We finally decided to crack open one of the bottles of Apidra that has been sitting in our refrigerator for, oh, I'd say close to a year. That decision was based on a lot of things: the post-meal spikes we were getting (often up close to 300), an A1C that was MUCH higher than I was ready to hear after basically two solid months of viruses and antibiotics and steroids and breathing treatments and doctor visits and hospital trips that he usually brought home new viruses from. The biggest push was that after this last virus, where he was hospitalized overnight and given a 4 day course of steroids- basically ALL of his pump settings weren't working and needing tweaking. We figured since we were basically starting from scratch... why not?
But now? WHY? What? What is happening? It's been about a day and a half and his usually flat night time line on the Dexcom is distinctively jagged. He is eating meals, staying pretty flat for the first 45 minutes, then taking off into oblivion. He turns around faster than I expect, but then he is crashing hard where he's never crashed before. His basals are bottomed out at those times, and I don't know what to do. It almost seems like we're seeing more of a tail on the Apidra than we did on the Novolog.
His overnight basals all need to be raised, his correction factor seems to not be working (or else his basals are set too low), and we're still seeing pretty huge post meal spikes.
I know it takes time and tweaking, but seriously, is this normal? Is this just a bad match for us?
I really would love to do some basal testing, but he's apparently decided to have a monster growth spurt and need to eat everything he can get his hands on, so that isn't looking too good for me.
My instinct is to raise the basals and decrease the carb coverage at meals, since he is crashing so hard, but still spiking, but I don't think I even know where to start.
Any ideas? I really want to hang in and see if we can make this work, but I'm getting desperate here.
I'd post some Dexcom pictures but what I'm looking at right now is more of the "sugar free Jello has a blue lid, not a red lid" variety than Apidra craziness. 17 carbs, not 0.
I read one post where a PWD's apidra expired really quickly so it wasn't very effective. I don't know if that's it or not, but that could be a possible reason? I was on humalog which worked well for me but then switched to novolog 2 years ago...it ended up not being a good match for me and I switched back to humalog, so I can't speak for the apidra...good luck!
ReplyDeleteWOW. It sounds like perhaps things were wonky a bit before the Apidra and now you are feeling really lost? I may be totally off base. So, a) go back to Novolog and get him "sugared-out" and then try again...
ReplyDeleteor
b) tweak. We did not end up having to make any changes to Joe's basals and had to make to of his ratios "stronger"...so totally the opposite of what you are seeing.
Lo, from TIC has used it and I think she had to crank some of the settings up.
I don't know about Lexi...she too has been using...and also Laura likes it for Nate I believe.
P.S. Love ya...you are doing GREAT. Diabetes isn't always cooperative with change.
ReplyDeleteHello, Twin!! We are in the same boat. Illness, higher than wanted A1c, large post prandial spikes... I am really thinking about Apidra. My endo says they don't prescribe it, tho... So I have sone convincing to do!! Good luck! Keep me posted!!
ReplyDeleteSo I have nothing to add except I *heart* you and you are awesome!
ReplyDeleteP.S. The intial rise in basal stabilized after about a month and she went back to her existing basals for the most part. The ICRs stayed lower. Apidra works differently for everybody. Some people see little to no difference. That is why you have to basal test all time periods, ICR test, sensitivity again.
ReplyDeleteI'd be concerned that after a year in the fridge the Apidra isn't good anymore. I just threw out a bottle that said it expires next month after two weeks of crazy blood sugars. I opened a new bottle this morning that expires in August and I've had the best blood sugars all day!!
ReplyDeleteSo the Apidra we used- first bottle, wasn't set to expire for another 6 months, and it was in the back of the fridge, but after it got left in the car for an hour on a sunny day, we popped open a new one. Yesterday, we were ENTIRELY within range (although a much looser range than I'd like) and today.... well... today. Sigh.
ReplyDeleteIn our case: We basal tested all time periods again, starting with 3 hours after dinner and overnight. Nailed that one. Tested sensitivity next night on the nailed overnight basal. Tested other time periods to get an idea of those basals. From there adjusted ICRs.
ReplyDeleteIn her case (everyone is different) she intially needed 20 percent more basal across the board... but only the first month; this amount lessened to maybe ten percent more. ICRs are lower; she needs more insulin to cover food and combo or increased temp basals for fatty slow digesting food. Sensitivity is a little lower, but not by much. Since Apidra is almost through working by 2.5 hours, we can be more aggressive with corrections sooner. Does take 3.5 hours for Apidra to be completely gone from her system. Apidra stronger earlier with much less of a tail; don't really notice much of a drop after 2.5 to 3 hours usually. Approach it as if you are starting from scratch and all will be revealed. Endo did tell us there are some who notice little to no difference and there are some for whom Apidra does not work. It did take a full month to totally settle in when we switched. Glad we stuck with it; works much better for her.