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Re: [IP] Forward from Bill at MiniMed re: Humalog Velosulin mixe

On  2 Jan 98 at 11:40, Michael wrote:

> From: email @ redacted (Bill Van Antwerp)
> Subject: Re: [IP] various comments
> >1/1/98
> >
> >How did everyone do last night watching bg values? I woke up this
> >morning with a 242, not bad considering. I have noticed in the past
> >when my bg is above 200 I have to be aggressive to get it down by
> >using bolus and an increased temp base rate. Last night I just used
> >the temp base rate increased by .3, it kept it below 300 but wasn't
> >enough to drop it below 200.
> >
> >I'm interested in the mixing of regular and humalog, can you tell me
> >what ratio you used? I'm going to mention it to my doctor it sounds
> >like a good idea for those of us who seem to be having trouble on the
> >third day.
> >
> >I got a sample silhoutte and bent needle from MM but no instructions
> >on how to use them, the silhoutte dosen't even have any tubing, how
> >am I going to use it?? Someone with experience please comment.
> >
> >Happy New Year to all
> >Carol
> >Carol Wasson
> >email @ redacted
> There have been a few comments on mixing Humalog and Velosulin to
> counteract the "loss of site" issues that appear to happen with
> straight Humalog.  SOmeone mentioned that their physician recommended
> this.  Does anyone have a theory how this might work?  We at MiniMed
> have heard this proposed and even heard some anecdotal evidence that
> it works, but how?  I can not think of a mechanism that could allow
> this mixture to work.  Several questions immediately appear when this
> is suggested and the first is what the heck is happening at the site. 
> We are working fairly hard at understanding the issue of site loss in
> some animal experiments and still have not enough leads.  IF anyone in
> the group has a theory no matter how silly you think it sounds, lets
> discuss it.
> Bill

1.	Saturation of the tissue in the area with Humalog - look for a 
difference in the transport rates or residual levels between Humalog 
an Regular.  

2. 	Presence/Absence of the buffering compounds changing the rates as 
suggested above.

3.	Solvent, esters, or something else being leached out of the 
tubing, resevoir or cannula by Humalog and  not leaching out by 
Regular - these compounds could either just interfere with absorption 
or actively inactivate the Humalog.

4.	The old temperature argument - and what happens to some of that 
residual Humalog that is still hanging around?  Does it break down? 
Could the accumulation of these breakdown products be contaminating 
the sites?  Does something similar happen to Regular but we've never 
noticed it?

Randall Winchester

* The views expressed here are mine and do not necessarily *
* reflect the official position of my employer.            *
* There's no guarantee on anything said here...
* If I say I understand something completely the only thing
* we can both be assured of is that I must have completely
* misunderstood something.