If My Pump Should Break

Tips, Tech & Gear Pump
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i am going to be on an island without a pharmacy. i am a long time pump user from before long acting insulins existed. now it seems that there are endless types and brands from Lantis, to Toujeo, to Tresbia, etc.

my endo claims that they are all basically the same, and that if my pump should break, i should just take my total daily basal dose with Lantus and my boluses with my NovoLog using my 1:10 carb ratio throughout the day. i tried this once before when i wanted to take a pump “vacation” and for the very first day my BGs were perfect. but from the second day forward, it was a nightmare for me, and i simply went right back on my pump.

now that i am going to be on this tiny island, if my pump should break, which insulin should i pack with me to cover the week that i will be away? will Lantus do the trick? i don’t know which insulin to pack.

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DM, we have tried Lantus and Basaglar for long acting insulins, and Humalog and Novolog for short acting insulins. We have seen no difference to speak of. So, if it was us, we’d bring whatever is available of either.

That said, some people do see a difference. If you are one of them, I am not sure if there is anything to do but to test: my understanding is that these difference are highly individual. Most people don’t see a difference, but, for those who do, the outcome is unique to themselves.

If you need some samples to try I can send you some of what we have. Most likely, your endo has samples, and you could ask him/her for a cartridge of each to try out also.

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Tresiba has a much much flatter profile than Lantus, and is also more consistent in its action (Lantus doesn’t always crystalize and then absorb right in some people, especially if for some reason you don’t hit fat with your injection). Also Lantus for me (and many people) only lasts 20 hours, so a once a day injection isn’t sufficient, and dose-splitting is needed for 24 hour coverage. Not an issue with Tresiba, which also has much more flexibility with dosing timing. So on the whole, I would strongly recommend Tresiba over Lantus; that said, you may need a letter of medical necessity to get insurance coverage for it, which may not work for a backup insulin and if you haven’t tried and struck out with Lantus first…

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thank you so much for the great info. i have the Tresiba sample pen at home. i have to see if i have the right screw in needles for it, though. if i do, i will certainly pack it as my back up.

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I’ve used Lantus, Toujeo, and now Tresiba. Tresiba is the only one that seems to last a full 24 hours.

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thank you for your offer. i do have my own samples from my endo, so i really just wanted to know info about their differences.

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@daisymae, be aware that Tresiba remains in your system for more than one day (42 hours is typically quoted), so the transition is trickier than for Lantus, Basaglar or Novomir. I think it takes about 3 days before you are stable on Tresiba?

You may want to ask the Tresiba users on the forum what the best transition method for Tresiba would be.

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That’s a good point—I would expect the first 24 hours to potentially run a bit high. I usually find by day 2, doses stabilize mostly for me, but I’d wait at least 3 before increasing doses (I would not wait to lower doses if you’re going low on the other hand initially, since it’s only going to increase as it builds up).

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Your endo is wrong. They are not the same.

Since you are talking about having something for an emergency in case your pump breaks, Tresiba is not the best choice. Because of its longer action, it takes a few days to fully ramp up, and once you got off the island and got back to your pump, there would still be some leftover in your system, which would be adding to your total basal when you hooked the pump back up. So Tresiba is not the way to go as an emergency basal insulin

The duration of Lantus or Levemir depend on how much you take! The more you take of Lantus or Levemir per pound of body weight, the longer they each last.

Based on what I know about your total basal dose and your body weight, Lantus will last you about 18-20 hours. That is a problem if you take it once a day, because it will leave you with no basal for a few hour each day.

Lantus and Basaglar are basically the same. You won’t notice a difference between them.

With your dosing, Levemir will give you about 12-14 hours. So if you take Levemir twice a day, that fits into a 24 hour day really nicely for you. For example, taking it 12 hours apart like 8am and 8pm would cover you well.

Levemir would be your best bet.

Can you get Levemir? I can send you some.

If you can’t get Levemir, go with Lantus, and split it to twice a day also, but know that it will have some overlap and you will have a few hours where you have a bit more basal.

How much?
Just based on what I know about you - in a pump emergency, start with 6.5 units of Levemir, twice a day, 12 hours apart (a total of 13 units). Adjust as needed.

If you use Lantus, start with 9.5 units, twice a day, 12 hours apart (a total of 19 units). Adjust as needed.

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That may be true in a mathematical sense, but practically speaking I don’t think it’s noteworthy… if I had my pick of any I would simply take tresiba same total bolus dose on day 1 and each day after and not adjust it for a few days…

The “3 days to stabilize” is more relevant in the context of dose adjustments, not so much in transition complexity imo. I think any of the above would be good options. Tresiba is also the most durable without refrigeration… at least based on their FDA approval of how many they can be unrefrigerated (28 Lantus, 42 levemir? 56 tresiba). Read into that as much as you like but I’m more comfortable traveling with it in the summertime than I would be with others. I think any of them would be fine for a backup really, whatever is on hand…

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@Eric makes some good points I hadn’t thought about. Levemir might be your best bet. I would avoid Lantus if you’ve had problems getting it to work for well for you in the past though, since it seems to be one of those things that works ok for some and really doesn’t for others, possibly due to its mechanism of action (which is different from either Levemir or Tresiba). Both Levemir and Tresiba appear to be more consistent in how they work both across people and within the same person for most people (although personally, I’m allergic to Levemir, so I can’t speak to that).

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is there a reason that i would need so much more Lantus than Levemir (6.5 untis 2x/day, vs 9.5 units 2x/day?

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i dont have Levemir. i only have the Lantus. and PS: i weighed 106 this morning. i am 5’4" tall (dont know if that makes a difference or not).

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I calculated your dose and weight. The more you use per pound, the longer it lasts.

BTW, I actually gave you a bit lower numbers for safety. I think you would actually need a bit more in reality, but it would depend on how active you were on the island, so I went with a lower number to be conservative. :wink:

The reason you would need more Lantus is because it lasts longer than Levemir. It is spread out over a few more hours.

Below is an interesting thing to read about it, but a little bit boring if you aren’t too into the science of all of this stuff. But skip to these sections which give a bit of info on release and dosing of Lantus (glargine) versus Levemir (detemir)

  • Pharmacokinetics
  • Pharmacodynamics
  • Clinical trials with glargine and detemir
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Sometimes I think the name of our site really oughta be For Active, Inquisitive Diabetics! :nerd_face:

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But then it will also overlap more than Levemir and build up more over time, so shouldn’t the difference go away? Similar to how, if switching from Lantus/Levemir, you’d need more of Tresiba than your TDD if you wanted to have ideal glucose levels immediately, but the advice is to use the same dose to start with and wait for it to catch up (and then people vary as to whether they need to make minor adjustments from there).

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In the estimates I was using, Lantus would last 18-20 hours, and Levemir would last 12 hours. These are just a best-guess.

So if you took them 12 hours apart, yes you would have about 6-8 hours of overlap, but by the time you got to the next day, the overlap would be gone. So you are only overlapping part of the time - about 6-8 hours, and not overlapping the rest of the time - 4-6 hours.

What it nice about Levemir is that the shorter time means less overlap. As long as you take it twice a day, it is easier to maintain a steady level. It also allows you the flexibility to adjust morning and night and have a variable rate when you want more or less.

But if you are taking a lot of either Levemir or Lantus, your duration will be more. When they say Lantus lasts 24 hours, that is for people who are taking a higher dose.

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Right, all of that makes sense. My point was that the TDD should ultimately be the same despite the longer action, it will just take longer to reach a stable point.

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Here is why I think the amount you take would need to be different.

As an illustration, I am using the width of a piece of paper (8.5 inches) to represent the duration of Levemir, the shorter duration. And the length of a piece of paper (11 inches) to represent the duration of Lantus, the longer duration. Those are actually close to the relative times we were talking about - 12 hours versus 18 hours.

The pennies represent units - 10 units of each.

You can see how the Levemir pennies, spread out over 12 hours are more concentrated than the Lantus pennies spread out over 18 hours. Of course for Lantus, longer duration means more overlap, which means a bit of time with more concentration.

But this is why I think you need more total Lantus.

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I get that, but what you’re not counting on is that the Lantus will eventually have overlapping pennies from the previous dose, whereas the Levemir won’t.