Insulin Lyumjev… Not as URLi as I expected! is another fabulous review of Lyumjev and its use in AIDs.from his website, Diabettech.com, 19 August 2020.
We learned from Profil that Lyumjev appears to peak between 35 and 45 minutes. And that it also appears to have a considerably shorter tail than nearly all the other fast insulins out there (very interesting from an AID point of view). Finally, in their meal tests, they found that it was as effective as the pancreas in eliminating post-prandial excursions for two hours after the meal, however beyond that, it wasn’t quite so good.
Side Effects? The clinical trial that was run to investigate use with a pump threw up some concerns. To put this in context, in the Fiasp pump trial, there were twice as many pump site reactions as regular Insulin Aspart. In other words, it appears that Lyumjev users are more likely to suffer reactions or pain at infusion sites than Fiasp users. However, the number of issues that resulted in the users changing the sites early were no worse than Humalog (if anything, the data suggests that Lyumjev required fewer irregular set changes):
Using Lyumjev with OpenAPS: Given all of the above, how should Lyumjev be used with OpenAPS? From the Profil clamp testing, it suggests that we need to run a custom insulin curve, which was a capability that was added when the exponential curves were added to all the systems. With the clamp testing data presented, my initial settings for the curve are:
Now, you may be asking “Why use six hours DIA, when the graph appears to show five?”. This allows the algorithm to think there is insulin on board when there may or may not be, and is a safety factor. As I observe behaviour, I may adjust it down. We can also see from the clamp graph that the profile for Lyumjev is slightly different from that of the other insulins, with the flattish peak that lasts from around 1 hour to 3 hours. Time will tell whether this is required to be modelled into the systems.
Secondly, for the run in period, I do not be adjust any profile settings before use. Instead I use a temporary target of 7.5mmol/l to leave space for landing should the insulin turn out to be more effective than the Fiasp/Humalog mix that I have been using. As I use OpenAPS with the option that a raised target tells the algorithm that I am more insulin sensitive, it also means that the system will run with a less aggressive ISF and therefore will be more conservative in dosing insulin.
But. How fast is it? I’ve not figured that out yet.
Read more: Insulin Lyumjev… Not as URLi as I expected!
So Cal Loopers offered a wonderful presentation by Dr. Stephen Ponder, developer of Sugar Surfing, which describes the discipline of diabetes self-management ‘in the moment’ using frequent pattern management of your own CGM data.
His 501(c)3 non-profit corporation called Dynamic Diabetes Management Inc. aims to change how diabetes education is delivered in the era of cgm, empowering patients, parents and their health care providers using this progressive system of diabetes self-management.
He adapted his discussion of Sugar Surfing to comment on using his principles while Looping. ENJOY!!!