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lantus and a pump

Discussion in 'Parents of Children with Type 1' started by Lakeman, Jan 11, 2016.

  1. Lakeman

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    After thinking about it for a long time we did it. We just got tired of the super high highs when there was a failure of some kind with the pump/site/tube/insulin. It seemed like three times a month she would be over four hundred for pump related reasons and by the time we diagnosed the problem and corrected far too much time had gone by while high. The last time it happened she was high for only two hours and already had large ketones and was sick to her stomach throwing up. If I can spare her this just occasionally it will be worth it.

    The clinic had told us that people who use lantus and a pump only do it because they are athletes and they want to be disconnected for hours at a time. So we knew it could be done. They were also not that willing to think about the pros and the cons nor even to give it much thought at all. So we just too the plunge.

    The first night I wrongly calculated how much basal to leave with the pump and how much to give with the lantus pen. If I had done the math right I think the transition would have been seamless. I can't say for sure but it just might be that that our numbers are slightly more stable throughout the day. I expected to have to do some tweaking of pump settings to make up for peaks in the lantus but so far the settings are just right.

    One thing I have learned is that living with something is far more informative than just thinking about it:

    Pros:

    Yes the high highs are less. If any number of things with the pump goes wrong then she still has lantus working to keep things from getting way out of control.

    She can disconnect for longer periods with less effect on numbers.

    I think numbers are a bit more stable. She has always swung rapidly from high to low and vice versa and now her numbers look more like her brothers. I did not expect this and have no explanation. This was true when she was on MDI and true when on a pump alone.

    Less insulin is delivered through the pump so the capacity of the reservoir is in effect larger. I knew the day would come when the cartridge would not be large enough and she would have to change it every two days. Now that day might not come.

    She gives lantus in the stomach where she does not put in sites so less relative insulin is being delivered through the other sites.

    We can still increase a temp rate as much as we want.

    Cons:

    We have to remember to give the lantus shot. We have been late twice and early once now with no negative effect.

    Super boluses are not as strong since the basal from the pump is lower.

    Shutting off the basal does not bring up BG as fast since the basal from the pump is lower.

    When a site goes bad it will be less obvious.

    We will have to get the clinic to approve a prescription for lantus again. I think they will especially now that we are already doing it.
     
  2. mamattorney

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    Very interesting! I'm glad you found a solution that works to minimize some of the negatives of pumping.

    My daughter took a pump vacation over winter break and I, too, was surprised at how "smooth" the trend line was with Lantus as opposed to Novolog. So much so that when she went back on her pump, I took away virtually all of the variation in her basal rates. She's got one rate for 20 out of 24 hours and a slightly higher rate (just .1 more) for the remaining four hours. Prior to her break, she had at least 4 rates and the variation between them was much more substantial than .1

    I would think your clinic would approve lantus regardless. What if you had a pump failure and couldn't get a new one for a day or two. Lantus would be the reasonable back up choice.
     
  3. mmgirls

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    Yes, we do now Levi Mir and pump. My oldest also ketone sensative, youngest too but she can not identify it as easily as my oldest.
    My oldest has been doing this method since 21st grade now in 5th and my youngest we started after we moved here and had new school and we where living half hour away.

    I love it, yes the biggest thing for us is if we totally forget. And harder to tell if site is going bad.

    In our old school district kiddo would be sent home with Ken tones of 0.6, luckily with the Levi Mir it kept ketone very low even with a pulled site.
     
  4. forHisglory

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    I don't really see these as complete cons. Each time, you have less negative consequences. That's great!
     
  5. jenm999

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    We were untethered for about 3 weeks when my son first started pumping because he was on only 1u of Lantus (lots of nighttime endogenous insulin) - too small to divide into 24 segments on the tslim. They had us disconnect and prime 5-10 units before every bolus to avoid the tube clogging since the insulin wasn't always moving delivering basal. Just something to consider.
     
  6. rgcainmd

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    Fortunately, my daughter has experienced very few site/pump failures, and with 24/7 Dexcom use, we've caught every one relatively early. Additionally, it takes quite a few hours (>6+) at over 350-ish before she has ketones (even at diagnosis, she had only small ketones that cleared in less than 24 hours, if memory serves). So for us, going the tethered route wouldn't be worth the trouble. But time will tell...
     
  7. mmgirls

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    Yes when we are disconnected I usually prime tubing because Apidra tends to get crusty, but that is only after we have been diconnect from the site for over an hour as we have no time with Zero basal.
     
  8. GChick

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    I had done it for a week on vacation before. We would be out in the boat and sometimes in the ocean itself for hours on end, so I figured that to be a good solution. A week wasn't enough time to perfect the technique, but I'd say it worked beautifully. I wouldn't "choose" to do that on a regular basis as I like the assistance with bringing a blood sugar up by discontinuing basal and also not having to remember to have Lantus around for whenever the Lantus dose was needed... but if I had a ~reason~ to as you seem to, it could solve a lot of problems (while also creating some, but sometimes you gotta take the good with the bad.)

    Here's to hoping it continues to work out.
     
  9. Beach bum

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    We go untethered for the summer due to all the water activity the kids do. They are unhooked so much that that it just makes more sense. Otherwise, we'd be spending so much time catching up on numbers. The only issue we have with one daughter is that Levimere does not work all day for her, so we supplement with a small basal in the overnight hours. I have to say that the pros outweigh the cons. We did have one day where we forgot to give the shot for a couple hours, so that was a big screw up, but it leveled out in the end.

    IMHO, if it works, go for it.
     
  10. quiltinmom

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    I'm glad to are having good success. :). Out of curiosity, what is the ratio of lantus/pump basal you use? I've suggested this approach to Ds and so far he hasn't seemed interested, but he may in the future.
     
  11. Lakeman

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    I didn't plan on it being a certain percent or ratio but it ends up being a little less than half of the total through a pen.
     
  12. jenm999

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    We may try this in February over break. We are going to see my mom in Florida and she has a pool. We have the omnipod and are trying to convince our son to use that for the week but he hates it. My husband and I are also taking a 24 hour getaway during that week and I'd rather have him on the omnipod which my mom can troubleshoot easier than the tslim, and even refill and prime if needed. My worry is that she'll prime the tubing for a bolus with the tslim still attached to him (actually I'm afraid of doing that myself).
     
  13. mmgirls

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    For me it was common for me to do a temp basal of -30%: so I have the Levimir around 70% and pump basal about 30%
     
  14. wilf

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    If my daughter had ever wanted to use a pump, we would have gone this direction.

    Sounds like it's working for you. :cwds:
     

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