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[IP] Bill Van Antwerp - Clarifying the Infusion Site Problem



Bill:

1)  What about the action of insulin "antibodies" as a possible contributor
to site loss with Humalog? I have heard a number of times that people who
have had diabetes for many years can sometimes produce insulin antibodies.
As I recall, these antibodies can result in the body not utilizing
exogenous insulin properly. Do you see different site loss statistics from
long term diabetics compared to patients "more recently diagnosed"?

2)  There are times when it appears that length of time for the set at one
site does not appear to be the issue as much as it might be the total
amount of insulin infused during a given time. In other words, there are
times when I can bolus much more than my usual (holidays, parties, or other
types of events), and the site might "fail" much sooner than the normal 2+
days. Sometimes this is a little as 1 to 1.5 days after insertion. Is it
possible that Humalog triggers "antibodies" quickly, and the sites will
fail in response to them?

3)  Are there any "by products" of the action of Humalog which are not
present with Velosolin, Regular or other slower acting insulins. Does the
presence of Velosolin or Regular (as in mixtures with Humalog) abate the
production or action of any "by products"? Note that some of us (myself in
particular) have noted some buildup or hardening of the tissue at the site,
despite Humalog's claims that this does not appear to be a result of the
product. This was more noticeable over time. I have heard no reports of
this from people injecting Humalog, but have heard from some people that
this has happened to them while pumping Humalog.

4)  Could there be certain "body types" which present a different set of
variables, re: loss of site? For example, people with different body mass
might have different results with a set over time. Are you seeing different
results with patients with a relatively low ratio of body fat to total
weight, etc.?

Many of us here are eager to hear your thoughts on this..

Bob Burnett
mailto:email @ redacted

<snip>
>I will be writing my thoughts about Humalog to the group soon, but one
>thing that is worth discussing now is the ideas of different buffers.
>Humalog and Velosulin are BOTH buffered with phosphate and use the same
>preservative system, i.e. m-cresol.  Both have the same temperature
>stability at least as measured in any lab experiment that I know about.
>Any other ideas are really welcome.
>
>Bill
>