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Re:[IP] heat and humalog

> On Sun, 3 Aug 2003 19:23:54 -0700 "Pam Basinger"
> <email @ redacted> wrote:
>  >>>I live near Palm Springs CA. Even though I'm in air conditioning
>  at 
> 80 degrees
> most of the time the humalog in my pump lasts less than 48 hours
> before drastically loosing potency. I'm going to have to replace
> insulin every morning and that's a drag. Any ideas? Thanks to you
> guys though for your info re. reusing the site, tubing and
> reservoir. That is helping me a lot.<<<

Hi Pam,

>From you brief description above, I would guess that you have a
mild allergy/sensitivity to Humalog. Almost ZERO people in the medical
profession know about this, but Insulin Pumpers has been tracking the
data for a number of years. Since we are not a "professional"
organization, our data findings are generally ignored except on a
one-to-one basis with individual docs.

Briefly, Approximately 6% of pumpers that use Humalog suffer some side
effects that appear to reduce site life to something like 36-48 hours,
after which bg's begin to rise and the site becomes very resistant to
additional insulin infusion and may exhibit reddening and/or small
lumps. Moving the site appears to alleviate the immediate problem. The
overall result appears to be a localized (at the site) resistance to
insulin that makes control very difficult. Mixing another insulin,
usually Velosulin (however a few pumpers use regular), seems to
alleviate the symptoms and allow the infusion sites to function as
well and as long as using regular or velosulin alone.

If you check the ABOUT page of the web site, you will see the 6%
number for "mixers" and that most people that mix us 5 parts of
Humalog and 1 part Velosulin. Your next question will be "what is
Velosulin" :-)   --- It is a regular insulin that was developed with
specific buffers for use in insulin pumps. In most other respects it
behaves pretty much like regular insulin.

It is thought by one researcher that the sensitivity to Humalog is
brought about by a complex chemical interaction with the infusion
tubing and that mixing small amounts of regular or Velosulin with
Humalog somehow prevents the interaction or scavenges the offending
molecules. That research is not published. 

A second solution is to switch to Novolog. Novolog is chemically
different than Humalog and does not appear to cause the same 
reaction in those sensitized to Humalog.

Neither Humalog nor Novolog are true insulins, they are insulin 
analogs. They differ in that both have certain amino acids modified or
switched in their molecular chains. In Humalog, the amino acids in
positions 28 and 29 on the insulin B-chain are reversed. In Novolog, a
single substitution of the amino acid proline with aspartic acid is
made at position 28 in the insulin B-chain.

So far a good number of our "mixer" pumpers have switched to
straight Novolog with good success. A few people have reported that
Novolog does not work for them, but they do fine on Humalog. Since
there are few users of Novolog at this time, it is not known if there
is a similar subset of individuals that may have sensitivity to the
composition of Novolog/NovoRapid.

Hope this helps,

Michael Robinton
Executive Director
email @ redacted
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