Pump to MDI and Maybe back?
After pumping insulin for the past six years, I decided to take a break from my Deltec Cozmo and go back to multiple daily injections (MDI via Lantus/Novolog). There were a few reasons for this decision:
- Getting lazy with my day to day care (this was actually a reason for going on the pump in the first place)
- Changing infusion sets infrequently, taking advantage of advanced boluses & possibly over eating
- Infusion sets becoming irritated, itchy, etc. (partly due to changing sets infrequently, but also a general scar tissue issue developing after 6 years)
- Exercising less due to uncomfortable sites and wanting to run without the pump attached/no basal being delivered during exercise
Now for the technical aspect of doing the switch – from my prior experience with Lantus, it does not last a full 24 hours (tapers off in my body around hour 22). Therefore, I’m using a split 12u every 12 hours, for a total 24u/day an approximate 1:1.1 relation to my overall basal in the pump (in my experience, I usually need a little more Lantus than Novolog for pumping a basal). With this setup, I can also change my “basal” Lantus dose in substantial 12-hour increments for say all day exercise.
Sunday at 6pm I had dinner, followed by a bolus for that meal on the pump. At 7pm I simultaneously took my first 12u Lantus injection and dropped my basal rate to 50% permanently. A few hours later I checked my BG and it looked great – no strange BGs. All clear.
Monday 6:30pm, breakfast, bloused, took another 12u of Lantus and removed the pump. I’m free from the pump and have a full dose of Lantus on board. This is a fairly scary point – since there is no going back – even though I know I already have 12-hours of good BG under my belt with half-Lantus.
A BG test at 10:30am proves the Lantus is working as expected.
At 3pm I am running a little high from lunch that I originally thought was likely a combination of under-dosing for the meal and not enough pre-lunch correction.
However, upon second thought, I remembered seeing insulin “leaking out” of the injection site. Here is one thing I just needed to re-teach myself. Since I am using an insulin pen, we don’t get instant gratification from the injection. I need to hold the needle in for about 5-10 seconds after fully depressing the injection, before can remove the needle to ensure a proper dose.
6pm – Gym Time. Ensure IOB and Carbs on Board match my BG, but I ended up adding 30g of carbs because my BG was slightly low for starting an hour or longer cardio set. No problems with the workout — and post BG numbers looked great too.
Five days into this experiment everything is going rather smoothly. The only changes I foresee is if I do any long weekend morning exercise, I will probably use a lower AM dose of Lantus. This would basically result in running a “temp basal” on the pump. In the event that I oversleep past 7am (it rarely happens), I still have a 12u for another 12 hours—what I consider my backup.
Some good things I noticed is that because of the change I am paying more attention to my diabetes. Shaking up my routine has had the desired affect so far of motivating me to be a little less lazy about my diabetes. And the great feeling of being able to go for a run without my insulin pump and still have a “basal” on board.
Cary, interesting. I have been thinking about splitting my dose as well. I use the omnipod but i prefer running without it. In fact the only time I like pumping is when I am out at restaurants, but that is it. I find it’s almost a crutch. Excellent post! ( oh lantus also seems to work less than 24 hours, which is the reason for my exploration into what others are doing). Keith