Thanks @bkh and @Chris,
we have not done a test. How did you perform such a test?
He gets his Lantus at nighttime, which is what the doctor had recommended, and we never changed or challenged it. How would a short lasting Lantus manifest itself? I would assume a rise in BG levels?
Thanks for the discussion. I appreciate benefitting from your experiences.
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Yes. If the BG tends to rise “all by itself for no reason” in the hours before the next Lantus dose, one would suspect insufficient basal during that time of day. To see if this is because the Lantus is not lasting the full 24 hours, one could try splitting into half doses twice per day. The transition to half doses is a bit awkward. One way is to start with a half dose in the evening instead of the usual full dose, expecting to drift high overnight until the morning dose. The Dexcom helps make this safe by alerting in case a supplemental correction of fast-acting insulin is needed during the night.
If splitting into half doses isn’t enough, then it may be time to start thinking about Levemir so that different doses can be given for 2 or 3 periods during the day, or perhaps a pump so that different levels of basal can be scheduled during different times of the day.
Let me add that I did MDI for 8 years before starting the pump, and although I was reluctant to start pumping, I quickly learned that the benefits greatly outweighed the shortcomings that I anticipated while still on MDI.
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Yeah, great question. The way I would go about testing is this. Eat low carb for lunch and an early evening snack, and plan to push dinner to past his injection time for two nights. Make sure the last food is early evening so there is as close to a flat line as possible (no food/insulin effect) during the hours 20-24. Then see when the basal wears off. It will be when the bg goes up all by itself. If you hold to a flat line for the whole time, you are good no problem. If you are like us at 23.5 hours his bg would start increasing all on its own, but this was so subtle in my son that it didn’t affect his control. If it doesn’t last as long as 23.5 or 24 hours, then you can probably improve his control by splitting the dose.
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@Andre I used Lantus for a year before moving to a pump. Endo recommended taking at night. I found I’d go low early morning, 3-5 am, about 4-6 hours after injection, and early evening I’d wander high. After reading about split doses here on FUD, I did some research and tried splitting my dose, half first thing in morning, half before bed. I found I needed to slightly increase my total daily from 12 to 14, but had no more early morning lows and less wandering up evening highs (the other part was needing to increase my evening meal bolus). As with all T1D, it may work for you, it may not, discuss with your doc!
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I experienced the same thing but had no idea that I could split my doses. If I had to go back on MDI, that’s what I’d do.
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Thanks everyone for your experience. Good lesson for me. Looks like our son doesn’t seem to have a short Lantus day. He sometimes has a big hump around midnight/early morning hours, about 3-5h after bedtime and Lantus injection. We check it off as hormones. And that same time may bring urgent lows and we wake him for a nighttime snack. And most days it’s all good. This is the way (stole that line from “The Mandalorian”). Cheers, ~Andre
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if your insurance will cover tresiba for the same cost as lantus, i would highly recommend switching… as far as basal testing, technically, he’s supposed to fast with normal activities and adjust accordingly, however, fasting might be difficult… for me, lantus seemed to peak at 6 and 12 hours…not quite nph, but still peaked, which was why i had to split into morning and night doses…tried levemir but i still had to take morning and night doses to avoid lows…i feel the same about the pump…the dexcom is much more important…especially with watch faces
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I lasted less 
I felt like I was injecting water and after IDK how many correction shots (like at least 20 throughout the day) I gave up. I’ll try again when I’m stronger mentally.
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That’s okay! At least you have a pump to go back to. Are you eligible for a different model?
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after 5 years on the 530 Medtronic minimed pump(2005? no cgm), my insertion sites were lasting maybe 2 days, especially in the summer, and would usually fail me as long as i didn’t have any backups available… fasting basal is key to mdi…one problem with a 24hr basal like tresiba, although a pump without a cgm always felt like Russian roulette to me…again, i haven’t tried a pump with a cgm, but with an accurate basal, im probably down to 5 shots per day…i also tried exubera(barely worked a1c from 6.5before to 8.5after), and afrezza(lots of coughing green phlegm after about a year), but a good basal and afrezza might be a good combo if you need a short pump break
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Hi all,
I’m feeling really, really stressed out. I’ve been approved for the Tandem t:slim with control IQ. It’s great that I’m approved, but I still have to pay out of pocket for an amount that is a lot for me to handle financially. That is one thing stressing me out, but the other which has taken me by surprise because I thought I was past this is the tubing. The idea of the tubing almost makes me want to burst into tears. I’ve got a lot to deal with in my personal life, which is probably why this is feeling so overwhelming when it should be based on facts and not emotion. Just want to be sure I’m not ADDING to the list of things that are hard in my life. Logically, I think the control IQ and the fact that I’ll have different options for canula material and angles should help my numbers. Logically, the added cost will make my life harder. Emotionally, having tubing might be hard for me but logically it means nothing.
Even if you think I’m being a freak of nature right now, can you please offer any insights? As things stand I have everything ready and signed, I just have to email my forms then everything will be set in motion.
This would be a lot easier if the cost wasn’t so hard for me, but that’s the hand I’ve been dealt. I want to get better control and think the IQ technology may be a game changer for me?
~ Jennifer
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Are you aware of the next gen pump from Tandem?
No formal date yet, but expected soon. You may want to check with Tandem rep if they may offer upgrade once newer ones come out. Some offer a cash pay to upgrade, or may need to wait till warranty ends. Some are interested in the mobi, described in the next generation pumps link.
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I’ll inquire about it! I did submit my forms. I feel like I need to try SOMETHING to get better control. Maybe looping / Control IQ will help me, maybe not, but I’m going to try it out.
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Lots of people here pump with tubed pumps and seem to love it so even if it’s an initial concern, many people are able to move past it and look at the things that made them go for tubed -vs- tubeless in the first place. For our son, it was a no brainer to go with the Omnipod because we didn’t want to have to fight with tubes and getting things snagged or needing to constantly play the tucking game. He may change his mind when he’s older, but for us, we definitely weren’t interested in pumping with Tubes. If tubes concern you and you’d rather have none, then consider (if you’re approved) the Omnipod.
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I’ve been on the omnipod for years. I can only get absorption (and not consistent at that) using my stomach. I have some success with my arms (it’s hit or miss) but they hurt the entire time, as I don’t have a lot of fat. I’ve never been able to use my legs without a). running high and b). knocking the thing off. I’m worried about scar tissue, as I’ve used my stomach exclusively for several years. I want to use other areas of my body by way of different canula angles and perhaps steel sets. But mostly, I’d like to see if the Control IQ technology helps me.
I went ahead and submitted the forms, so I’ll see how it goes. I’m going to try to emotionally detach (I have a lot of experience with this in my personal life) till I adjust to the tubing.
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i still suggest trying tresiba and fiasp,lyuumjev, novorapid, or whichever fast acting insulin pen brand your insurer prefers…the key to mdi is having the correct basal, knowing how foods will affect your levels(if im not sure, ill use bitesnap and its usually pretty close, just a little time consuming), and your numbers…insulin to carb ratios, insulin sensitivity, or all the settings in the xdrip predictive simulation settings, which helps a lot…mdi with a cgm makes a world of difference…as long as you have a cgm and tresiba, you’ll discover you don’t need as much insulin as you thought…i personally prefer 5-10 shots a day, usually closer to 5 over a pump, but costs are also a factor, as my current insurance makes me play the durable medical deductible wipeout game which always looks like a horrible idea
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I bet you’ll get used to the t:slim quickly and like it. I’ve been going back and forth between pods and a tubed pump for the past half year, and for the most part I prefer the tubed pump. One thing that you pointed out is that the infusion set can go in lots of places (I use all up my sides and around my back) and the set is so small I don’t notice it at all (I can sleep on it, lean on it, never a problem.) The other good thing about the tubed pump is that it can deliver larger boluses consistently. With the pod, I usually had issues whenever I needed more than about 5u, so I end up having to give repeated small boluses, or more often, just use a syringe for the large bolus.
The only thing to take care with the tubed pump is to keep the tube well tucked in so there’s no loop sticking out to snag. I wear the pump on my belt with the tube looped tight down into my pants and never have an issue.
And of course Control-IQ will help get flatter lines with much less work, once you get your settings dialed in.
I think you made a good choice.
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I don’t think there is a problem splitting to /12 hour from /24 hour lantus; just start the split at the time of the next /24 hour dose. Changing the dosing times is more problematic; e.g. moving from @Chris’s mid-day to morning/evening requires caution because of the overlap. Going back from /12 to /24 has similar overlap issues.
I do go from pump to Lantus and back. I’ve never had any problems that are outside my normal problem range; going to Lantus twice a day I would expect to go high after the first dose, but I’ve never noticed that. Going from Lantus back to the pump I’ve been more careful and have run 1/2 basal in the pump to deal with the transition; 1/2 basal for the first 12 hours maybe with a lower temporary basal initially.
I have the same experience with the Omnipod; stomach doesn’t work for me (perhaps too many years MDI there), arms are hit or miss (normally miss), legs are hit-and-miss (the pod invariably comes off).
Tubed pumps are attractive for that reason - more places to put the canula - yet inherently unattractive. We do always have the option of MDI; it’s a good fall back, so trying a tubed pump isn’t live-or-die. Because the Omnipod is prescription you should be able to just renew the prescription if you need to; I can’t see how using a DME pump would destroy the Omnipod prescription but maybe Medtronic have found a way to make it so.
I’m experimenting with changing the insulin I use in the Omnipod, just 24 hours so far so no conclusions 
If it doesn’t work then I might try the damned tubes, probably Tandem because I don’t like Medtronics [politics], but it’s the same diff.
Lack of control because of site issues really is a very, very big issue. One of several elephants in the room for long term T1Ds. It seems to be underinvestigated.
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