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Re: [IPk] NovoRapid/Detimir

Hi Melissa

I recently switched from Humalog to Novorapid (by request) and was told by 
my endo (Australian) that he only recommends Novorapid for pump users (I 
had only seen him once before, long and boring story there) so he was happy 
to switch me. I requested the change as I had on occasion "stolen" some 
Novorapid from my type 2 hubby for when i was out and about as backup (and 
needed it), or to get BG down quickly when in dangerous territory with no 
real pump response visible, and I had noticed (and timed/checked) a much 
faster response rate in me to Novorapid than to Humalog (albeit a longer 
wearing-off too).

After a week of bouncing, I found my BGs came down considerably overall 
(with fewer hypos) and they have remained so now for about 4 weeks. I don't 
think I'll change back. But this bolusing *after* eating lark (after 35 
years of "insulin before food" mantra) is hard! I haven't got it wrong too 
much, thankfully :)

After a day of hypoing on Novorapid (presuming all my basals and boluses 
would remain the same even with the switch), a friend suggested I look at 
http://www.diabetesnet.com/diabetes_treatments/insulin_humalog.php which 
was incredibly useful. As it turned out my basals went from 18.1 to 
14.8units/24hrs, and my boluses went from 0.7 to 0.6 per 15g CHO. I would 
recommend that particular page to anyone thinking of swapping.

There is another "short acting" insulin being worked on as well by Aventis 
(who make Lantus/glargine), called insulin glulisine (brand name Apidra). 
Insulin detemir's brand name is Basulin in case anyone cares. (I obviously 
don't ... maybe it's the time or the wine here!)


At 07:53 PM 2/11/2003, you wrote:

>Hi all (especially Samantha and Adrian--I think),
>Re Novorapid in a pump: Caroline Batistoni (MiniMed 508 c.18 months, also 
>on this listserv) and I had a real-life chat about the differences between 
>Humalog and NovoRapid in a pump a while ago. I posted our conclusion to 
>the listserv then, but here it is again: unless you have trouble using 
>Humalog (some people find they're resistant to it, for example), you may 
>find NovoRapid is better for injection than for infusion in a pump, and 
>that Humalog is better in a pump.
>Humalog has a quick peak--for some people, the same as Humalog, for others 
>a bit slower or faster than, but still beating Actrapid--but 'wears off' 
>faster than NovoRapid. The longer 'tail of action' that NovoRapid (which, 
>again, may start to work at the same rate Humalog does) means it'll keep 
>working longer--great if you're on Lantus or (dare I say it--bad 
>stuff!--isophane). But if you're on a pump, and your basals are right, and 
>your carb counting is pretty accurate, you will probably not need that 
>extra 'tail of action'. You will need your mealtime insulin to 'step 
>aside' (as it were) when its job is done so that your basal can keep you 
>steady without going hypo.
>After a few years(!) of using Humalog in my pump, I tried NovoRapid for a 
>month and found that my 1.5-hour post-meal blood sugars were fantastic, 
>but sometimes too low, even when I reduced the number of units (or tenths 
>thereof) of insulin compared with how much Humalog I would have budgeted 
>for the same meal. Then, about 2.5 to 3 hours after a NovoRapid bolus, I'd 
>get a mild hypo. I started to fear going to the gym in case I got a hypo, 
>something I hadn't been afraid of in ages and ages. That's when I decided 
>to go back to Humalog. I'm not saying you shouldn't try NovoRapid in your 
>pump; I am saying that if you get hypos you don't want, Humalog works 
>differently and may be better for you.
>Adrian, I bet your doctor was talking about Novo Nordisk's new insulin 
>called detemir: 
>http://www.novonordisk.com/investors/rd_pipeline/rd_pipeline.asp?showid=1 .
>Detemir has just received an 'approvable letter' from the US Food & Drug 
>Administration, which means, 'Nice work, fix these things and come back'. 
>On Thursday and Friday of this week I will be at a Novo Nordisk-sponsored 
>event in London (see http://www.dawnstudy.com). I will ask when detemir is 
>supposed to be available in the UK.
>All best,
>still catching up with my correspondence!
>P.S. Are there any Oxford area prospective or actual pumpers lurking on 
>this listserv? If so, would you e-mail me: email @ redacted ? Thanks
>IDDM 10 years; MiniMed pumper 7+ years
>Co-ordinator, Oxford University Student Union Diabetes Network
>Peer support for Type 1 diabetics, friends, family and others
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