I start pumping Monday at 1:00 pm but I was not told what to do about my Lantus tonight. Do I discontinue or not?


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I must say, I'm a bit concerned that your doctor didn't give you any direction on this. Starting mid-day on a Monday without any prior training, testing, or preparation? I'd be highly suspicious of how well your doctor is handling this transition. Having said that, the transition can be a rough 24 hours but afterwards should be smooth sailing.

I'm assuming (but don't know for sure), that you're Type 1. If you're Type 2, disregard what I'm about to say. First, YOU NEED INSULIN IN YOUR BODY AT ALL TIMES. Whether you're taking Lantus once a day or twice a day, it won't stay in your system by 1pm tomorrow. When I did my transition, my doc gave me a sample of good ol' 8-12 hour NPH to use in place of my final Lantus shot., and timed it so it would wear off at just about the time I started pumping. Seeing as that isn't an option for you, then YES, you need your Lantus unless you're going to be shooting Humalog/Novolog every hour or so. I doubt you've been told the latter.

That means, of course, that you can't start pumping at 1pm safely with your standard basal rates. Maybe you'll be using it for bolus (mealtime) only for the time being, or maybe you'll be pumping harmless saline, as I did for a week before switching to real insulin. Maybe you'll be told to reprogram basals a few hours after starting, but that sounds risky, being that your new at this AND that your basal transition will occur when you go to sleep. Things can happen while you're sleeping, I'm sure you know, when you're not fully aware.

In summary, you have to take some long acting insulin tonight; you can't get by with nothing. That's a given. Tomorrow, I'd talk to your doc/pump trainer about possibly delaying the transition, or doing it in stages (i.e. saline, bolus only) for awhile. Come up with a plan, and make sure you fully understand it and are comfortable with it -- and make sure someone will be available at all times should you have questions.

If you're being trained by a pump-manufacturer's rep and not your doctor's office, call their 24-hour helpline. They probably have prescribed transition plans for all their pump-users and can tell you what to do and what to expect.

I hope what I just wrote doesn't scare you. Switching to an insulin pump after resisting for years was one of the best things I've ever done, and it's easy once you get the hang of it. My A1c dropped a full percentage point in the 3 months after the switch. I'm sure it will work well for you, but if you're not working with someone who knows how to get you started, it may be wise to look for someone else.

I second Scott's wise words. If you are a T1, IMO you should definitely take your lantus, even if it means delaying starting pumping - they can always give you saline so you can start Tuesday am without risk.

Hi Danboy. A lot of good info here. I do think that a temporary lower basal would probably solve the problem. Whoever helps you get started should be able to set it and at the same time show you how to use the temporary basal when you need it.




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