What you should know about using Lyumjev in Pumps
Lyumjev is the newest ultra-rapid acting insulin on the block. Lyumjev was approved by the FDA on June 15, 2020. So it can now can be prescribed by your Healthcare provider (HCP) and is available in pharmacy. While it has been approved for mealtime dosing, it has NOT been approved to be used in insulin pumps…yet.
So of course, I wanted to try this new insulin, in my pod, while looping, to see how it compares to the other ultra-rapid insulin, Fiasp, and let you know the good and the bad about Lyumjev. So yes. a whole lot of off-label going on in this personal experiment.
What is Lyumjev?
Lyumjev is an ultra-rapid acting insulin made by Ely Lilly, which is the company that produces Humalog (rapid-acting insulin). While it contains the same active ingredients as Humalog, it contains additional ingredients which allow for increase in speed for insulin absorption.
What's So Great About Lyumjev?
The research is showing that Lyumjev is the FASTEST available fast-acting insulin, even faster than Fiasp. If you are unaware, Fiasp was released in 2017. It is the other ultra-rapid acting insulin and is produced by Novo Nordisk, which is the company that produces Novolog (another fast-acting insulin similar to Humalog).
In a head-to-head comparison study, Lyumjev demonstrated to have the fastest insulin absorption and the least post-prandial glucose (PPG) excursions compared to Fiasp, Humalog, and NovoRapid (1).
Below is the results of the insulin absorption after injection of Lyumjev compared to Fiasp, NovoRapid, and Humalog (IL-100) with patients with type 1 diabetes.
As you can see in the above graph, Lyumjev has a significantly faster insulin absorption compared to all other fast-acting insulins, including ultra-rapid acting Fiasp.
A faster insulin absorption time means that you would require less time pre-bolusing or dosing before you eat a meal, and less time to bring down a high. Not only should a faster insulin reduce the amount of highs, but by allowing the insulin to work in your system more quickly, it can reduce the blood glucose excursions (AKA the roller coaster swings). Also, a faster time should allow people with diabetes to be a bit more intuitive with their eating. With the typical 15-20 minutes to do a pre-bolus of the guestimated amount of carbs you think you will eat, it doesn’t allow you to listen to your hunger cues to determine how hungry or satisfied you are in the moment.
How many times have you dosed for a decent sized meal, but you got busy or you just aren’t as hungry as you thought?? Doing so would cause you to go super low and then, cause you to overtreat, and thus the blood sugar roller tycoon begins! And boy is that exhausting.
My Personal Experience Using Lyumjev
As a diabetes educator who has type 1 diabetes, the moment I learned about Lyumjev, I wanted to try it and let others know my personal experience. AKA I like to be the guinea pig so if something goes wrong or right, I can give my personal experience and help others with diabetes go through the process more smoothly.
Similar to when Fiasp was first released, Lyumjev is not FDA-approved to be used in a pump. Fiasp was released in 2017, and not until October 2019 was it FDA-approved to used in pumps. However, what I have seen as a educator is that Fiasp doesn’t do as well in tubed pump, especially for my Tandem users. This is believed to be due to Fiasp being a slightly “stickier” substance in comparison to Novolog or Humalog. Which results in the first 1-2 days allowing for improved blood sugar control due to the faster timing, but then all heck breaks loose with bringing down highs because the insulin seems to get “stuck” or occluded. Which is unbelievably frustrating. You could have the PERFECT settings, eat well, and exercise, but if your insulin isn’t working, it doesn’t matter, you will still have poor BG control. While this isn’t an issue for podders, it makes Tandem users even more curious about Lyumjev in hopes that this newest ultra-rapid insulin will be more usable for their tubed pumps.
While I am a pump trainer for Tandem, Medtronic, and Insulet (Omnipod), I personally use Omnipod to loop (off-label). I do however have a Tandem pump with Control IQ and use it from time to time so I can better relate to my Tandem clients.
As a podder, I have been using Lyumjev for the past 2 months. Before Lyumjev, I have been using Fiasp for almost 3 years. Then of course, I have used Humalog and Novolog throughout my 25+ years of having type 1 diabetes.
Available in Different Concentrations
One ultra cool factor about Lyumjev compared to Fiasp, is similar to Humalog, Lyumjev also comes in a U-200 concentration. Fiasp and Novolog only come in U-100 concentration. Having a U-200 concentration gives a lot more flexibility for those who are more insulin-resistance because U-200 is double the concentration. Double the concentration means you only need to use half your usual dose compared to U-100 insulin. For example if you usually take a total of 120 units of insulin, using U-200 would allow you to cut that amount to 60 units a day.
However, again with the off-label, U-200 is NOT approved for pumps…and I should leave it at that and not prompt you to look into using U-200 for pump use… But yes, having the U-200 concentration option with Lyumjev allows more flexibility for those who are more insulin resistant. And as a double plus, U-200 in the Humalog form seems to work faster than U-100 due to the doubled concentration. Therefore the Lyumjev U-200 would likely work even faster than the normal already ultra-rapid U-100 concentration of Lyumjev.
Lyumjev and Painful Sites
Overall, I was enjoying my Lyumjev during my expierment. It had a slightly faster onset compared to Fiasp. But then, the intense burning site happened…
The burning, itchy and very uncomfortable site because of the Lyumjev.
I noticed a slight increased irritability at first, but thought it was in my head, so I ignored and actually forgot about it. But then, I had a couple clients that were using it had gotten back to me about their experience and let me know that while they saw a slightly improved insulin absorption rate, ultimately they had to stop because of how terribly itchy and painful it became at their infusion sites.
It affects everyone differently, but many of my clients expressed that the site was growing increasingly more irritable which ultimately led them to ripping it off early and switching back to the insulin they used prior to starting on Lyumjev. Also, it’s important to note, the higher the basal and bolus amount used and the longer the site was on, the more irritable the site became.
My Thoughts About Lyumjev for Pump Users
The slightly faster insulin absorption is nice, but not THAT noticeable. As a side note, I also had some users who reported that they felt that the faster absorption caused them to eat a less healthy diet because they were eating more spur-of-the-moment junk foods because they knew they didn’t have to bolus and wait forever. While I do not notice a HUGE difference in timing compared to Fiasp, I didn’t feel that my personal diet changed. My biggest concern was the nasty painful sites, especially for my Medtronic and Tandem pumpers who use tubes.
My Experience Using Low and High Amounts of Lyumjev
Okay, this is a bit personal. But recently I stopped using Metformin and Jardiance because my husband and I are thinking that we may try for another baby. We understand that we are crazy for wanting three kids. 😀
I used Metformin, then Synjardy (which is a mix of Metformin and the SGLT2, Jardiance) to experiment an additional way to reduce my total daily dose (TDD). I already eat well, exercise, try to get my 8 hours of sleep in to naturally reduce my TDD, but I was curious about how this would add additional insulin sensitivity to my lifestyle habits. I was able to get down to 14U a day when I was REALLY working at it. However, my usual was typically between about 18-22U while eating well, exercising, sleeping, and using Synjardy.
The reason this is related, is that when my insulin dose was usually between 18-22U per day, I did not have any noticeable issues with Lyumjev because I had a low total daily dose of insulin. Now that I am off Metformin and Jardiance, I am closer to about 30-35U per day (and let’s be real, closer to 45U when I bake with my kids), and now my site and bolusing is PAINFUL! So painful, that while I was in mid-vial, I switched back to Fiasp. Which is heart-wrenching to throw away liquid gold at the mid-vial point, but Lyumjev with my normal total daily dose is just to dang painful.
Now that I back on Fiasp, I do not have any pain and feel everything is runny pretty smoothly.
Bottom Line for Lyumjev in Pumps
While I was initially optimistic, my personal experience along with many of my clients, I feel that Lyumjev should not be used for the majority of people with diabetes on pumps. The pain and discomfort from the sites is not worth the slight increase in speed in insulin absorption . Only if someone does not use very much insulin and doesn’t use a tubed pump, would I say Lyumjev is an option. Therefore the only people that I think who may get away with Lyumjev, or those who have a low total daily dose of insulin and either use Omnipod or use Multiple Daily Injections (MDI).
If you Need Help with your Diabetes...
Hopefully, this has been helpful for you. I hope you are doing well and I wish you the best with your diabetes management, your health, and happiness.
As always, if you are struggling with your diabetes (newly diagnosed or a long-time veteran), do not hesitate to write me an email or schedule with me for a consultation. I’m here to help you with your nutrition, exercise, settings, and understanding YOUR diabetes. I love helping people like you increase control so you can spend less time treating the highs and lows, and more time living your life.