Diabetes question

[chicoborja]

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If someone regularly uses and insulin pump with Humalog, and switches to injections temporarily then how should the glucose levels be maintained in the night when sleeping? Can this person go to bed with a larger injection before bedtime, etc?

 

[SmittySC]

In most cases, a person on an insulin pump is a type I diabetic. Therefore, they make little or no insulin. When on the pump, a rapid acting insulin like Humalog or Novolog is used due to its rapid onset of action (15 minutes). The pump is programed to give a basal rate throughout the day (X number of units/hour). The person then will manually program in a basal rate whenever they eat to cover for the carbohydrates they ingest. This process is very similar to a normal functioning pancreas. The other reason that a rapid acting insulin is its short duration of action. The Humalog and Novolog peaks at approximately 1 hour. This keeps the insulin from building up in the body and causing constant problems with hypoglycemia. The reason I go into this detail about insulin pump therapy is that a good understanding of how it works is needed in order to properly convert back to doing injections if it becomes necessary. It would be very difficult to convert to injections using just Humalog or Novolog alone. The short duration of action makes it difficult to cover at night like you ask in your question. Giving a larger dose at bedtime, will not make the insulin last any longer. Most likely it will cause hyoglycemia around 2-3 in the morning. The only way to adaquately cover using just the rapid acting insulins would be to get up in the middle of the night to give another injection (most people would probably not want to do this). The best way to duplicate insulin pump therapy would be to use a Lantus/Humalog or Novolog regimen. The Lantus is a basal insulin that last for 24 hours. It is used to keep the blood sugar at normal levels throughout the day. The person could then use the Humalog or Novolog like they do when they bolus using the pump by giving themselves an injection of the rapid acting insulin with each meal. The person may have to make sure to do a good job of glucose monitoring until the dosages are correctly adjusted to get the desired blood sugars. Once the person is ready to go back on the pump, the injections can be stopped and the pump can be resumed.

I hope this helps answer your question.

 

[chicoborja]

thanks

 

[DadofDr2B]

In most cases, a person on an insulin pump is a type I diabetic. Therefore, they make little or no insulin. When on the pump, a rapid acting insulin like Humalog or Novolog is used due to its rapid onset of action (15 minutes). The pump is programed to give a basal rate throughout the day (X number of units/hour). The person then will manually program in a basal rate whenever they eat to cover for the carbohydrates they ingest. This process is very similar to a normal functioning pancreas. The other reason that a rapid acting insulin is its short duration of action. The Humalog and Novolog peaks at approximately 1 hour. This keeps the insulin from building up in the body and causing constant problems with hypoglycemia. The reason I go into this detail about insulin pump therapy is that a good understanding of how it works is needed in order to properly convert back to doing injections if it becomes necessary. It would be very difficult to convert to injections using just Humalog or Novolog alone. The short duration of action makes it difficult to cover at night like you ask in your question. Giving a larger dose at bedtime, will not make the insulin last any longer. Most likely it will cause hyoglycemia around 2-3 in the morning. The only way to adaquately cover using just the rapid acting insulins would be to get up in the middle of the night to give another injection (most people would probably not want to do this). The best way to duplicate insulin pump therapy would be to use a Lantus/Humalog or Novolog regimen. The Lantus is a basal insulin that last for 24 hours. It is used to keep the blood sugar at normal levels throughout the day. The person could then use the Humalog or Novolog like they do when they bolus using the pump by giving themselves an injection of the rapid acting insulin with each meal. The person may have to make sure to do a good job of glucose monitoring until the dosages are correctly adjusted to get the desired blood sugars. Once the person is ready to go back on the pump, the injections can be stopped and the pump can be resumed.

I hope this helps answer your question.

You may be interested in knowing that Humalog is not approved for use with insulin pumps. Novolog is the only approved insulin for use with insulin pumps. I spoke to an FDA official because my daughter's insulin, Novolog, was not covered completely by the insurance carrier, Cigna, and was placed on the third tier payment scale causing me extra out of pocket expense. I would not let my daughter use a non FDA approved insulin when there is an approved one. Cigna wanted me to use Humalog and not the FDA approved insulin.

 

[SmittySC]

You may be interested in knowing that Humalog is not approved for use with insulin pumps. Novolog is the only approved insulin for use with insulin pumps. I spoke to an FDA official because my daughter's insulin, Novolog, was not covered completely by the insurance carrier, Cigna, and was placed on the third tier payment scale causing me extra out of pocket expense. I would not let my daughter use a non FDA approved insulin when there is an approved one. Cigna wanted me to use Humalog and not the FDA approved insulin.

DadofDR2B, thanks for the information. I was unaware that Humalog was not approved for insulin pump therapy. However, besides being a physician, I am a diabetic with an insulin pump. I have used both Humalog and Novolog in my pump. When I was using the Humalog I did not have any problems whatsoever. There was also no difference in my blood sugar control when on the Humalog compared to the Novolog. It is sad that the insurance companies dictate what they want used and adjust the price accordingly. The price of medications in this country is a big issue. I also understand your concern for not wanting to use a non approved medication. Since I am unaware of your financial situation I am going to leave you with the following advice. If the extra out of pocket expense of using the Novolog is not a financial burden to you and your family, continue to use the Novolog. However, if the extra cost is a financial burden, I would recommend, as both a physician and an insulin pump user, that the Humalog would be a safe option to be used in your daughter's pump