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[IPm] Humalog Sensitivity -- Problem, Solutions

Humalog Sensitivity -- Problem, Solutions

There is substantial anecdotal evidence that something on the order of
5-6% of insulin pump users that use Humalog in their pumps experience
premature infusion site failure, marked by rising blood sugar levels
and increasing resistance to further administration of Humalog to the
same site. The solution to this problem for many has been to mix a
small amount of Velosulin or regular insulin with the Humalog. The
most common mix is 5 parts Humalog and 1 part Velosulin or regular
(Velosulin being the most common choice in the US). For current stats


For some time I have been in communication with Novo Nordisk about
their new insulin analog, Novolog. Recently I have received a "few"
reports from first users of Novolog that previously were using an H/V
mix because of the aforementioned problems indicating that the
premature site loss problems do not appear to be present when they use
Novolog in their pumps. This is not very conclusive and not at all
scientific. There is some science behind this but the problem is still
under investigation and this the description of the problem I received
from the researcher. If you would like further information, contact me
privately and I will provide you with a phone number and/or email as
you choose. ------------- quote" ...What is going on in the tubing set
is a very complicated interaction between lispro, the tubing and any
human insulin you have put in the formulation.  To understand it
thoroughly, you need to understand a lot about protein chemistry and
protein-protein interactions.... I don't think (although I can not
prove it) that the formulation that the human insulin is in makes a
difference. ....what I can say is that the "site loss" is related to
lispro chemistry and the presence of lispro monomer in the tubing.  I
believe that the addition of Velosulin competes for lispro monomer and
that the lispro-insulin heterodimer is more stable than the
lispro-lispro dimer." --------------

Last week I receive a communication from Novo indicating that they
would make Novolog available under their compassionate use program for
people with diabetes who are experiencing difficulty  with other
insulins. The details follow. Hopefully this information will allow
you to make a few more patient's lives a little more pleasant.


Michael Robinton
Executive Director
Insulin Pumpers
email @ redacted
Tel: 650 947-3350
Fax: 650 947-3356

> Novo Nordisk compassionate use program
> NovoLog(tm) is expected to be commercially available sometime in
> September or October.  In the meanwhile the medical department would
> like to provide NovoLog(tm) as a treatment option in individuals who
> are experiencing problems with other insulin products or who would
> clinically benefit from NovoLog(tm).
> If you would like to obtain NovoLog(tm), I would recommend you send 
> in the following material for consideration: 
> 1.	a letter from your
> treating physician on his/her letterhead stating your name and why
> they feel that NovoLog(tm) would be of clinical benefit to you in 
> your treatment. 
> 2.	A prescription for NovoLog(tm) specifically 
> stating how many vials you would need for a two month period.
> Please FAX the materials to my attention at 609-919-7713 and I will
> have our endocrinologist review them.  We will let you know of the
> results and the estimated shipping date if you are approved.
> If you need any additional information, please feel free to call me 
> at 609-987-5872.
> Kind regards,
> Sofia A. Iqbal, R.Ph.
> Drug Information Scientist
> Novo Nordisk Pharmaceuticals, Inc.
> 100 College Road West
> Princeton, NJ 08540
> (609)987-5872
> email @ redacted
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