Hello, Goodbye

Apidra week from Hell - normally these range bars are short and close(ish) to the green happy-zone. 😦

First a little background as to why I decided to try out Apidra:
I’ve mentioned before that I participated in Joslin’s Why WAIT? program. It was accomplished through a combination of increased exercise, decreased food intake, and the addition of Symlin to my D-regimen. These things combined to cut my total daily dose of insulin in half, and then some. Originally the team had wanted to switch me from Humalog to Apidra because it peaks faster and would theoretically have made blousing with Symlin a bit easier. But, I had 10 vials of Humalog in my fridge, no real job, and switching just wasn’t an option.

Fast forward to last month, about 4 or 5 months post Why WAIT?, to my endo appointment. I approached my endo about switching to Apidra since my humalog supply had dwindled, and, although she wasn’t sure the benefit would be significant, she didn’t see any reason not to try it. So, I walked away with a prescription for a three months supply of Apidra.

After some trouble getting things straightened out with my new online pharmacy, I finally received the Apidra two weeks ago and began using it last week, on Feb 28 at 7pm. And then it began.

Day 1: Hello Apidra. My BG is running high all day; I wake up with a BG of 120, eat nothing and by the time I’m at work an hour later my BG has jumped to over 250. I do correction bolus after correction bolus to no avail and spend the entire work day over 250, even after eating a carb-free salad for lunch. Promptly at 5pm, when I normally head home from work, all of the boluses finally catch up to me and I drop almost instantly to about 55. I correct and make it home with a BG hovering around 100. Dinner is chicken and brown rice. My BG stays flat until bedtime but as soon as I fell asleep, Dex begins to wail. I probably test and correct 5 times overnight and my BG stays flat around 200 all night until an hour or so before dawn when it levels off around 100.

Day 2: Site change in AM. Repeat of day one.

Day 3: After the last 2 days of BG hell , I increase all rates and ratios by about 10% (except the post work/before bed ones) and shorten the IOB time on my pump so I can bolus more aggressively. I also add Symlin to most meals. My BGs level off a bit but they still sit well above my happy zone all day and require frequent corrections that seem to have no effect. I go low overnight.

Day 4: It is like Day 3 never happened and is a repeat of Day 1, again. (Only I have a low-carb, high fiber dinner that send my BG up to over 400!) In the middle of the night I have a low that requires 3 juice boxes and I still wake up the next day with a BG of only 75.

Day 5: Increase all rates again. No change. At this point I realized that I should be monitoring for ketones and luckily find none.

Day 6: Realize that I can’t fix this problem on my own and call Joslin for help. I upload my pump and Dex data from the last week and send it after work. At this point the 5+ days of highs have given me a terrible headache that I can’t quite shake. I officially hate Apidra. However, having a carb-free dinner has allowed me to sleep an entire night without any complaints from Dex. (Although he caught a low before bedtime that I corrected with ice cream perfectly – flat at 100 all night!!)

Day 7: After talking with the nurse educator and experiencing my 8th BG over 400 in less than a week (which is a number I haven’t hit in years!), we decide that I will switch back to Humalog immediately after work today.  Good bye Apidra.  You will not be missed.

So, unless this was some sort of ill-timed, un-related BG surge (which I doubt), everything should be straightened out soon.  And I can’t wait.

However, I now have 5 bottles of Apidra that I don’t know what to do with.  does anyone know of a place to “sell” (It would be great to get some part of the $60 copay back) or donate unopened bottle of insulin?


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