Using long acting insulin in addition to the omnipod

My endo has put me on long acting insulin once a day to try and get my glucose levels down in the morning. This is in addition to using humalog in my pod. Has anyone else tried this with any success? My glucose levels are in excess of 300 in the morning no matter what I do.

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Permalink Reply by MountainDolphin on September 1, 2010 at 11:26pm

Not that I'm a physician, but what your endo recommends sounds *really* odd to me.
The whole point of pumps is to try to approximate what the body does, which is to release insulin.

I'd get a second opinion on this;
at the very least, having insulin from another source the pump doesn't know about means it can't make informed
recommendations on boluses.

Permalink Reply by MaiaJane on September 2, 2010 at 1:08am

Have you tried raising your Basal in the morning? Or have you just used a flat-line basal? Seems odd to me too...but good luck, and I hope it works out for the best!

Permalink Reply by Kim on September 2, 2010 at 3:52am

Yes, they do not want me to raise it anymore. I am up to 1.6 units per hour at night and 1.4 during the day. Plus I cannot afford to go through a pod every 2 days. They are trying to figure out what is making my glucose levels go so high. I eat very low carbs 99% of the time, exercise 1 to 2 hours a day, etc... My endo said that they were experimenting with it because they have a few cases like mine. They have been trying to get my levels under control for over a year now.

Permalink Reply by Natasha Bowlds on September 2, 2010 at 5:09am

What about more "concentrated" insulin? I can't remember what it's called but I know there is insulin that you would need less of to do the same thing.

Why do you only have two basal rates? Has anyone checked your overnight blood sugars with a CGM? Even for the short term - it's possible that you actually just need a higher basal for the dawn hours - or even that your basal is too high and you are experiencing the rebound effect.

Sorry if you know all that - it just seems so odd to me, especially since you have only 2 basal rates. My 10 year old has five or six depending on the day - and he needs a very low number overnight (.2/hour) so he doesn't bottom out but twice that from 6-8 AM (.4/hour) to keep him from spiking.

Permalink Reply by Kim on September 2, 2010 at 8:48am

I do not think that the more concentrated insulin works in the pods. I am not sure on that one. I will do some research on that. My endo only has me on 2 rates. I did recently do a free trial on the dexcom CGM. It was like pulling teeth to get them to email me my results on the 4 day trial. It was the week that I always run higher out of the month. I did notice that even though i was running really high that my sugars dropped rapidly in the middle of the night and rebounded about 3 or 4 in the morning. But with that said, according to the CGM graph they emailed me. I have taken the long acting insulin for 2 days now and the first morning my glucose levels were at 246 and this morning i was at 185, so it seems to be working. It is just a pain to take shots and have two types of insulin.

Permalink Reply by Natasha Bowlds on September 2, 2010 at 10:53am

That sounds like a classic Symogie (I have no idea how to spell that) effect - if you go really low and then you rebound, then you actually might need LESS basal at night. I have read about that problem but my son hasn't experienced it. But if you had that AND a dawn phenomenon, you would definitely need some adjustments to your basal. If you read "Think Like a Pancreas" you can see the "typical" (haha) basal rates at different ages, and they are nowhere near 1 in the day and 1 at night. I find it surprising - not that your endo is trying something different, because that seems refreshing to me - but surprising that they are trying adding lantus before trying adjusting your basals down at night, or adding more basal rates.

Permalink Reply by Lorraine on September 2, 2010 at 6:32am

We have not done this, but I have thought about it. I miss the effect that the long acting insulin had - it worked like a sponge on certain things, particularly food.

I've heard of other people doing this and know of one in particular who does it because of sports. He uses a tubed pump and disconnects for sports. It made managing his BGs difficult. Adding a shot of Lantus of 24 units and reducing his basal by 1 unit per hour made a huge difference in his care - for the better.

You seem to be using it for a different reason. Nevertheless I wanted to share that success story. I hope this works out for you.

Permalink Reply by Kim on September 2, 2010 at 8:52am

Thank you. Although I am not using it for sports. I am very active most of the time.

Permalink Reply by Steve D on September 2, 2010 at 6:42am

I''ve noticed the word 'odd" in many responses here, Kim, and I want to reverberate that. ODD, ODD, ODD! Like, Crazy ODD! I have never heard of any endo who would reccomend such a thing! In fact, my endo often tells me "isnt it great to just have to buy ONE kind of insulin now?" (yeah, great like diabetes). I believe one of the benefits of a pump is to use only one kind of insulin, and to be in control of your basal needs! I would definitely see if there is a way around this, I would be concerned with unexpected lows during the day, and I would just try a heavier basal for a couple hours in the morning. I also experience the 'dawn phenomenon" and my sugars rise in the early am, so I increase my basal from 4 am to 6 am....when I first made thie change I (much to my wife's dismay) set my alarm for 4, 5, and 6 am to monitor. Everything worked out perfect! Whatever you decide, good luck and PEACE

Permalink Reply by Kim on September 2, 2010 at 8:59am

Well at this point of fighting for over a year to get everything under control, I am willing to try just about anything. I have taken a shot of Humulin N, 12 units for the past 2 nights. One thing I do not like about long acting insulin is it makes me feel like I am standing or sitting at a 45 degree angle. When I went on my pump back in April, I lost that gling for the first time since the doctors started treating me for diabetes. It felt like I was almost normal again. I know it sounds odd. I looked at my endo like she had 3 heads when she told me to add a shot of long acting insulin at night. She told me that they have a few patients like me and they have been experimenting with that on them and have had some success with it. So I guess I am a guinea pig for them.

Permalink Reply by Kim on September 2, 2010 at 9:04am

Yes it is very frustrating. Bread, what is that ? lol I have not been able to eat hardly any carbs since I was diagnosed with diabetes. I have had it once or twice and was ill for 2 days after that. No I have not tried Symlin. I will have to wait to get a second opinion until I am employed again. My insurance is not the best and to see a specialist it is $75 a visit... OUCH!! But on the other hand at least I have insurance. No I have not done an over night glucose curve. I will have to google that one. It was never suggested.

Permalink Reply by Katsz on September 2, 2010 at 8:02am

I thought that it would be nice peace of mind if my son had both a long acting insulin like lantus along w/ the pods...only because if they failed... he wouldn't be totally w/out insulin and go in to Ketosis as quick... but the doctor said no to that...why have a shot if he doesn't need one.... son said he didn't care either way. He requires 1.0 basal and 1.5 in the am.
If you need that extra and don't want to have to change pods too much.... it makes sense to me. But... I am not an expert at all... lol Good luck with it.