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Re: [IP] Site absorption

> This is definitely a newbie question.  I've been pumping for under a
> month.  I've noticed that my bg is much better on days one and two
> of a site than on day three.  This is day three and my numbers are
> creeping slightly, its also hotter than h*#% here as I'm sure it is
> most everywhere.  Is the problem that the site is old or is it the
> heat, or both?  My CDE wants me to change my sets every 48 hrs, this
> is probably why.

Site degradation within 36-48 hours of a site change is usually a 
sign of sensitivity to Humalog and can most often be eliminated by 
mixing Velosulin or regular insulin in small quantities with the 
Humalog. The subject of mixing H and V or R has been discussed in 
many threads on the list. I would first encourage you or anyone else 
suspecting a sensitivity to H to use some other insulin for a week or 
two to verify that whatever symptoms you see that makes you suspect a 
sensitivity GO AWAY on straight Velosulin or Regular. I know it is a 
pain to use a slower insulin, but the time needed to verify your 
suspicions is short. Many people have skipped this step successfully, 
but my engineering background makes me suspicious and prone to want 
solid answers first :o)

The question has come up periodically about mixing Humalog and 
Velosulin or regular insulin to reduce or eliminate infusion site
corruption / loss. There is substantial ancedotal evidence that this
mix solves the immediate problem however WHY is not clearly
understood. Around 5% of pumpers report a sensitivity (not an allergy)
to Humalog that is mediated by mixing a small amount of Velosulin or
regular with the H. Current science indicates that the underlying
problem is related to lispro chemistry and the presence of lispro
monomer in the tubing. What is going on in the tubing set appears to
be an interaction between lispro, the tubing  and any human insulin in
the formulation. It is believed that the addition of Velosulin
competes for lispro monomer and that the lispro-insulin heterodimer is
more stable than the lispro-lispro dimer. Most pumpers who decide to 
try this method (my daughter included) use 5 parts of Humalog and one 
part of Velosulin.

Any persons working on this problem or physicians seeking additional
information / explaination for patient treatment should contact me
privately by telephone or e-mail and I will provide contact
information for the folks doing the investigation so that you may
obtain a better understanding of the science behind this. The
information may be limited as there are intellectual property
considerations that have not yet been resolved.

Michael Robinton
Executive Director
email @ redacted
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