Replies to This Discussion

Permalink Reply by Kelly WPA on February 8, 2011 at 12:13pm

I have an Animas pump and not a Minimed but I do have some problems with Apidra in the pump. I find that Apidra breaks down pretty fast. I had a lot of problems especially in the summer because of the heat (even though I don’t spend that much time outside) and was having to change my cartridge every day and a half. If I don’t do that, my BS goes up like clockwork. I did not have problems with clogging but probably because I decided to yank the cartridge before that point.

If you like the Apidra and want to continue using it, I would suggest not filling your cartridge the whole way and changing the cartridge every 48 hours (you don’t have to do a site change to change the cartridge). When I have a bad site, I save the tubing so I have some extra tubes if I have a problem with tubes.

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Permalink Reply by Brad Potter on February 8, 2011 at 5:43pm

Thanks for the reply Kelly. I had assumed (probably incorrectly) that when the clog occurs it could be in either the infusion set or the cartridge. As a result, I assumed it would be necessary to replace both the cartridge and the infusion set early.

I'm going to try partially filling the cartridge (reservoir) as you suggest and see if that allows me to extend the life of the infusion set. Good idea!

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Permalink Reply by Marps on February 8, 2011 at 2:33pm

Hi Brad! I'm sorry to hear about your troubles! I do know that Humalog, for example, has been seen to clog pumps as well. Especially in heat (like if you live in Texas), or so my Endocronologist says since he used to live there. He says the Humalog insulin swells in the heat, which will cause it to clog the tubing in pumps. Novolog doesn't seem to do the same thing.

Is it possible for you to use Novolog on the pump and maybe use an Apidra Solostar insulin pen for corrections?

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Permalink Reply by Brad Potter on February 8, 2011 at 5:59pm

Thanks Marps. That sounds like a good alternative if I can't find a way to prevent the Apidra pump clogs. I had been using a pen prior to going on the pump - so I know it wouldn't too much trouble to add to the mix if needed.

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Permalink Reply by Donna Heun on February 8, 2011 at 2:48pm

I have had very good success with Novolog but apidra didn't work for me at all. It seemed very slow but I don't believe it clogged the tubing. If you want to improve post prandial BGs have you tried Symlin? It works wonderfully for me for preventing the spikes after meals. You might talk with your doctor about it. Since you weren't having problems with the Novolog clogging maybe you could go back to Novolog in the pump and use Symlin before meals (it would be an injection before each meal). I wondered at first why I would want to inject again after being on the pump but it is worth the better control. (for me at least).

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Permalink Reply by Brad Potter on February 8, 2011 at 6:03pm

Thanks Donna. I had never heard of Symlin before. I will definitely ask my doctor if it's something he'd recommend.

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Permalink Reply by Sarah on February 8, 2011 at 6:09pm

The 48 hour limit is a CYA move... I commonly go 4-5 days with my reservoirs (even in the summer) and the insulin is just fine over that time (I usually do change my infusion set every other day though.. they stop working as well if I don't). I think either Novolog or Humalog has the same 48 hour "rule" but most people don't pay attention to it.

I've not actually had a single no delivery/clog since starting Apidra.... but I got them all the time with Novolog (and ages ago, with Humalog). I use an Animas pump though, not MM.

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Permalink Reply by Brad Potter on February 8, 2011 at 7:35pm

Sarah - thanks for the reply. You mentioned that you change your infusion sets every other day or they stop working. Does that mean that your infusion set is clogging as well, or, are you just experiencing high blood sugars when the infusion set is not changed frequently?

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Permalink Reply by Jay on February 8, 2011 at 6:58pm

The 48 hour rule is not a CYA maneuver. Most insulin is four molecules of "real insulin" that must be broken down to be used by the body. Apidra has already been divided in to those four parts and goes to work faster. Hence, its name is RAPID in pig-Latin. The problem is with smaller molecules, it penetrates between tubing molecules more easily and faster than Novolog for instance.

Ideas:
1) can you detach and prime about 3-5 units to get up and running again?
2) can you make the MM more sensitive to obstructions? (I wear an Animas Ping)
3) changing tubing length will not change the problem because the Apidra is going to co-mingle with the tubing its entire length - so the problem is tubing long regardless.
4) I missed, do you have a CGM - if so lower the upper level, get up fix the problem and return to bed.

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Permalink Reply by Brad Potter on February 8, 2011 at 7:49pm

Hi Jay - thanks for the reply. I recall my doctor describing the benefits of the smaller molecules as being both faster acting as well as reduced clogs (he was only half right).

Based on my experience, I agree with you, in that the smaller molecules are not reducing the likelihood of clogging (which I've never experienced with Novolog). Given that the Animas users that have responded don't have the same problem with Apidra, it may also be a problem unique to the structure of the Minimed resevoir and infusion sets (or maybe increased sensitivity of the MM pump - which can't be modified).

One thing I haven't tried is detaching and priming to try to remove the clog. That would be an easy fix, so will give it a try next time I get the pump clogs.

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Permalink Reply by Jay on February 8, 2011 at 8:40pm

I think the standard Animas set is Inset made by Unomedical. I know I use this with a 9mm cannula and 43" tubing. However, I am using Novolog and see a 3 hour peak time.

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Permalink Reply by Brad Potter on February 8, 2011 at 8:58pm

The Minimed infusion set is also made by Unomedical. I'm also using a 9mm cannula and 43" tubing. It's not obvious who makes the reservoir. Unfortunately, it's impossible to tell whether the 'No Delivery' error is a result of a problem in the infusion set or the reservoir.

Other Animas pump users have indicated they've had no problem with Apidra, so, if they use a similar set as yourself, it seems unlikely that the infusion set is too blame.

Next clog, I may try just swapping out the reservoir and leave the infusion set in place to see what happens.

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