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Re: [IPm] Re: Humalog Sensitivity -- Problem, Solutions

> Dear Michael:
> The explanations that you have been given are very improbable.
> Although I am not privy to all of the physico-chemical data
> regarding lispro insulin, insulin loss can occur by one of three
> mechanisms.
Hi Dr. Shank.
I don't have any personal knowledge or understanding of the 
mechanisms involved in the chemical interactions that I reported, I'm 
just the bearer of the news. 
> I invite your pharmacist contact, Sofia A. Iqbal, R.Ph., to respond
> to my analysis.

This is not the person who provided the information, she is the Novo 
representative co-ordinating the Compassionate Need program.

If you'd like to pursue further discussion, contact 
> Bill Van Antwerp <email @ redacted>
> I am perfectly happy to be quoted, in fact if any doctors want to
> talk, give them my phone number, 818 576 4913.

Bill is the scientist doing the investigation into the Humalog / site 
life problem. Bill has been investigating this for some time and as I 
understand it is co-ordinating his work with people at Lilly.

I'm sure you have a better grasp than I of what is going on with 
insulin in the tubing and at the infusion site. However, just 
because conventional wisdom dictates that my hypothesis doesn't make 
sense, it should not be discounted because there are are large number 
of people for whom mixing insulin demonstratively extends the life of 
the infusion site. I must admit it does not seem reasonable to me on 
the surface, but having carefully tested that mixing H/V works I can 
at least say personally that the results are very compelling. I did 
not relate this in my original post because I don't feel that it is 
relevant nor does it add to the "science" behind why it works but I 
will relate my experience to you in the hope that it will raise some 
questions in your mind.

My daughter (now 18) has been diabetic since age 11 and began pump 
therapy with  a few months of diagnosis using steel needles and 
Velosulin. She quickly developed a regimen of changing her infusion 
sites twice a week on every 3rd and 4th day. This routine fit nicely 
into her schedule and there was no discernable change in bg's on the 
3rd or 4th day for a particular infusion set. When Humalog came on 
the market, she stopped using Velosulin and switched to the new 
insulin analog. Immediately she began seeing bg's rise unpredictably, 
usually on the second day after an infusion set change. Putting in a 
new set would immediately fix the problem. At the time, it was not as 
simple as that since we had no idea what was causing the problem and 
investigated all imaginable scenarios. I am an engineer by profession 
so I like tidy answers. After a month of "fooling" with Humalog, I 
switched her back to Velosulin and her bg's immediately stabilized 
with site life returning to >> 3-4 days. Around that time I received 
an email report from a man in Davis Calif. that he had tried mixing 
insulins and found that it helped with site life problems. This 
didn't make a lot of sense to me but my daughter much preferred the 
rapid action of the Humalog and wanted to continue using it if 
possible. We continued using only Velosulin for a 4 week period while 
I kept a record of my daughter's bg's and site longevity. We then 
switched to a mixture of 5 parts Humalog and 1 part Velosulin and I 
again observed her bg's and site life. These remained substantially 
identical to the case with Velosulin only but much better than her 
previous experience with Humalog. We later experimented with lower 
mix ratios, but the "tail" on the longer acting insulin was 
undesirable and there was no apparent improvement in bg stability or 
site life.

I realize that a data point of one is not good science, but it is 
what I have to offer for direct evidence. I don't have any 
explanation for the results other than what I've related to you. 
However, I have related this information to others who have 
experienced similar problems with Humalog and site life. There are 
over 3400 members of the Insulin Pumpers support forum. Of these, 
over 1200 have voluntarily submitted information about various 
aspects of their diabetes management including details about their 
insulin usage. 6% report using an H/V or H/regular mix in their 
pumps. I have not contacted all of them, but of those with whom I 
have corresponded, universally they relate a similar story to the one 
I shared with you about my daughter. This scenario has been poo-pooed 
by many until the numbers became so large that an investigator (Bill 
Van-Antwerp at Minimed) became interested enough to check it out.

I have no axe to grind in this, I just want to help out others who 
are having difficulty with similar problems. I will be collecting 
data on the results of those switching to Novolog from an H/V mix to 
see if Novolog can replace the H/V mix for those experiencing 
difficulty with H alone. Hopefully within a few months, there will 
be some useful statistics.


Michael Robinton
Executive Director
Insulin Pumpers
4600 El Camino Real - Suite 206
Los Altos, CA 94022
Tel: 650 947-3350
Fax: 650 947-3356
email @ redacted
Insulin-Pumpers website http://www.insulin-pumpers.org/
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