Anybody out there using the new U-500 insulin in their pump. Knowing the U-500 to be 5x as strong as the U-100 (Apidra, Regular, etc) how is it going. I have the hardest time getting regulated ending up with long highs (>300) and long lows (<60). This insulin seems to peak about the same as apidra and regular but lasts longer (slopes off longer) I like to hear any other experiences.
I searched for "U500" and there's a Group for that (7 members) and a few discussions of members using it in their MiniMeds, Omnipods, and Accu-chek Spirit pumps. here:
The long reaction time is difficult with the Boluses but for the rest it is nice not to have to fill the pump as often and Basal rates can be figured out. Good luck with the change can say anything about MC or Plan B as I'm not familiar with that.
U-500 reacts differently than U-100. It has a different duration of action, causing delays in onset and then a very extended tail. There was a discussion on using U-500 by Irl Hirsch over at DiabetesInControl. We also have other examples of members who have been successful with U-500 in a pump, perhaps they will also respond.
I agree with what you said and would agree that there is price gouging going on. I had found a good presentation on insulin use that discussed U-500 and found the price per unit about the same. But things have actually changed, U-100 R has gotten cheaper ($25 at Walmart) while the price of U-500 R is increased. The net result is that U-500 costs 3 times U-100 on a per unit basis.
Aeon I agree with what you are saying and as to Brian's statements it all is about the money. Hence here in the States we can't even get an Animas Vibe (a 2020 (ping) with Dexcom Seven+ all in one) that you can get anywhere else in the world. Why not approved here because less money to be made by the strip manufacturers. I'm lucky to have great insurance so cost of insulin is not a point for me.
All I was after is again my original question how to bolus with this long tail on the R-500
Have you changed the duration of action setting in your pump to reflect the "long tail?"
Of course yes
I'm sorry I am not more helpful. I just think that overall U-500 has a poor bolus profile. There are some small things that you can do to perhaps help. One is to do what is called Super Bolus. In order to superbolus, you borrow from "future" basal and stack it onto your bolus. John Walsh has a good description of the Super Bolus on his site. It may not help much, but it might help some.
Brian don't be sorry talking about it and ideas is what might lead to an answer. Yea I did think about the super bolus and I also (when I can) bolus an hour or more B-4 eating, but again as this R-500 has the long tail it isn't acting fast enough for me to catch the highs. Even the Apidra I used previously was slow to peak(2-3 hours) for me and now I'm at 6-8 hours with the Humalog R U-500 which is hard to bolus for.
I should stop eating then I don't have to bolus and I'll loose weight too (lol)
Why do you think the Aprida was slow to peak? Did you have very large bolus injections? It is my understanding that a large bolus (like 50 units) can take longer to absorb. I think it has to do with absorption being proportional to the area of the sphere while the volume is the number of units. Thus the absorption drops off with larger bolues. Do you think that may be a problem as well?
I don't bolus now and didn't bolus with the Apidra never ever more than 15 units. My mean bolus currently is 1.78 units on the pump (x 5 = 8.9 units (U-100)) Look at page 13 of http://products.sanofi.us/apidra/apidra.pdf and see how Apidra works faster than Regular. 100 or 500 is just the strength so the equivalent quantities are still the same and 1 unit of Apidra is quicker acting than 1 unit of Regular
Wow, that bolus just seems low. I presume that you have a very high basal and that is what is driving the need for U-500. Is that right?
Have you tried Humalog and Novolog to see if you have the same delayed onset issues? Perhaps using a needle with rapid for a bolus to correct a high is one option. You can of course speed it up by doing an intramuscular injection.