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Re: [IP] Continuing Humalog / Velosulin saga
My apologies in advance for what may be a boring, lengthy ramble. Please
delete if not interested ;-)
Some other musings on Humalog / Regular / Velosulin:
Humalog is absorbed by the cells much more quickly than other synthetic
insulins (obvious, but important). It is possible that this faster cellular
absorption may also eventually affect the cells, "tiring them out" in
effect. It's entirely possible that this end result is independent of any
other factors being discussed (antibodies, etc).
Some users have reported situations where they have consumed more carbs
during a day than normal (examples include picnics, meals out, liberal
snacking, etc). Boluses have been correct for all carbs consumed, but a
point is eventually reached where the Humalog "seems to completely stop
working", or "just gives out". This is sometimes described within the
context of "early site loss". It's often been noted well in advance of the
time a site change is scheduled, sometimes within a day of starting a new
site. These anecdotal reports indicate that moving the site in these
situations resolved this problem.
I don't know for certain how tired cells "react", but it seems plausible
that tissue hardening at the site might be one end result of this, as the
cells go through a rejuvenation or "refresh" process. I also wonder if
sensitivity or allergic reaction to Humalog can be a by product (short term
or long term) of changes in how the cells react to the different insulin
I've suggested several times in the past that insulin antibodies might be a
possible factor, but within the context of "long term insulin dependent"
diabetics. I was specifically wondering if antibodies which had been
present for some time *prior* to the start of Humalog therapy could
eventually interfere with cellular transport of Humalog. I've never
received any definitive answers to these questions.
It is worth reading the package inserts for the insulins. Eli Lilly posts
these on their web site: http://www.lilly.com/diabetes/humalog/index.html.
Lilly specifically mentions in the "Prescribing Information for Health Care
Professionals" that Humalog "has less intra- and inter-patient variability
compared to human regular insulin." I assume many health care professionals
prefer less variability, hence Humalog's popularity, especially with new
pumpers. Basically, it limits many of the start up variables for the health
care team and the patient. Quicker "ramp up" times, fewer wrestling matches
with basals, carb ratios, next patient please ;-) (No slap in the face for
any of the dedicated health care professionals, but there is a tremendous
amount of pressure in the "industry" for quick turn around times).
Careful reading between the lines here also hints at why Regular or
Velosulin are more time consuming start up choices for pumping. More intra-
and inter-patient variability of these insulins require more time spent
adjusting rates, revising, checking with the patient / health care team, etc.
This next point is important, so try to stick with me here: It is this
variability of the Regular and Velosulin insulins which make mixing with
Humalog such an "in exact" process. If R or V exhibited as little intra-
and inter-patient variability as Humalog, the mix ratios and combinations
would be very straightforward to compute, adjust and settle in with. The
proper ratios would be pretty consistent among users. That's not the case,
though. This is one possible reason why there is no "blanket endorsement"
of this procedure.
That's why YMMV, sometimes greatly.
Bob - who wishes that I listened to my mom and became a scientist or doctor
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