I would be interested to hear from anyone using Apidra in an insulin pump.

I've been using Novolog since I started on a Medtronic 722 (with CGMS) pump 3 years ago. I recently tried a switch to Apidra to help reduce postpandrial blood sugars. It has accomplished this....but I find it annoying that the pump seems to clog (NO DELIVERY msg) after only about 2 days with the Apidra insulin.

Novolog (NovoRapid) isn't as fast acting, but doesn't require as frequent infusion set changes (at least 5 days for me). I have never experienced a clog (or NO DELIVERY msg) with Novolog.

The Apidra product write-up from Sonofi-Aventis does indicate a 48 hour limit in any pump. I'm not sure if that is just a manufacturers CYA thing or if everyone sees this limit. Since clogs occur at unpredictable intervals - this doesn't seem to be a vial insulin for pump users. i.e. if I'm sleeping, by the time I realize I have a clogged infusion set, my blood sugar is extremely high (normally I'm well controlled).

As mentioned, I use a MM 722 with the Quickset (43") infustion set. The clog is repeatable in that I've never completely used a 3.0ml reservoir without experiencing a NO DELIVERY message from the pump (have been using Apidra for a month now). When using Novolog, I was going 5-6 days (avg. 50 units/day) on a 3.0ml reservoir. With Apidra I am throwing out about 1/2 the reservoir every time due to the NO DELIVERY message as a result of the clogs.

I would be interested if there's anything I could change to extend the life of Apidra in the pump.....i.e. would a shorter infusion set help, would inserting the infusion set in a different location help? Also, once a clog has occurred, is there anyway to clear it (and avoid throwing out the infusion set).

Thanks.

Brad.

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We have recently had a lot of no deliveries with Apidra. I feel like they occur most often after my child has dosed a lot of insulin in a short time (for pizza, chinese, etc). We are using the Sure T's. I've tried 8 and 10mm Sure T's also - we get less No delivery errors but the site only lasts 2 days.
MidwestMommy, when I'm on the MM pump and need a lot of insulin in a hurry, I take half of the amount with a syringe on the other side of the body, which works very well. I use Apidra.

In other postings on this site, it has been suggested that Apidra becomes denatured over time by the plastic in the cartridge. This idea fits into my experience. I prefer to change every two days with my Sure-Ts, but in experimenting I've found that one cartridge with Apidra stops working at 3 1/2 days.

As far as actual clogging at the entrance to the cartridge, only Humalog was a problem; I had that type of clog with Humalog in about 12 hours.
OmniPod user here. Caleb has been using Apidra since October. He went 2 months swimmingly! It was almost heavenly. Then this 48 hour thing started. It's very inconsistent. Sometimes we get beyond it, and sometimes we get through it - meaning we have a little bump and then it's okay. It's been very frustrating. And we never ever get an occlusion alarm. And lots of times the cannula looks just fine - clean as a whistle.

Thanks for this thread. It gives me something to think about. Any users I know are able to use Apidra a full three days with no issue so I was really baffled.
Is this the second time you've tried Apidra, or am I getting my post dates all mixed up?

http://www.tudiabetes.org/forum/topics/583967:Topic:58261?page=5&am...
Just read further through the thread - it seems it is. I hope some of the suggestions here help you and this proves to be a more successful attempt. I really like the lack of tail on Apidra and don't want to go back to Novolog.
Hi Lorraine - you're right, I'm on my fourth reservoir with Apidra now. In addition, I had given Apidra a try about a year ago, but had only tried a couple reservoirs, so thought it might be worth another attempt.

So far, all attempts have resulted in more clogs than I'm used to seeing while using Novolog. The other thing I'm noticing is some unexplained high blood sugars beyond the 48 hour mark. The last reservoir did not result in a clog (in fact, I went 5 days with is the longest I've gone with Apidra without clogging), but I did experience more highs beyond the 48 hours than I'm used to. I'll probably try at least 1 more reservoir before going back to Novolog.
I feel like we are seeing something very similar. It's not consistent which is why it's been hard to diagnose. Caleb's been ill, we've had a couple Pod errors (which I wonder if it relates to the Apidra use since we typically get no errors).

May I ask, how do you know it's clogged - are you able to see a build up in the cannula, or concluding it because you know you would not otherwise have high bgs.

Fingers crossed with your new reservoir!

Lorraine
I'm assuming the clog has occurred because the the Medtronic pump gives a "NO DELIVERY" error message meaning the pump can't move the insulin for some reason. It could also result from kinked tubing etc., but since the error only occurs when using Apidra (and tubing is fine), I'm assuming the insulin is clogging in the infusion set or reservoir. There is nothing visible that would identify a clog.

As you point out, diagnosis is difficult and many factors could result in occasional high blood sugar and possibly even the No Delivery error - so I'll keep trying.

I haven't tried the MM continuous glucose monitor (CGM) yet with Apidra, so I'm trying that today with a new reservoir. The continuous monitoring should help correlate the time of high sugars with age of the Apidra.

By the way the last reservoir of Apidra worked flawlessly, but that's only 1 of 4 reservoirs, but I'm hoping that continues.
Oh yes of course. I misread (or read too quickly) your previous statements as you received no "no delivery" charge. My mistake. I understand now.

With Caleb, my gut is usually 95% right that insulin isn't getting through, particularly when I see his bg rising on CGM. I try to rationalize the twenty other things that could be causing it though. Fun times.

Hoping for 2 of 5!
Wow, I just finished reading this thread and its been very useful.

I've been using the MM pump (713 (4 yrs) / 723 (1 yr)) for over 5 years now with Humalog. The last problem I had where I spiked and took forever to come down, I was informed that most likely it was a clog. I am assuming the clog occurred in the cannula. The tubing looked fine, no kinks. When I pulled the infusion site, the cannula wasn't bent and I thought I saw a small drop of blood in it. I had originally thought I hit some scar tissue and had a dead zone or that my bottle of insulin went bad.

On my last visit to my Endo, he gave me a bottle of Apidra to try out. It took me a bit to get the courage up to make the change but I finally did. Unfortunately when I got to about 60 hours (2 1/2 days), I began to spike! I had read in other places where people seem to see a 48 hour limit, just as stated in this thread.

I double check the insulin web sites for Apidra, Humalog, and Novolog. Apidra and Humalog say the entire set should be changed every 48 hours, where Novolog says the infusion site should be changed every 3 days and the reservoir every 6.

This 48 time limit is a little frustrating to me. I normally go 3 to 3 1/2 days with the Humalog.

However, I might be inclined to change my infusion set every 2 days if I get such steady graphs from my CGM like I saw. I am taking a small break, in order to kick a cold, then I will try to switch back to Apidra.

If anyone is interested, I had started an Apidra Users group here a week ago.
Brad, Too bad about your problem. I've used Apidra in my first MM 522 and now for the last 1 1/2 years the Omnipod. I have never experienced a clog. I've been using Apidra for 3 years now.

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