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Fast acting Insulin Apidra.
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krhudson posted:
Hi everyone,

I have not checked in for a while now. Everything is still going great
with my type 1 Diabetes keeping my A1Cs down to 6.5 - 6.7. I have
been taking Lantus 24 hour Insulin and Fast Acting mealtime insulin
Humalog. My Insurance company will no longer cover the HUMALOG
and I had been on it for over 10 years. The Insurance companies gave
me other choices to take with the Lantus and the 2 main fast acting
choices are Novalog and Apidra. My Dr. said no use fighting with
the Insurance company because you have to try each of the
alternates before they will make an exception to continue HUMALOG
based on documented evidence that the others do not work as well.
We addressed Novalog since I took it at the hospital during a stay a
few years ago and it was not the greatest but not much is after a
surgery it takes a while for the body to heal before you get the
maximum effectiveness out of certain medications.

I decided Apidra since it is made by the same manufacturer as
Lantus. It is the new kid on the block. Anyone had great results on
Apidra for fast acting insulin to go with the long acting Lantus?
Both Pharmacists I spoke to said they get many more orders for
Humalog than Apidra since Apidra is pretty new compared to others.
The good news on Apidra.com is that their is no copay right now. I
saved $35.00. One of the Pharmacists gave me the particulars about
timing and when to inject etc....Now I need real feedback on results.
Thank you!!

Krhudson
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auriga1 responded:
Good to know things are going great for you.

I use the Humalog with another long-lasting basal. Apridra is a new one on me. Never have heard of it. Haven't even seen any advertising for it. Wish you luck with it.

The only thing I know is that Humalog has a faster start time than Novalog. Both have nearly the same duration of time.
 
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krhudson replied to auriga1's response:
Hi Auriga 1!

Thanks for the Reply. I think the marketing
on Apidra is slow. I had never heard of it either but if you
go to Apidra.com the information is there. I spoke to a
Pharmacist that compared insulin for me and Apidra is a
fast acting and a mealtime insulin made by the same
company that makes Lantus. You take it 15 minutes
before a meal or up to 20 minutes after a meal and it
works for 4 to 5.3 hours. Novalog is 3-5 hours and
Humalog 3 to 6.5 hours. The nice thing about the Apidra
for now no co pay for most insurance. That is attractive.
I will see how it goes, I will pick it up tomorrow!

Humalog start time I think is 5-10 minutes and Novalog
10-20 minutes according to the Pharmacist.

Are you by chance on Leveler for the long acting Insulin?

I hope things are going fine for you to. Very glad to hear
from you again!

Krhudson
 
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mrscora01 responded:
I know of quite a number of people online who have used apidra and have had success with it. Apparently in some it works faster than humalog or novolg. Some pumpers may have had some problems with clotting in the tubing, but that is anecdotal. I wouldn't worry too much about the switch. I have heard really nothing but good things about it.

Cora
T1 1966, Dialysis 2001, kidney transplant and pump 2002, pancreas transplant 2008
 
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krhudson replied to mrscora01's response:
Hi MrsCora01,

I am glad to hear that you have heard nothing but good things
about Apidra. I will start my doses lower and then slowly
increase it and establish a carb counting formula. On
Humalog I took 1 unit for every 20 carbs. On 80 carbs in
a meal that would be 4 units and If I were to eat something
a little higher in carbs I would pad it with another unit. I
also have to be sure I get the hang of how much less to
take when I work out. It will be done within a week I am sure
and I will know how my body will respond regularly.

One other difference is that the Humalog works an additional
hour and a half . I will hope the Lantus covers that gap
enough, an hour is a long time when it relates to glucose
levels.

Hope things are going great for you these days! Glad to
hear your response. Thank you.

Krhudson
 
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auriga1 replied to krhudson's response:
kr, I was on Lantus until it ran out last week. Worked well for me. My first A1C was 13.2 and now I'm at 5.6. The combo of Lantus and Humalog did the trick. Or course, the reduction of carbs and physical activity helped everything.

My husband lost his job so our health insurance went along with it. I had to buy the over-the-counter insulin at WalMart, Novolin N. ReliOn WalMart brand made by Novo Nordisk. I'm still trying to figure out the best dosage as I keep going low daily at work. I use less of that than I did the Lantus. I'm unable to test frequently because of work. The same thing happened with the Lantus so my doctor lowered that dosage, too. The more physical I am, the less basal insulin I need.

Huge pro for the Novolin N is that it IS over the counter. No script needed. $24.00 for a vial. You can't beat that. The syringes are no-script needed, too. I don't mind the vial and syringes because it is just a once a day injection. Also, it lasts longer than 28 days. The info that came with it says it is good for 42 days once it is opened.

Hubby found a job, so the health insurance will kick in July 1st. If this Novolin N works well for me, I will stick with it. Doesn't make sense to purchase Lantus with a $60.00 copay that I used to have. My receipt from the old pharmacy always said that "my insurance saved me $259.00." Who knows what the pharmacy billed the insurance company for the Lantus.

When we had the insurance, we were to "shop around" for the best prices on our meds. Of course, the pharmacy I was using had the highest prices on all my meds. In the nation. We will be switching to save EVERYONE some dollars.

Good to hear from you again Kr! Hope it works well for you. Keep in touch and let us know.
 
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krhudson replied to auriga1's response:
Auriga 1,

I knew you were on Lantus at one time when we were both
on Humalog and Lantus and doing very well. I just picked
up my prescriptions on Lantus and Apidra. The Lantus costs
$160.00 per vial now at Sam's club! My co pay went up from
$35.00 to $38.00 on that one. The Apridra costs $130.00
and no copay right now (probably a promotion from
the manufacturer).

The insurance companies always seem to limit how many
tests you can do per day for blood glucose so a long time
ago when I was not insured I found the Target UP and UP
meter for $9.00 and 100 test strips for $36.00 and syringes
for $13.00 a box. I still go that route since their would be
a copay anyways and this way I can test as many times a
day as I want. Can you imagine only 36 cents per test when
those expensive meters have strips that cost $100. for 100
strips? My UP and UP Meter far surpasses Accu Chek for
accuracy and my A1Cs improved partly do to that. Keep
in mind though that the Target brand UP an UP strips are
taxed so bring it to .40 cents per test and that is still great.
Wal Mart is less I think. If I want to, now that I have insurance,
I could get a prescription for syringes, meter and strips to see
if the co pay will beat what I am doing now. I just do not want
limitations. The only way I am de stressed is to know what
my blood sugars are at all times if I am questioning it.

Tell me more about Novolin N, only once a day? When?
Does it cover meals for you? Is it DNA origin? Beef/ Pork?
I know you worked hard on mealtime spikes to regulate the
Humalog like I did so what is up now with the lows? What is
the peak time of Novolin N. Amazing no script needed for
that.

So glad for you that new insurance starts soon! I did get
married recently after numerous years and I was added
to benefits. What a difference after being on COBRA for
$586. a month blah!

krhudson
 
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auriga1 replied to krhudson's response:
Kr, the Novolin N is also known as a NPH. It is an intermediate-acting insulin lasting 18-24 hours and used as a basal insulin. It's also a man-made insulin, an isophane suspension. DNA recombinant origin.

The insulin is cloudy and should stay that way. I take it once a day in the a.m. like I did the Lantus. I still take Humalog with meals if I eat more than 12 carbs. 1 unit Humalog to 12 grams of carbs. The Novolin starts working 1 1/2 hours after injection and the peak blood sugar lowering effect is 4-12 hours.

All the lows that I experience are from my basal insulin, according to my doctor. My job is very physical and I work 3-4 hours a day, five days a week. I don't even have to take my Humalog when I eat lunch. I haven't determined how to regulate carbs and physical activity. Each day is different. Obviously, I must move more some days than others. I didn't go low today. The past three days, my BS dropped to 50 during work and that's without taking Humalog; just the Novolin.

Kr, when I was diagnosed, my FBS averaged 250-300 every day. That's why they started me on insulin. The doctor started with the lowest dose of Lantus possible at 15U. That number didn't even touch by BS. It was still in the 200's. He had me call every other day to let him know if my numbers were coming down. After a couple of months, I wound up on 40 units of Lantus. Crazy. The Humalog was 1:15. Then he changed that to 1:10. Now it's 1:12. LOL.

My job changed my insulin needs. My feet hurt, but my BS is great. LOL. If I stop working, I will have to do heavy exercise every day for two hours or more.

Congratulations! A new bride. Hear you about Cobra. For our family it would have been $1,948. Yeah, sure. Two thousand a month for full coverage. Had to go without. My other meds are relatively cheap, so it wasn't too hard. I was not going to pay over $300 out of pocket a month for Lantus, so that's why I switched. I still have 1 1/2 pens of Humalog left because I don't use a lot of that. I greatly restrict my carbs, so I don't have to use it. When the insurance kicks in, that will be a big help.
 
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krhudson replied to auriga1's response:
Auriga 1,I have definitely heard of NPH. I took it a long time
ago before Humalog was recommended for meals. I probably took Regular? I think there was also one called R as in
Regular for a faster acting Insulin to take with NPH? I am really dating myself.

The Dr. also changed me to Lantus at a later date off the NPH. I had a feeling you were still on Humalog for meals like you were before.

Amazing what physical activity does and it is nice if you can
go without Humalog much of the day. I could if I tried harder
but since I only have 1 kidney I have to cut back protein and
have more of the better carbs. The kidney has a high count
of protein and it could be because 1 kidney is doing all the
work as if I had 2 kidneys. I did just see my Urologist and
my Kidney overall is in great condition, better than many.
My Internist said I am doing everything right and that I do
not at this point need to see a Kidney Dr. They have meds
to assist but no need now, overall the Kidney is fine. By
Kidney Dr. I am referring to Nephrologist since my Urologist
is a Surgeon he is not a Medical Dr. totally specializing in all
Medical conditions of the Kidney or Kidney disease. I do not
have Kidney disease pertaining to Diabetes or a failing Kidney at this time. Let's hope to keep it that way. If I eat right and
control my blood sugars most of the time I will be fine for
a long time. That goes for all of us with these problems.

krhudson
 
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karen46203 replied to krhudson's response:
krhudson,

Walmart has Relion Prime meters forgot the cost on that but they also have box of 50 strips for $9.00 which is pretty cheap.
They are also comparable to the higher priced strips as far as accuracy. I usually test 4-8 times per day because I don't like to go low and I don't know when it does until I am already there.

karen
 
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krhudson replied to karen46203's response:
Thank you Karen. I will look into those. The last time I
checked Walmart was a while back. My Target meter and
strips are great. It is amazing that these items can be
produced and sold for such a low price. I firmly believe the
Insurance Companies fell into a trap with these other high
priced strips that other companies manufacture and sell
and we wonder why insurance companies charge us
skyrocketing premium and pay out like they do.

If Target and Walmart make perfectly good meters for
$9.00 and can sell 100 strips for $36.00 or $18.00 as you
mentioned Walmart is doing (for 100 strips), then why are
we not speaking out to those companies that charge $1.00
a test or $100.00 for 100 strips which is ridicules and
discourages people from testing more often if they feel
they need to. I test many times a day for changes in activity
and being a type 1 Diabetic and it is nice to know I can
get 100 strips for the same price as a co pay for the
strips on a prescription. I do not have them on a prescription because the Insurance company will only allow a certain
number of tests per day in the prescription.

KrHudson
 
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auriga1 replied to krhudson's response:
We pay through the nose for insurance premiums even if you have it through work. Then add the copays on everything we need for diabetic supplies. It makes me ill to think that the insurance companies, including Medicare can dictate how often one tests.

Being insulin dependent, it matters that we test. I take 4-5 insulin injections a day. I need to know my readings just in case I need a unit or more extra beside the insulin/carb ratio bolus I normally use.

Having lost my insurance because of job loss, I dropped all my meds except for my BP med and insulin. As a family unit, we don't quite fall below the poverty line but just above. Pretty sad because we don't qualify for Medicaid. Just plain old aggravating.
 
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krhudson replied to auriga1's response:
Hi Auriga,

Your husband's new insurance starts up July 1 right? That
will sure help. Yes, for a family a lot will come out of the
paycheck but much less than trying to find it elsewhere. It
is almost impossible to think of the cost that we incur
having this medical condition and treating it daily or else
we are in deep trouble. Their are a lot of costly medical
conditions out their so we have to go one day at a time
and stay as positive as we can. The good news is if we
stay on top of this we will outlive others that do not have
it!!

krhudson
 
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auriga1 replied to krhudson's response:
Yes, the insurance is effective July 1st.

I might have to go back to the Lantus. I've been using ReliOn intermediate insulin with one big drawback. Been experiencing way too many lows. Have adjusted the insulin to a lower dosage, but my fasting is much higher than it should be. Fasting is high, then it drops significantly from working. I tested in the a.m. at 111. Usually, I'm between 75-80. The bottom dropped out on me while at work.

I have been testing since day one seven years ago. In all this time, my meter has never registered LOW. I was fine sitting, but when I stood up, holy cow. The lowest my meter registered one time was 26. Must have been lower than that. Drank 4 oz. of juice and I tested at 60 a few minutes later. Didn't have the energy to do anything after that. So needed a nap, but had things to do. In the back of my mind, I think I was afraid to sleep. LOL.

I love your postitive attitude!
 
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nutrijoy replied to auriga1's response:
Auriga,
NPH insulin can be used as a "poor man's basal" but it takes a bit of a learning curve since we all respond somewhat differently. The key is to stick with small doses and to anticipate using it up to three times per day instead of the once a day regimen that most people are used to with Lantus and Levemir. Here's an abbreviated explanation that may help. Basal insulins by their very nature are much weaker than regular and/or rapid-acting insulin; approximately one-fourth (25%) as strong. It also releases its payload much more slowly over an 18 hour to 24 hour period. NPH insulin is a protamine-zinc complex of regular insulin that is four times stronger than basal insulins. It also releases its payload much faster, typically in six to eight hours (for most people) than a basal. That means, in effect, that it is as much as ten times stronger in terms of per unit time. Our metabolisms and metabolic rate vary somewhat in each of us so trial and error is an essential component in the learning curve when using NPH as a basal substitute. I can only provide you with an example of what I do and it is not always a daily procedure (I sometimes skip the NPH altogether and only use meal time insulin on days when I rev up my metabolism over and above the norm through intensive exercise).

During waking hours, I do not use nor do I seem to need a basal insulin. My activity levels are sufficiently high that meal time insulin adequately controls my BG levels. At bedtime (I retire at 11:00 — 11:30 pm), I rarely use more than 3 units of NPH and normally arise at 5:00 am (no alarm clock; just the nature of my circadian rhythm). I also use NPH during daytine hours for planned off-plan meals such as dining at buffet restaurants and holiday celebrations (e.g., Thanksgiving, Christmas, and other get-togethers). On such occasions, I use an NPH dose up to six units. In almost all instances, the NPH releases the bulk of its payload (in my body, at least) in approximately six hours and is virtually spent after that (based on numerous test readings in the past). The reason why I need a longer-acting insulin for off-plan eating is because I consume lots of protein at these meals (predominantly seafood and poultry). Protein (in excess or abundance) tends to digest relatively slowly in my system and my meal time insulin is long spent before the protein is fully metabolized (and yes, protein does raise my BG levels but only about a fourth as much as carbs).

Based on C-peptide tests, the beta cells of my pancreas no longer produce much insulin (if any). Two to three hours after an off-plan meal, my BG often tests in the 85 to 120 range. Without NPH, my BG will continue to rise another thirty to eighty points (within the three to five hours range after the meal), depending upon the extent of my excessive indulgence. With the use of NPH, I can often offset the continuing rise in BG by keeping it closer to the 100 mark three to five hours post prandial. I am also not hesitant to inject additional units of meal time insulin (adjustment doses) if I think they may be warranted (I use guesstimates, past experiences, and "gut feelings" to make the determination and do not necessarily wait the full five hours that Dr. Bernstein recommends).

Auriga, I don't have a clue how many units of NPH you are using but might suggest that you try using smaller doses (e.g., 3 units). Then closely monitor the effects, including time and duration, and log them in a journal for additional evaluation and analysis. But that only applies if you are serious about using NPH as an alternative to Lantus. Many diabetics don't think it's worth the initial time/effort so it is entirely a personal decision.


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