Switching Insulins for Andrew

     I was so busy updating on Kaitlyn, that I never filled you in on Andrew's appointment!  Thankfully, his A1c had dropped back down, and we are happy with it. 
     While at Kaitlyn's test, they visited with an adult using Apidra in her pump.  Apidra is a newer fast-acting insulin that works faster than the Novolog we've been using.  It helps minimize the after meal spikes because it works faster and clears the system sooner.  Gene asked about it and got samples of Humalog and Apidra.  Humalog has a similar action time to Novolog, but it doesn't have the "tail" that Novolog has for Andrew.  The tail is extra insulin action that comes just before the insulin works out of his system.  It has always been a problem in the morning.  If we give Andrew enough insulin to keep his breakfast numbers in check, he will bottom out at 10:30, when the insulin "should" be out of his system. We work around it with a snack, lowering basal, or just being content that his number looks good at lunch.  However, with a cgm, it is hard to be content with a 90 at breakfast and a 90 at lunch when you see that he hit 300 in between.  I'm not that excited about the Humalog though, because I've heard that it crystallizes in pumps easier than Novolog and necessitates changing sites every two days instead of every three.  Apidra though, I think could be great.  Apidra works quickly and doesn't have a tail.  Andrew's nurse wanted us to watch him very carefully if we switch him to Apidra, because he will come down very fast.  If the pump site fails, he will also run out of insulin quickly.  That isn't a frequent issue, but it will be important to replace insulin as soon as we notice a site came out.
     When we went to change his site on Friday, we needed a new bottle of insulin.  Andrew wanted to try Apidra, but I said no.  I didn't want that level of stress with a new faster acting insulin over Christmas.  So, we opened the Humalog.   His numbers over Christmas were horrible.  It isn't really fair to the Humalog. It was Christmas.  But, his numbers were so bad!  By yesterday morning, he wasn't getting ketones, but he was high and corrections weren't bringing him down.  He hadn't had breakfast, so it wasn't food.  Some people say they just need more insulin on Humalog.  Since I was already suspicous of day 3 on Humalog, we just changed the site.  We decided to try the Apidra since we can watch him this week.  Two hours later, he dropped from 434 to 56.  Yes, Apidra works!  It made us a little nervous since we didn't know how much farther he would drop.  He responded just fine.  I did stay up late last night.  He was right around 80 for several hours, and I wanted to make sure he didn't drop any lower.  I finally turned his basal down and went to bed around 1:00.  Yes, the break is the perfect time to experiment with insulins!  I can't say his numbers are perfect, but I'm pretty confident that I'm going to like Apidra!