hi gang:
this isn’t actually for a kid, it’s for me, but i heard this was the place to come for information on half-unit pen options. i currently take lantus and novolog, but i find that full units aren’t always the increment i need.
i have tricare insurance, so other insulins will be covered i believe considering my t1 diagnosis. ultimately i hope to get on a pump but that will be a bit yet. any advice, my wise new friends? or should i just add syringes to my program? thank you in advance!
I use to love my Humalog Junior Kwikpens. Maybe someone knows of a novolog option??? I know the Novo Pen Echo smart pen is half units but I would check with insurance if that prescription could make getting coverage for a pump harder?
Hi @panda I also do MDI and find half-units invaluable. I’ve used Humalog Junior Kwikpens and currently use an InPen with Novolog cartridges (also comes in a Humalog version). Both of these are great options for more fine-grained control. Here’s the InPen:
This pairs with your phone to track doses given, and has an IOB calculator that’s handy. You can also use it for dose estimation if you know your IC ratios. Only downside to the InPen is it’s a little longer than a standard pen so dosing takes some getting used to.
These are the Humalog half-unit disposable pens:
Hi @panda
As I mentioned to you, the Humalog Kwikpen Junior is the one I use. It’s really good. 
I am going to send you some diluent along with your other stuff too. The diluent let’s you do absolutely ANY amount! We will discuss this on your other thread.
I have all of your other stuff ready, just gotta find a bigger box for all the other extras. 
We use Novopen Echos. When they are hard to get in the US we order them in Canada on mail order.
thank you all!!! please keep it coming; i have a doctors appointment coming up and hope to discuss these options then and hopefully get squared away with something that works. extra helpful to think about insurance approvals downstream and so on too. appreciate you all!
@Eric goody goody!!! i will let daya b* know that her own little christmas is on the way! 
words aren’t enough.
*once out with mara wearing her alert patches, a kid walked past with his grownup. “what’s daya betties?”, the kid asked, sounding it out. i loved that so much that ever since, i use “daya betty” as a silly way to refer to it poor eric is going to be very tired of hearing me repeat myself, sorry man!
@panda, you must have super-powers, somehow you brought @Michel out of hibernation!
Good to see you, @Michel!
hey team! thanks to you fabulous and kindhearted folks, my humalog kwikpen jr is processing (with insurance coverage) as we speak!!! half unit dosing here we come!!!
i am also striving to get vials so i can do dilutions for even further finesse, and i think there was a slight mixup at the pharmacy but that should be sorted within a day or two. thank you all infinity for pointing out that whole units aren’t absolute: half a unit of insulin is like half a donut, easy enough, it isn’t like half a baby! by which i mean i truly had not contemplated that a unit itself is arbitrary and there’s no real reason not to subdivide that.
thanks again fam!
Wait until your pump and can deliver insulin in 0.1 unit increments. The world opens up a bit as far as choosing what you eat.
i CANNOT WAIT for a pump looks like tricare also just added omnipod 5 coverage, which i think i recall being floated here as a likely good option for me. 
Do you have an iPhone? If so, I encourage you to get the Omnipod Dash instead of the Omnipod 5.
yes i’m an iphone user. the dash is also covered! so far you have literally not steered me wrong, so that’s what i’ll ask my endo for. 
The reason I mentioned Dash instead of the O5 is because with Dash you can Loop.
(I don’t know if Loop support the Libre, but it does support Dexcom G6 and Dexcom G7.)
If you want to try Loop, there are some easier ways to do it than what I have done. Don’t do it my way. 
There are a lot of people here who do it. @TomH would be a good resource to ask about getting setup with it.
But…before you go down the Loop road, first just get the pump setup normally. And use if for a few months in the normal way. That way, you get your basal rates figured out.
After you have done that, then using Loop will make more sense and you will know what you are doing.
i don’t know what looping is, but a whole world of insurance-covered choices opened up to me when they fixed my dx from t2 to t1, so really i just need to figure out reasonable choices to get my care team on it - i’m not really married to any one thing. and a pump is probably still a few months out given endocrinologist wait lists.
I think I remember you not having CGM yet? Seriously, get a CGM first. Even though you’re new to the diagnosis, I think you’ll see it as life-changing.
i wear a libre 3 actually. i have had to pay out of pocket because misdiagnosed so insurance denied, and i had good coupons with my local pharmacy, so i wear that. my recent dive into more frequent finger sticks is for training purposes: it’s revealing a surprising amount of deviation by the libre to be honest.
ultimately i believe now that i have the accurate diagnosis, dexcom is what tricare covers for me. so that is a likely switch in the near future. but you’re right about how great they are!!! me with diabetes and no cgm would go a lot like me with a car and no gps: both those scenarios end in a really bad place 
Hi @panda, I’m the TomH @Eric mentioned. Loop is one of the DIY (i.e. do it yourself) AID (Automated Insulin Delivery) programs available to integrate data from your CGM and control of your insulin pump to automatically deliver basal and bolus insulin doses. Some AIDs claim to also dose for meals with or without notification. Loop currently still requires entry of carbs eaten. Loop is “carb centric” i.e. it depends on carb entries to do its magic. Others may be BG centric, i.e. they take in data on carbs, but rely mostly on the BG level generated by the CGM in their algorithms.
I couldn’t agree more with @Eric and @JessicaD about CGM needing to be first priority; glad to hear you have one. I think most folks would agree CGM benefits vice finger sticks are fantastic; but some do prefer the latter. CGM info can be used solo or with anything else: inhale-able insulin, MDI, or about any pump. I also agree with @Eric it’s good to use a CGM with any pump using the app or PDM it comes with them for awhile; it provides a built-in backup if any other app or your phone fails. If the CGM/pump relies on a phone app, many will carry an old phone with the app on it or have spouse have the app installed ready to use. Most manufacturers use a cheap cell phone as a Personal Data Manager (PDM) (I don’t recall if Libre uses a separate one or depends on a phone app). Many users advocate taking the PDM or other back-up means on a vacation or trip. How long should you use a CGM or pump with its own software/app? That’s a personal decision. I went tubeless with Omnipod Dash and knew I wanted try Loop eventually; I used the Dash PDM for about 4 months and still take it on vacations as a back up means of running my pump (granted its in addition to a copy of Loop on my wife’s phone).
If you’re thinking of a pump, your choice depends on several factors: compatibility with your CGM or your ability to switch; your insurance coverage (unless you’re independently wealthy); preference for a long tube/short tube/tubeless; type of insulin in use; type of cannula(s) that work for you; and whether you have iPhone, Android, or none at all. Another factor may be a desire to use an AID (Automated Insulin Delivery) system to tie your CGM and pump together, which can be commercial or DIY. Commercial AIDs include Beta Bionics iLet, Tandem T:Slim X2, Insulet Omnipod 5, and a couple others depending on where you are in the world. For DIY AIDs, you can use Loop with Omnipod Dash, Omnipod Eros (currently being phased out), and a few of Medtronic’s older pumps (Check https://www.loopandlearn.org/ and LoopDocs). Loop works with Dexcom G6/7 and with Libre (I believe both 2 and 3) depending on Loop version #; using Libre may require a Loop modification to deal with the 1 minute reporting, vice Dexcom 5 minute, if you want your phone to last all day). iAPS works with iPhone, but there’s been controversy about its development practices lately. Android users can look at OpenAPS, AAPS, FreeAPS and a few others, most are variations of a similar base algorithm.
I encourage you to do your own research, read about all your choices, commercial and DIY. All manufacturers have websites and will push their latest products. Most DIY systems have Facebook presences and websites (LoopandLearn.org addresses both Loop and iAPS). The DIY efforts usually use Github. Some have Discord channels. Once you’ve narrowed down your choices, feel free to ask any questions you have. A post here on FUD is a good start and assure you of different perspectives; take it all in. Keep in mind some pumps have a “warranty” period that last years and many/most insurance won’t cover a second pump until that period is up. Check that with your insurance before hand.
Look forward to hearing from you!
thank you! this is a ton of info!
here’s my info in return:
insurance: tricare select west (i can probably switch back to tricare prime once i get a residence address for school this fall, but for now my location locks me to select) - omnipod should be covered for t1 either way though
iphone user
covered insulins: most, i currently have novolog, humalog, and lantus
backup options: i don’t have a partner or roommate, so it will have to be fully one person contained
cgm: currently using libre 3 out of pocket but i believe now i have t1 dx dexcom will be covered? switching should not be a problem really
i have heard omnipod dash standard config might be a good jumping off point for me…?
still digesting all of this, thank you!!! (edit to add: there are a lot of other threads on this too! i’m gonna look around and i’ll kick off my own if/when it’s time!)
Tom gave a big dose of good information. Let me make a few simple comments.
Loop is an app that you can build for the iPhone. It listens to the CGM to see what your BG is doing, and tells the pump to give or withhold insulin every 5 minutes to keep guiding the BG in a good direction. That sounds better than it actually is, because sometimes the CGM is inaccurate, and sometimes the pump cannula isn’t getting all the insulin into your body, and sometimes the Loop software’s prediction of where the BG will go is wrong.
So some folks recommend that you first learn insulin dosing with a syringe so you have that skill. Then use a “dumb pump” that basically acts like an electronic syringe that holds 3 (or more) days of insulin, but you still determine how much to give, same as with the syringe. After that, having Loop watching out for the BG every 5 minutes will reduce some of the effort, especially overnight. With Loop running, you are promoted from BG labor to BG supervisor.
If insurance buys you a $7000 t:slim or Medtronic pump, I think they expect you to stick with it until the 4 year warranty runs out before they’re willing to pay for a different pump. Omnipods are disposable prescription items rather than a big-ticket medical device, so you’re not locked into that choice if you want to switch.
@panda I’m TFL (Tricare military retiree), I think the same pharmacy support as Select. If so, you should have good coverage: Dexcom or Libre CGMs, though they do require prior authorization (your doc needs to file that you qualify by having T1/T2, on insulin or having to finger prick 4+ times per day). Tricare covers Novolog, Humalog, Lyumjev, Lantus and Tresiba insulins, possibly a few others with prior auth, but doesn’t yet cover Afrezza or Fiasp (Fiasp was on their formulary for a short period, but has been taken off). They cover both the Omnipod Dash and 5 pumps with prior authorization/qualifying (similar to CGMs); I don’t know about other pumps.
After you’ve researched the pump options, if you’re interested in the Dash pump there are several of us here with experience with it. Some have moved on to try the 5 or iLet, some have stayed with Dash. There’s been rumors of Dash being discontinue by the end of the year, but it doesn’t seem likely. If you’re interested in the DIY approach and have iPhone, I and couple of others can speak about Loop (one or two have experience with heavy mods of it), a couple can discuss iAPS, and how to go about the build process (@bkh has offered some advice about it as well…his description is great and I agree with his comments on learning to use syringe/pens too!).
It’s a lot to take in…and lots of good people here on FUD to offer their advice!
