Replies to This Discussion

Permalink Reply by Laura S. on July 25, 2009 at 1:38pm

I think you might want to research on this. I cant remember where, but I think I have read about people doing this before.
You're maybe in an opposite category though, because usually people have trouble with the long lasting insulins in their system, and no way to cut that down. You might want to ask on some diabetes sites, including www.integrateddiabetes.com.

Permalink Reply by MelissaBL on July 25, 2009 at 6:52pm

Hmm. One of the things you might want to consider is that some pumps (I think) have a minimum amount you can have in the reservoir and/or a minimum basal rate you can program in (while I think some let you program in 0.00 units per hour). The other major issue would be that without a regular flow of insulin through the tubing and cannula, occlusions and clogs will be a nightmare.

Have you considered instead going to an i-port (infusion set style syringe port) in combination with syringes (or better yet, pens) that allow you to dial half-units? I think that a pump isn't going to give you smooth performance as a bolus-only device. But that's just my two cents. If you feel like you have better control on your Lantus, find a way to streamline or detail-work your Humalog through injection as well. I know I heard Kristin mention half-unit syringes as some point.

Permalink Reply by Lindsey on July 25, 2009 at 9:04pm

Hi Melissa,

The minimed paradigm pump allows a 0.00 units/hour basal and I'm not sure about a minimum in the reservoir (the lowest I've loaded it without before was about 40 units). Does the absence of a regular flow really cause a lot of occlusions and clogs? I guess it makes sense, but it still seems like it'd be roughly the same since there's still insulin sitting in the tubing.

Thanks for the other ideas!

Permalink Reply by Lorraine on July 25, 2009 at 7:10pm

Yes, I have heard of people doing this. I believe it's referred to as "untethered". I do not have any personal experience with it however.

Permalink Reply by Lorraine on July 26, 2009 at 5:49am

http://en.wikipedia.org/wiki/Untethered_regimen

Permalink Reply by Lindsey on July 26, 2009 at 7:38am

Thanks, Lorraine! I'd seen that article along with several others about that. And while I don't think I need a basal through the pump, it is pretty close to what I'd like to achieve with it.

Permalink Reply by Lorraine on July 26, 2009 at 7:45am

No problem. I've actually considered doing this for Caleb. When he was on injection therapy it seemed like the NPH would soak up so much "loose ends". With only Novolog, I see him very sensitive to whatever variables (food, growth, whatever) that would cause him to go high. On the pump, we saw our first 300s since dx, but we were also able to correct very easily. Ultimately, I decided against it because it seemed to go against the whole point of pumping and to ask Caleb to endure shots AND the pump insertion seemed unfair. Nevertheless, I can relate to wanting to use the approach if it helps stabilize your BGs.

Permalink Reply by elaine peterson on July 26, 2009 at 6:53am

If you use the pump for boluses, you'd have to wear it all the time and might have the same issues with the infusion site regardless of not having a steady dosing going on. Are you thinking that less insulin entering through the site will be better absorbed?

Permalink Reply by Lindsey on July 26, 2009 at 7:40am

By just doing boluses with the pump, it's not mandatory that I wear the pump continuously as long as my infusion site is accessible for bolusing. I don't think it's anything with absorption going on with my blood sugars, so no, that's not what I'm seeking through bolusing with the pump. Basically, it's easier to calculate the boluses through the pump, I can easily use an extended bolus, and easily keep track of where I'm bolusing, etc to give me a better idea what my boluses are actually doing.

Permalink Reply by Hector Gonzalez on July 26, 2009 at 7:44am

Lindsey. I was on humalog and lantus for more than 8 years and my. A1C. Was. 6%. Now I am on a minimed 722. For almost 8 months and my A1C. Is 6.5%. So pumps or multiple shots are tools you can use the way is better for you or any one
My recomendation for you is review your diet and excersise routines with. A new diabetes instructor and a new endo for 8 months and make a new test for your A1c there is nothing beter to control your basal insuling that a pump
Take care

Permalink Reply by Kristin on July 26, 2009 at 3:19pm

I have heard of people wearing the pump part time. They take their minimum basal level as an injection of Lantus or Levemir (the equivalent dose for the lowest basal insulin per hour amount), then wear the pump only part of the day (for example, wearing it only at night etc). But you still need to re-connect to bolus.

Honestly, for me it makes the pump not worth it. I have considered taking 1-2 units of Lantus a day, just to avoid DKA caused by bad infusion sets, but I think this would be too expensive as I would need to throw out a lot of Lantus, but I have thought about doing this during pregnancy to guarantee that I have some insulin in my system even if I experience pump problems.

Permalink Reply by Scott on August 8, 2009 at 3:12am

Yes I have. My numbers were probably the best they ever were when I used lantus and the pump for novolog. The biggest thing I did was just trying to figure out what my bolus ratio was on the pump and eventually started doing it manually off the pump. I don't know if I could see me doing that 24/7. I didn't know there was an actual term for it until I read this post. I personally just can't get use to the pump, almost like my body rejects it..I guess I mean using a basal on the pump has never worked right for me. Then again I have LADA so that could explain it. Lantus shouldn't have anything to do with your bolus. I have learned everyone is different and reacts different and their diabetes is different, so it might work for you and it might not. One thing that is important on the pump is finding the right infusion set that works best for you and causes less problems. Another thing is I'm sure the cost of doing both of these treatments might not be available for some.. If you try it, let me know how it works. I would like to know others who have had great results doing the untethered regimen like myself. BTW, never had a problem with with occlusions or clogs. I use the sure-t and don't have to prime or make up for not wearing it 24/7.

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