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Untethered advice

Discussion in 'Parents of Children with Type 1' started by MEVsmom, May 11, 2016.

  1. MEVsmom

    MEVsmom Approved members

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    I searched and the last thread on this was pretty dated, so I thought I would just start a new one.

    We are frustrated with failed sites recently, so we want to try to go untethered with my 10 yr old. With summer coming, it seems like a good time. Does anyone have any good advice for me as far as percentages of Lantus v. Basal through the pump. I think I'd like to keep it higher on the Lantus dosing than the pump.

    For those who have done it, what works well for you?
     
  2. kiwikid

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    My elder daughter uses Lantus with a pump.. She has 17 units of Lantus around 10pm .. and .35 running all day ..
     
  3. mmgirls

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    Hi, I have 2daughters mostly doing untethered. We do 70ish percent basal via Levimir and 30ish % from pump basal. My girls currently wear their pumps to school but at home they often take their pump off during activity/ lows. Basically for us it's a 30% basal reduction when we do so. I love the long acting in the background for sites that are failing, they might have higher numbers that don't come down but rarely get ketones above 0.6.

    We have done fully untethered but then you have to play with ratios /ISF a bit more to get the varied basal you need. And if high actively you have to feed the long acting basal carbs.
     
  4. Beach bum

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    In the summer, we do about a 70/30 split. We give a shot in the am, then hook back up at night. Due to the fact that the girls are teens, this is why we need to go with an extra boost of basal at night. Depending on their moods, they may do a shot to bolus/correct, but I always make sure to run it through the pump so we have a general idea of IOB. We've always had good success with partially untethered.
     
  5. rgcainmd

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    For those of you either considering or currently utilizing this untethered approach, I invite you to look into using Tresiba as your long-acting insulin, based on the extremely impressive results I am reading written by adults who have switched to Tresiba and have found it to be just short of amazing in smoothing out their basal profiles and lowering their A1c's. Disclaimer: I do not have my daughter on Tresiba, but I have a pen of Tresiba in the fridge (mandatorily placed in the butter compartment, of course!) for use as back-up in the case of pump failure.
     
  6. mmgirls

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    I asked but our endo will not RX to my 11 and 7 year olds yet, she wants to see more "field tests" from others first. I said ok but hope to switch to it before year end.
     
  7. quiltinmom

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    70/30 seems to be pretty common.

    I haven't done untethered, but I have considered it and have wondered the same thing.

    The conclusion I came to is that I would choose pump/shot ratio based on what I want my temp basal capabilities to be. If I never go below a 50% temp. basal, for example, then it would be safe to give half of his basal via long acting. (Or, I would just plan to correct by feeding him, instead of using temp basal.)

    The second component is basal rate variability. You will want to calculate the 70/30 (or whatever ratio you use) based on the lowest basal rate. If you decided to do 100% basal by shot, you would have some times of day when the pump basal setting would be zero, but he would most likely still need basal through the pump at the times when basal needs are higher. It just depends on what his basal profile is like, and how much difference there is between his highest and lowest hourly rates.

    Hope this is helpful! Let us know how it goes, if you decide to go this route. I'm hoping my Ds will try this over the summer. I've heard using long acting with a pump can help even out their bg's...there are days when his dexcom is nothing but zig zags the entire day. Or nights when he's stuck at 300 despite several corrections. I'd be happy if we could avoid that!
     
  8. sarahspins

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    When I go untethered I aim for about 70/30, but considering the time my pump stays off me, it really works out to more like 80/20, with lower basal needs entirely due to activity. Just remember it's easier to add extra basal coverage with the pump than it is to feed lows caused by too much basal coverage from a shot :)

    I'd personally rather chase moderate highs than to feed lows.
     

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