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dbz2988
02-18-2008, 10:28 AM
Ok, I'm pretty sure I saw a post here on pumping either the regular way or the untethered way but I can't find it. (sorry, not sure of the terminology here! :o We are looking into a pump and I'd really like to hear the pro's and con's of each and your experiences. Untethered sounds great from everything I have read, however, are there more risks involved with that method? is not as good for controlling BS? can he still snack the same as he would using the regular pump method?
Any help and information would be appreciated!

taximom
02-18-2008, 11:36 AM
There has been quite a few threads recently about "untethered" pumping.

Go to the "search" feature in the forums section, and type in "untethered". There is quite a bit of info. in there to sift through, but hopefully you find some of it helpful.

Flutterby
02-18-2008, 11:40 AM
I don't think there are any added 'risks' to the untethered method.. most people use it because it takes away the 'what if' of a site failure.. there is always that background insulin going.. I think the one 'con' would be they are still getting one shot a day, and the added variable of the lantus.. especially if you do part lantus and part fast acting in the pump for basal.. like Denise said, there have been quite a few discussions on this subject lately.. if you do a search, you'll find lots of great information from both sides..

Nancy in VA
02-18-2008, 11:58 AM
I don't think there are any added 'risks' to the untethered method.. most people use it because it takes away the 'what if' of a site failure.. there is always that background insulin going.. I think the one 'con' would be they are still getting one shot a day, and the added variable of the lantus.. especially if you do part lantus and part fast acting in the pump for basal.. like Denise said, there have been quite a few discussions on this subject lately.. if you do a search, you'll find lots of great information from both sides..


To add on to this - something about untethered that's not necessarily a "con", but an area that you can't fully exploit - variable basals during the day.

When you do your basal from Lantus, you get an even rate all day long. When you use the pump, you can have variable rates throughout the day. As we have all found, our kids have variable needs at different times of day. The ability to vary basals throughout the day is, in my opinion, one of the biggest benefits of the pump.

For us, the ability to be as accurate as possible with the dose, for small doses, is also a benefit of the pump. We also like that we can dose her 2-3 times a meal as she continues to decide what to eat. We could conceivably do this with injections, but who wants to give 3 shots for a meal.

Marina
02-18-2008, 12:38 PM
One of my favorite features of the pump is the temporary basal. So if your child is running low, e.g. after an active afternoon or simply because you didn't quite dose correctly, you don't have to feed them sugar but you can just lower the basal for one or two hours and get over the "low". The untethered method wouldn't give you this flexibility, plus you still have to do the site changes and wear the pump for much of the day. It sounds second best to me, but of course everyone is different.

Boo
02-18-2008, 01:28 PM
I think there are (at least theoretically) actually LESS risks with the untethered method because you do have the additional lantus (or levemir) working in the background at all times. So therefore, if you were to have a site go bad, some background would still be there. On the flip side, because that lantus is present, it may be harder to diagnose a bad site versus a bolus or basal issue, simply because there are more potential factors to consider (there was a recent thread demonstrating this, posted by twodoor2 about post bath site issues, which I believe ended up being a lantus issue after all was said and done...but I may be wrong about that :confused:).

As for being able to use temporary basals, that really depends on how much percentage of the basal is being delivered through the pump. For a small child with a high % of lantus, and low % of pump basal, temporary basal reductions probably wouldn't work. However, with an older child, teen or adult who requires a good bit of basal insulin, the % given by pump might still allow for basals to be temporarily adjusted effectively.

I believe there are advantages and disadvantages to both, and that you just need to find what you are most comfortable with and what works best for your lifestyle.

This is our story...I was very interested in the untethered method prior to pumping, mainly because of the fear of DKA. Now that we have been pumping for almost a year, I see logically that we test often enough that we will catch the infrequent bad sites before they become too serious of an issue. Between the comfort of knowing that, and the fact that my son would now balk at having a lantus injection each day, we are very happy with the straight pumping method.

The good news is...if you try one way and it isn't working well for you, you can always try the other method, or even go back to MDI. It is good to have options.

twodoor2
02-18-2008, 01:30 PM
To add on to this - something about untethered that's not necessarily a "con", but an area that you can't fully exploit - variable basals during the day.

Actually, there is a misconception that you cannot use variable basals with the untethered regimen, but you can. As Nancy states, you just cannot fully exploit those because you cannot lower the basal more than the amount of Lantus will allow. However, you can raise and lower the basal if you are giving part of your basal as fast acting, like we do. We give 80% Lantus, and 20% Novolog as basal, and I think Dr. Edelman's website really gives a good discussion about how that works. Check out his website on CWD that talks about the untethered regimen.

Wikipedia also has a nice discussion on the pros

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

Dr. Edelman had more glucose variability with his pump than he did with Lantus. Now there was some discussion here not too long ago about some studies that indicate that the pump provides less glucose variability than Lantus. I was given some input from a mother that got this information from Medtronic's website. However, upon further research into this, I found that the study that Medtronic was referencing used insulins that were developed before Lantus or Levemir, like NPH, and various animal insulins. I am still eagerly wanting a study that reflects Lantus glucose variability vs 100% basal from the pump variability, and I cannot find one.

I think the untethered regimen is a particularly nice option for people that are doing very well on Lantus, like Dr. Edelman. However, not everyone does, and going to the pump with 100% fast acting is a major improvement for them. It also gives me some peace of mind in lieu of site failures and DKA, but I've been reminded by several parents that my fears are unfounded.

In any case, research both options with an open mind, and just know there is more than one way to use the pump.:)

twodoor2
02-18-2008, 01:33 PM
On the flip side, because that lantus is present, it may be harder to diagnose a bad site versus a bolus or basal issue, simply because there are more potential factors to consider (there was a recent thread demonstrating this, posted by twodoor2 about post bath site issues, which I believe ended up being a lantus issue after all was said and done...but I may be wrong about that :confused:).

Just to clarify, this had nothing to do with Lantus.:)

Ivan's Mum
03-04-2008, 04:27 PM
hi there, sorry only just found this post. I must have been napping!

We do untethered 27/7 and don't really have a problem with lows. No more than I believe someone pump exclusively would have. Van's basal is 100% lantus, injecting in to his site pigtail in the morning and flushed through with his breakfast bolus. No extra injections for him.

He needs extra carbs if he's going to exercise or it's something unexpected. I don't know a child that does the same thing day in day out to a timetable so doesn't have lows.

He's disconnected except for bolusing or any corrections. He does wear the pump if he's lazing around on the weekend and he will wear if for a combo bolus.

He loves it and so do we!

momtojess
03-04-2008, 04:43 PM
I believe there are advantages and disadvantages to both, and that you just need to find what you are most comfortable with and what works best for your lifestyle.


The good news is...if you try one way and it isn't working well for you, you can always try the other method, or even go back to MDI. It is good to have options.

:) well said

Judy&Alli
03-04-2008, 04:51 PM
hi there, sorry only just found this post. I must have been napping!

We do untethered 27/7 and don't really have a problem with lows. No more than I believe someone pump exclusively would have. Van's basal is 100% lantus, injecting in to his site pigtail in the morning and flushed through with his breakfast bolus. No extra injections for him.

He needs extra carbs if he's going to exercise or it's something unexpected. I don't know a child that does the same thing day in day out to a timetable so doesn't have lows.

He's disconnected except for bolusing or any corrections. He does wear the pump if he's lazing around on the weekend and he will wear if for a combo bolus.

He loves it and so do we!

Hi Ivan's mum, Did you say that there is a piggy back so Ivan does not need another injection??????? I'm so excited!!!!! My husband and I were talking about how that would be the perfect solution. Where do you get them? Are they available in the states? That just made untethered much more attractive!!!
Thanks Judy:D

Ivan's Mum
03-04-2008, 08:05 PM
What I do is use the Rapid D by roche. I often see their sites pop up on the advertisments at the top of the pages.

It has a pigtail (so the disconnect is away from the body), I worked out the tubing is about 2.5 units long so I inject the insulin in to the pigtail at breakfast, then flush it thru with the b/fast bolus (which as to be more than 2.5 or you'll muck up the dose). It goes like this

Draw up lantus,
Inject which send 2.5 units of fast acting and part of the lantus thru
Bolus for breakfast which flushes the rest of the lantus and b/fast bolus thru.

It's kinda like sandwich-ing the lantus in between 2 slices of novorapid.:D

We didn't want to give more injections and one night I though... why not?

Works a treat.

PM me if you need to know more.

miss_behave
03-05-2008, 03:36 AM
RE: 100% untethered. Honestly I don't see the point of having a pump at all then. One of the biggest advantages of pumping is the variable basal rates, and the ability to set temp basals. Neither can be done 100% untethered. Basically you are just using the pump as a $6000 electronic syringe JMO.
You really miss out on a lot of the best things about pumping!

Most people who do untethered do a portion of basal through the pump, and a portion from Lantus (e.g 25/75 split) You still wear the pump full time, but there is a Lantus backup if the pump fails, so your numbers won't go too high. You can also disconnect for longer periods (eg swimming)

dbz2988
03-05-2008, 08:11 AM
So we questioned the untethered method to the D educator at the dtr office and she said they don't do the untethered method there and that Jr would need to stop the lantus for 24 hours before hooking back up to the pump, which would cause him a lot of problems????:confused: I don't remember reading anything about that, and no on has said anything about that here. Am I missing something?

Lee
03-05-2008, 08:28 AM
I have got to add my 2 cents worth - there are a few families here who love untethered - but most of them worked hard trying to get the pump to work BEFORE trying untethered - so they fully tried the equipment before deciding that it wasn't right for their family. I have to agree Miss Behave here, without using the equipment to it's fullest functionality, it is just a $6000 syringe...I urge you to try the pump - don't be worried about having something hooked up 24/7 - your child will tell you if it doesn't work for them or not, don't be worried about not using Lantus - by pumping you are actually taking away one for unnatural ingredient - one medication - from your child's regimen...

And if it does every fail, then try the untethered...

I'm actually going to run a poll about DKA and Pumps now....

valerie k
03-05-2008, 08:30 AM
What I do is use the Rapid D by roche. I often see their sites pop up on the advertisments at the top of the pages.

It has a pigtail (so the disconnect is away from the body), I worked out the tubing is about 2.5 units long so I inject the insulin in to the pigtail at breakfast, then flush it thru with the b/fast bolus (which as to be more than 2.5 or you'll muck up the dose). It goes like this

Draw up lantus,
Inject which send 2.5 units of fast acting and part of the lantus thru
Bolus for breakfast which flushes the rest of the lantus and b/fast bolus thru.

It's kinda like sandwich-ing the lantus in between 2 slices of novorapid.:D

We didn't want to give more injections and one night I though... why not?

Works a treat.

PM me if you need to know more.

I have to ask, at my drs office, we were specifically told not to use the two insulins together. my theory was to use one syringe one shot one time... and they said NO. They said the insulins were to be given a ways away on the body. Maybe its just my drs office with this issue? Any body else have a dr who said the same thing?

twodoor2
03-05-2008, 08:33 AM
I have got to add my 2 cents worth - there are a few families here who love untethered - but most of them worked hard trying to get the pump to work BEFORE trying untethered - so they fully tried the equipment before deciding that it wasn't right for their family. I have to agree Miss Behave here, without using the equipment to it's fullest functionality, it is just a $6000 syringe...I urge you to try the pump - don't be worried about having something hooked up 24/7 - your child will tell you if it doesn't work for them or not, don't be worried about not using Lantus - by pumping you are actually taking away one for unnatural ingredient - one medication - from your child's regimen...

And if it does every fail, then try the untethered...

I'm actually going to run a poll about DKA and Pumps now....

I respectfully disagree with you.:) I really enjoy taking it off of Elizabeth. The only thing I cannot do is lower basals more than the Lantus allows, but that one negative doesn't even come close the the positives that we've reaped with untethered. She can take it off for long periods of time, I still can use variable basals, and the various bolus functions. I mean, for us, it's the best of both worlds. I really don't even have to use variable basals, the Lantus keeps her flat, and if I have to compensate for basal, I just give her more bolus. Her numbers are very steady, even through the night, knock on wood. However, if they weren't I could use variable basals to bring her up, or lower the basal and give her variable basals to bring her down.

We didn't just do it for DKA worries, we did it for the freedom it allows, the ability to easily go back to injections, and because my daughter did so well on Lantus, why fix something that isn't broken? I'm not saying it's for everyone, but for us it was a great option, and the best decision we ever made in Elizabeth's diabetes care.:) We have excellent control as well. I didn't try traditional pumping first, you're correct. However the thought of having something hooked to Elizabeth 24/7 was very bothersome to me, and she did so incredibly well on Lantus, why not go untethered?? That was my way of analyzing the situation. However, I do respect your opinion, and I understand where you're coming from :-) I'm also a big fan of your charts!!

The fact of the matter is that there are different ways to pump, why not allow people the information, and let them decide. I was horrified to know that with the pump there was no Lantus, and then one of the moms, I think it was Nancy, told me about "Ivan's Mum", and using the untethered method. I did lots of research on it first, and then decided it was worth trying. I was very grateful for the reference. You see, I look at it backwards, if she was doing so well on Lantus, why go to something so vastly different? I went to untethered because the idea appealed to me. I highly recommend that people read Dr. Edelman's disseration on the Untethered Method in CWD. I also don't understand why people are so negative about it. I think people should research all the available ways to pump and go about it with an open mind. Traditional pumping is great as well for many kids, and has worked out so much better than a Lantus MDI routine for them. If you did poorly on Lantus, no matter what you did, I wouldn't recommend untethered in that case.

valerie k
03-05-2008, 08:34 AM
So we questioned the untethered method to the D educator at the dtr office and she said they don't do the untethered method there and that Jr would need to stop the lantus for 24 hours before hooking back up to the pump, which would cause him a lot of problems????:confused: I don't remember reading anything about that, and no on has said anything about that here. Am I missing something?


Matt started last week. We also didnt use the lantus for 24 hours. They said there is a residual that could/would be in the body... and to get proper dosages of the novalog, we would have to stop lantus. They will help you before hand to tell you how to go about checking and giving enough novalog (insert your brand) to cover before the pump is in place and up and working. So far, best thing we have done. It hasnt been a week, but we love it.

sammysmom
03-05-2008, 08:34 AM
RE: 100% untethered. Honestly I don't see the point of having a pump at all then. One of the biggest advantages of pumping is the variable basal rates, and the ability to set temp basals. Neither can be done 100% untethered. Basically you are just using the pump as a $6000 electronic syringe JMO.
You really miss out on a lot of the best things about pumping!

Most people who do untethered do a portion of basal through the pump, and a portion from Lantus (e.g 25/75 split) You still wear the pump full time, but there is a Lantus backup if the pump fails, so your numbers won't go too high. You can also disconnect for longer periods (eg swimming)


But the point that you are missing is that for this family, what they are doing works! You don't have to understand it but you could listen to this family and hear about the success they are having with this method and offer some support. Obviously with the success this family is having they are doing something right even if you don't understand it!

If I remember correctly, this family tried using the pump without lantus and it was a disaster. When you have a child with diabetes, as a parent you do whatever you can to make life easier. Pumping and lantus was the solution to their problem and to minimize it by saying they are just using a $6000 syringe is almost insulting. Pumping and lantus may not be right for you and you may not understand it but as you know (or may not know, knowing and understanding comes with age and expierence) YDMV.

Parents have a hard enough job, so when you do not understand something it may be worth looking into, if just for the knowledge to know that pumping and diabetes care can be successfully done differently.

shannon

miss_behave
03-05-2008, 08:43 AM
If I remember correctly, this family tried using the pump without lantus and it was a disaster.


I only know of one family who tried untethered because of this, and I wasn't referring to them, I should have made myself clearer. I'm happy they found something that worked for them when all else failed.
I just think that those pushing the untethered method are raising extra fear in newer pumpers about DKA, when its really not really an issue because most people on here check levels often enough to catch it.

I'm just a little frustrated when people decide to take an alternative route when they haven't tried the conventional route, and then go on about how great their way is vs the conventional way KWIM?
Like people who start the Omnipod without even considering or trying any other pumps, and then go on about how awful tubing is.

Lee
03-05-2008, 08:50 AM
I respectfully disagree with you.:) I really enjoy taking it off of Elizabeth. The only thing I cannot do is lower basals more than the Lantus allows, but that one negative doesn't even come close the the positives that we've reaped with untethered. She can take it off for long periods of time, I still can use variable basals, and the various bolus functions. I mean, for us, it's the best of both worlds. I really don't even have to use variable basals, the Lantus keeps her flat, and if I have to compensate for basal, I just give her more bolus. Her numbers are very steady, even through the night, knock on wood. However, if they weren't I could use variable basals to bring her up, or lower the basal and give her variable basals to bring her down.

We didn't just do it for DKA worries, we did it for the freedom it allows, the ability to easily go back to injections, and because my daughter did so well on Lantus, why fix something that isn't broken? I'm not saying it's for everyone, but for us it was a great option, and the best decision we ever made in Elizabeth's diabetes care.:) We have excellent control as well. I didn't try traditional pumping first, you're correct. However the thought of having something hooked to Elizabeth 24/7 was very bothersome to me, and she did so incredibly well on Lantus, why not go untethered?? That was my way of analyzing the situation. However, I do respect your opinion, and I understand where you're coming from :-) I'm also a big fan of your charts!!

My turn - I also very respectfully disagree with you ;)...boy, aren't we PC now a days :D

I think that the other families did try conventional pumping then switched to untethered, which works great for them. And when you first started, I was shaking my head, thinking, wow - if she would only try...with that said, I am impressed with how well untehtered is working for you and your family - and I can definitely see the pros of it. I am also curious in how much resistance you met with the endo

twodoor2
03-05-2008, 09:01 AM
My turn - I also very respectfully disagree with you ;)...boy, aren't we PC now a days :D

I think that the other families did try conventional pumping then switched to untethered, which works great for them. And when you first started, I was shaking my head, thinking, wow - if she would only try...with that said, I am impressed with how well untehtered is working for you and your family - and I can definitely see the pros of it. I am also curious in how much resistance you met with the endo

Becky, I had no resistance whatsoever from my endo. I said "I'm doing untethered," and she said "ok, that's fine." That's one of the reasons I love her, she lets us do whatever we want. The pump trainer was very supportive as well. :D

There are more and more options in diabetes care these days, pumping and now traditional pumping and untethered pumping. I think it's really great to have more options to help us with diabetes care. There was a time not too long ago that people could only use NPH and then pumping was a major improvement for them. However, with the new basal insulins like Lantus and Levemir, it opened up the door for other ways to use the pump. We're really happy that we did, and we have no regrets whatsoever. I wish everyone tremendous luck in whatever route they decide to go. Traditional pumping is fantastic as well, and many parents here can attest to that.:D

Stacey Nagel
03-05-2008, 09:16 AM
Jesse has untehered every summer for the last 4 summers.. It's just more convenient for our lifestyle- we live by the beach and belong to a local beach club.
Here is something I wrote a few years about our/his experiences with untethereing :

Jesse has been untethered since the beginning of June.
He used 18-19 U of lantus @ 6-7 pm.. and infused 4.5
U novolog thru his pump as basals thruout the day
... We decided to try it, so
1- he wouldnt have to wear his pump all day at the
beach.
2- I wouldnt have to search for him to give him
bolus's for his missed basals all day, on the beach.
3- Peace of mind. Not having to worry about him
getting ketones, or going sky high from being
disconnected for hours at a time.
4-He's either in the ocean, pool, or playing basketball or paddleball from the minute we get there

Our results-
- It worked. he was able to run around without having
either of us worry.
- his #'s have been sooooo much smoother. His lows
were not as severe and were more easily treated . His
lows were usually in the mid 60's
- His highs were never as high..generally in the low
200- range. Once in the 3 months , he hit 471. That
was possibly due to a bad site, while we were
traveling that week , taking Alli and Daniel to their
prospective colleges....or it could just be because he
has diabetes and felt like torturing me...!!!

There were many nights that his BS was around 100, so
we just disconnected his pump, and let him sleep like
that. It was just like putting him on a temp rate....
while unthehered -
AND THE BEST PART OF UNTETHERING FOR JESSE WAS THAT
HIS A1C was............ 5.7.......at his endo appt
today.
I was shocked. Usually he's between 6-6.5... wow...
His doctor wasnt concerned that it was so low, due to
seeing how great his #'s have been...

By the end of the summer, Jesse gets of the shots and usually wants
to go back to just pumping, in time for when school starts .

momtojess
03-05-2008, 09:35 AM
So we questioned the untethered method to the D educator at the dtr office and she said they don't do the untethered method there and that Jr would need to stop the lantus for 24 hours before hooking back up to the pump, which would cause him a lot of problems????:confused: I don't remember reading anything about that, and no on has said anything about that here. Am I missing something?

I think alot of endo do not offer untethered at their offfices because it isnt a really common way of pumping. Maybe you could get articles, studies, etc supporting it and show them to the endo. Perhaps they would be really to research it alittle or let you give it a try.

When we started pumping we had to stop lantus for 24 hrs. Jess got more injections of fast acting during that time to keep her lower, but it wasnt a huge issue.

twodoor2
03-05-2008, 10:07 AM
I think alot of endo do not offer untethered at their offfices because it isnt a really common way of pumping. Maybe you could get articles, studies, etc supporting it and show them to the endo. Perhaps they would be really to research it alittle or let you give it a try.

When we started pumping we had to stop lantus for 24 hrs. Jess got more injections of fast acting during that time to keep her lower, but it wasnt a huge issue.

If you need more information, there is this wikipedia.org article

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

and Dr. Edelman's article in which he describes also about how to use variable basals.

http://www.childrenwithdiabetes.com/clinic/untethered.htm

The other thing about site failures I forgot to mention is if they do happen, and they did to us in the beginning, I didn't have to immediately change the site. I had to run off ot work, or do other things, so we just used syringes for the day until I did get home to change the site. I work full time, so I have trained our nanny how to use syringes. We have a flow chart that delineates what she should do in case of a suspected site failure. The fact of the matter is that I cannot be around her 24/7, so we were able to go back to traditional injections for a day. That was also very nice. The Lantus was sufficient enough to keep her going great even with the existing carb ratios that the pump had.

Dr. Edelman flip flops between pumping and his injections. He likes to swim on the weekends, so he does his injections on the weekend.

However, and again, I don't mean this in any disrespect whatsoever to traditional pumpers, if you do a search on CWD, you will see all the benefits of traditional pumping as well. There are tons of parents that are just so happy they went to traditional pumping, and it has changed their lives for the better.

My belief is that no matter what you try with your diabetes management care, MDI, traditional pumping, untethered pumping, you do as much research as possible and give it your all. Many parents on the board detest NPH, but Wilf has made it work wonderfully for his family. Just do what works best. If you want to go to traditional pumping before trying untethered, I encourage that as well. Every family situation is different, and every individual's diabetes is different.:D

kiwikid
03-05-2008, 02:27 PM
Are there any problems with Insurance companies covering both pump and supplies AND Lantus?

twodoor2
03-05-2008, 03:41 PM
Are there any problems with Insurance companies covering both pump and supplies AND Lantus?

Not ours, and we get extra syringes as well. BCBS of IL. We have a PPO. However, that is something to think about.

Ivan's Mum
03-05-2008, 06:14 PM
[QUOTE=miss_behave;130854]RE: 100% untethered. Honestly I don't see the point of having a pump at all then. One of the biggest advantages of pumping is the variable basal rates, and the ability to set temp basals. Neither can be done 100% untethered. Basically you are just using the pump as a $6000 electronic syringe JMO.
You really miss out on a lot of the best things about pumping!

It depends what your reasons for untethered are. Essential IVan doesn't want to wear a pump all the time. We do use a basal if he's lying around doing nothing on the weekend otherwise he'd go hi. For me, I want the ability to make finer corrections, temp basals, combo boluses, ability to send him off to friends and not expect them to attempt to draw up insulin or count carbs correctly. This method gave us BOTH what we needed.And and A1c that went from the 8's on MDI to the 6's on untethered. Do you really need to ask what the point is?

I use every feature that the pump offers to some degree or other. It's so much more that a $7,500 electronic syringe, nothing is funded in this country so I'd have to be pretty sure I was doing the right things as this comes out of our purse.

Just because we don't use a basal rate every day makes this method no less efficient. And this isn't to be taken as a dig but I get sick to death of having to defend this method.

As for your endo team not backing you, I think that's really bad. Talk about stuck in their ways. Even if you decided to pump I think untethered is an excellent way to get started on pumping alone. You get used to what the pump has to offer and move on from there.

Whatever your reason for doing untethered - it's valid... whether it's the disconnecting, fear of DKA, dislike of wearing a pump, I'm not dismissing anyones reasons as unvalid. They're real to you.

I asked Jeff a while ago to get some more info on this subject up as I get soooo many questions about it and I think it's valuable enough to get out there for everyone to read - including a few of those stuborn endos.

I wonder if pumping go this much dismissal when it first came on the scene... probably.

Ivan's Mum
03-05-2008, 06:17 PM
I think alot of endo do not offer untethered at their offfices because it isnt a really common way of pumping. Maybe you could get articles, studies, etc supporting it and show them to the endo. Perhaps they would be really to research it alittle or let you give it a try.

When we started pumping we had to stop lantus for 24 hrs. Jess got more injections of fast acting during that time to keep her lower, but it wasnt a huge issue.

Also, whilst I'm on a roll....

Once we got the pump we were left too it. If you know how to work a pump you're not really going to need much support from you endo. You'll make all the same decisions about increasing insulin as you always did.

Mixing insulins - you can mix lantus and novorapid. It's in plenty of the diabetic books I've read, Ivan's endo team no he does it and there's been no problem with it. I know there are certain types that you can't mix, but our routine isn't one of them.

In addition, I have never pushed untethered as a way of skipping DKA. It's never been a factor, I like it for no ketones, the poor dude feels rotten if he gets them but essentially we're all about control and disconnecting. I never thought I'd be dealing with the 'like everyone else' at 6 - what are the teenage years going to bring?

Jessesmom
05-11-2008, 07:06 PM
Are there any problems with Insurance companies covering both pump and supplies AND Lantus?

Not that I'm aware of. Every pumper should have a vial of long-acting insulin on hand for emergencies, and for those who decide to adopt this protocol, their insurance company would end up forking over fewer bucks for short-acting insulin. It seems a wash to me.

We're right now into our second day of the untethered regimen. Our son gave himself 75% of his short-acting basal as Lantus near bedtime, and the other 25% was given over 24 hours through his pump. We discovered that the 75% Lantus was way too much, at least during the wee hours of the morning.

Last night, we cut the Lantus way back, and today, his readings have been on the high side. We'll find a happy medium.

Our son has been pumping since 6 mos post-diagnosis (9/03). He's now 16 years old. Pumping has tremendous benefits, but the practice also has its downside. For us, the minuses include those highs that ensue after our son's litany of possibilities: bad site, tubing catches on doorknob, bubbles in tubing, and my personal favorite (not)....cat chews hole in tubing while son sleeps.

I became interested in the untethered regimen for one reason and one reason only: to give our son a small foundation of insulin, so that when the site went bad, or the cat played frisky with his tubing, Jesse would have a buffer to keep him from skyrocketing.

Our endo has been opposed to this regimen since the first day I mentioned it. However, we decided to give it a try regardless. Time will tell whether it works for our family.

L

saxmaniac
05-11-2008, 10:19 PM
I like the idea of untethered, though with OmniPod it is less attractive since you can't disconnect. Still, I suspect some day we will experiment with it, and see what happens.

dqmomof3
05-12-2008, 10:24 AM
My endo's office had never heard of untethered pumping. I gave them Dr. Edelman's paper on the subject, and after they read it, they were willing to let me have a go at it if I wanted to do it. We haven't done it, but I'm still interested, especially because we have a special situation with the gymnastics, and she's disconnected from the pump ten hours a week for sure, plus any time we're swimming.

Right now, we're in great shape, A1C is great, so we're not changing anything. If that changes, though, we'll look at doing the Lantus for most of the basal, to make up for the basal she's missing when she disconnects.