Semi-untethered with Levemir instead of Lantus

Lisa P. · #1 05-11-2011, 10:13 AM

Had our appointment yesterday, we're back to where we were before "The Great Pumping Into Muscle Maybe" debacle where we found we had to switch to angled sets. Life is much better.

During the craziness I was looking at returning to shots or going untethered, I was convinced we weren't getting the tiny basals sometimes at night because we'd move to 400 and get stuck there until we gave an overcorrection, at which point she drop like Hoffa. So, it's better now, but our nights still include many corrections one way or the other. It's not a basal rate problem, because sometimes we're even. I know some folks adjust basals several times a week, which would probably be one useful way to go, but I don't have the skills for that so we need to find another way.

We did better at night on Lantus, to my memory. But our CDE is really really against going untethered (she doesn't like not being able to turn it off), and since her concern is clearly for my kid, not just because she has to have her way or something, I want to give her POV a try. She suggest putting 1/2 unit of levemir into the mix, so that it will wear off sooner and so that some basal will still come through the pump. I'm thinking I'll give it a run starting tonight.

Any thoughts?

hawkeyegirl · #2 05-11-2011, 10:45 AM

We've never tried it, but I can think of a lot of situations where getting some basal from a long-acting would be a great idea.

Have you use Levemir before? Some folks get near 24 hour coverage from it, and some don't. It might be a bit tricky at first figuring out when it wears off for Selah and adjusting the pump basals accordingly. I don't have any real advice, but I'll be interested to hear how it goes.

Also, "drop like Hoffa." LOL.

SarahKelly · #3 05-11-2011, 10:58 AM

Lisa let us know how it goes we're having similar issues, and watching it on the CGM is strange...it's like there's a switch and he goes from being in the low 100's then bam sky rockets up to the 300's, and this only happens occassionally so it's not a basal thing per se...and it's not correlated to food either.
So, why is Levimer a better choice than Lantus if it can last up to 24hrs?
:

Lisa P. · #4 05-11-2011, 11:10 AM

We did use Levemir when we were on MDI, not for long, we tried it for the no-sting thing but it didn't last 24 hours for us, I can't remember, it was more like 15 so the overlapping or gapping was really hard to calculate around, we dropped it.

I think the CDEs thinking is that being on a long-acting shot "traps" us if we need to reduce insulin for sickness, etc. Frankly, though, she's on less than 4 units of basal insulin a day (on Lantus she was on two), reducing basal is something we have tried but it's rarely an effective technique for managing for us. Of course, the superstitious side of me is sure we'll get a huge stomach bug 45 minutes after our first shot!

So she is suggesting levimir because it will wear off sooner. I think it might be good for us to try and then if we hate it, we can easily return to the status quo, and if we like it, we can stay or consider bumping up to using lantus and being untethered 24/7 if we'd like. It might be kind of handy.

For us it's inconsistent, too, the drops and rises out of nowhere, and there certainly could be a different explanation. But I think it's reasonable to think that even a small bubble or even a pressure differential from shifting around a lying on tubing, absorption problems at a site, etc. would mean that sometimes a tiny increment (like, .15 units -- I mean, come on!) might not "get in". And then it's all messed up, and we're in reactive mode for the rest of the night, and its unpredictable.

I'll take any advice here and give it a try tonight, let you guys know if we see anything interesting.

mmgirls · #5 05-11-2011, 11:34 AM

Wow still only 4units of basal! YDMV

I will be watching this, I have thought of introducing a long acting shot to help deal with being disconnected for dance/cheer and summer fun, since it can be hard sometimes to figure out the boluses after being disconnected for more than an hour.

Lisa P. · #6 05-11-2011, 01:34 PM

Quote:

Originally Posted by mmgirls

Wow still only 4units of basal! YDMV

I will be watching this, I have thought of introducing a long acting shot to help deal with being disconnected for dance/cheer and summer fun, since it can be hard sometimes to figure out the boluses after being disconnected for more than an hour.

Well, she's about 36 pounds and I think her basal is 35% of her TDD! But, yeah, I had a friend tell me she gave a patient 10 units to bring down a 250 and I almost fell on the floor! Of course it was an adult and no problem!

wilf · #7 05-11-2011, 01:43 PM

So instead of giving the Levemir in a shot, she proposed mixing it in to the pump insulin?!

Or is it 1/2 unit shot of Levemir, with the rest of the basal supplied by the pump?

Lisa P. · #8 05-11-2011, 02:33 PM

Quote:

Originally Posted by wilf

So instead of giving the Levemir in a shot, she proposed mixing it in to the pump insulin?!

Or is it 1/2 unit shot of Levemir, with the rest of the basal supplied by the pump?

Yikes! I hope I didn't confuse anyone. It would be a shot of half a unit of Levemir in addition to the basal Humalog being delivered through the pump (with the basal being reduced there, by maybe half, which I'm not sure works with the tiny basal increments we've got so we'll have to play with it).

Yes, this means we get a shot in addition to pumping, which is less than ideal, the gain would hopefully be fewer corrections in the middle of the night (some nights none, but I'd say she usually eats, gets insulin or both at least twice a night, not consistently one way or the other). But I have to admit that if this works my eventual goal would probably be to have some period of the day untethered completely. It will also clue me in about her tolerance for shots now.

Tigerlilly's mom · #9 05-11-2011, 06:17 PM

Tyler has been doing semi-untethered too...I love the fact that he can disconnect without going sky high during the day and I still have the option to change the basal rates for these crazy hormonal times!

I hope it works as well for you as it has for him!

wilf · #10 05-11-2011, 11:26 PM

Quote:

Originally Posted by Lisa P.

Yikes! I hope I didn't confuse anyone. It would be a shot of half a unit of Levemir in addition to the basal Humalog being delivered through the pump (with the basal being reduced there, by maybe half, which I'm not sure works with the tiny basal increments we've got so we'll have to play with it).

Yes, this means we get a shot in addition to pumping, which is less than ideal, the gain would hopefully be fewer corrections in the middle of the night (some nights none, but I'd say she usually eats, gets insulin or both at least twice a night, not consistently one way or the other). But I have to admit that if this works my eventual goal would probably be to have some period of the day untethered completely. It will also clue me in about her tolerance for shots now.

Sounds like a good plan!