and Velosulin. I
think I was too often on "the edge" with Humalog, and had a bunch more
lows, but a good A1c. My endo and I are happy with my current reading of
6.8. I am one of those people who can drop very low very quickly. Trying to
achieve an A1c of lower than 6 would be very difficult for me.

>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.

I'm a big advocate of testing as often as you need to - damn whatever
"magic formula" the insurance providers are using to predict strip usage. I
*always* test before driving - if I'm in and out of the car 4 times during
the day, I'll test each time. I always test before and after physical
exercise and often during the exercise. 8 to 12 times daily is not unheard
of for me. After more than 15 years of test strip insurance reimbursement,
I still get questioned on the number of times I test each day.  I still
have big highs or big lows, I test when I need to. I've got diabetes, after
all - stuff happens <g>.

>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.
With Velosulin, I reduce my basal rates 1.5 hours prior to the start of my
exercise. This seems to work well. If I drop the basal 2 hours in advance,
I start to climb a bit too rapidly to at the beginning of the exercise to
"ease into" it (things like golf, curling, etc.) For cross country skiing,
ice skating, roller blading, I'll drop the basal 2 hours in advance, since
I tend to be very active right from the start. A BG that's a little high to
start with is often easy to deal with for these latter activities. It's a
constant experiment :-)


Sorry for the ramble - it's a long story.

Bob Burnett

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