FUDiabetes

Insulin pump with large capacity?

I recently had an episode of Psoriatic Arthritis flare up in my knee. My average BG went up about three days before the inflammation became painful. My Orthopedist told me that inflammation makes the body produce more cortisol. Then she prescribed Prednisone. Now I am injecting insulin hourly to get my BG below 300.

I don’t use an insulin pump, but what is the capacity of them? Typically I will inject 30-50 iu of Novolog with meals - how quickly would I deplete my supply? Would I spread it out to a gradual drip over time?

When I inquired with my endo, she prefers me to be on injections.

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Did she give you reasons?

Pump capacity depends on the pump. Anywhere from 200 units to 480 units.

Yes, you could set it to give you more insulin gradually.

With pumps you can basically set them up to deliver in any way you want.

Are you taking basal insulin also? Like Tresiba or Toujeo or Lantus?

If you are only using insulin with meals, I could see where a pump might not be as useful. But if you are doing basal, then a pump could be helpful for you.

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Wow what pump has a max of 480 units??

Tandem used to market a pump aimed at T2s and those with greater insulin needs called the t:flex. 480u capacity. I think, but don’t know specifically, that that pump has been discontinued in favor of growing the t:slim line of pumps.

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I am not sure if it has been discontinued, but @Thomas knows all the inner workings of Tandem…

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if you’re thinking about using a pump just for short-term, while you’re experiencing very high insulin resistance and wanting to limit how many injections you do, I’m not sure it makes sense. There’s a huge learning curve with a pump and you’d likely not get any benefits before the situation changed.

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Tandem website says it is discontinued.

T-flex

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Accurate. The Tandem t:flex is still supported for people that have them but no longer being sold.

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A lot of pumps have 200 units. But what is the largest pump capacity that is still available for new users?

Is it the t:slim, 300 units?

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Would a double Omnipod count as 400?

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Medtronic pumps have 2 sizes, 180 and 300.

Another option may be to cover some bolus from syringe or pen, using pump for smaller bolus or extended bolus.

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The t:flex “WAS” the largest FDA approved reservoir.

Although I guess if one were to consider pumps which are FDA approved for concentrated insulin then we would have to decide if it is about volume or units able to go into the pump (FDA approved).

Obviously if not FDA approved, then you can put whatever you want into the pump.

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:exploding_head::exploding_head::exploding_head:

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There’s another option to getting a larger (pump) reservoir, it’s one many of us have never heard of.

For a growing number of patients who require very high insulin doses, a more concentrated insulin product is available: U-500 regular insulin

https://www.pharmacytimes.com/publications/supplementals/2018/diabetessupplementjuly2018/embracing-concentrated-insulins-with-a-focus-on-humulin-r-u500

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Thanks for the inputs.
I take 35 iu of Lantus BID in addition to mealtime Novolog.
My next regular appointment is in a few weeks and I’ll bring it up again . Maybe that now that I am on the CGM a pump might be more acceptable.

I have another related question, but I’ll start a new topic.

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Prior to getting my t:slim, I spoke with an Omnipod trainer who would help to set up patients on u-200 & u-500. This was definitely not Omnipod policy, though I have read they are/were working on u200 & u500 certification.

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I switched from Lantus for the basal (long acting/slower absorption) and Humalog (fast-acting) for bolus (mealtime shots) to Humalog for both. A pump will allow you to microdose the humalog for small releases while Lantus does that by itself in your body

I was faced with the same issue of having too large of basal + bolus insulin-units on a daily base to utilize the lifespan of omnipods (3 days + 8 hours if you want to really stretch it) but decided to do only the basal with the pump and continue kwikpens for bolus. This way I was able to maximize the lifespan of the pod since I am cheap (or thrifty?) and did not have to deal with carrying around that extra PDM to schedule/trigger the bolus with the pods. Just my good old KwikPens which are faster and pretty discreet in public imho.

Since then I was able to lower my insulin dosage and I am doing more and more bolus shots from the pods not to waste pods or insulin. You just need to sit down and do the math of how it would work out for you, which way to go. Usually physicians like clear plans and numbers they don’t have to come up with themselves.

And as elver said, Omnipod is working on U2-U5 certification. But if you know what you are doing in regards to your units and understand U2-U5, it is already doable without recommending it obviously. But the KwikPens I am using are U2’s and the Humalog ampules for the pod are U1’s and I am doing bolus-shots from either one.

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No, my question about pumps is aside from my current Prednisone treatment. I do five injections a day now, and reducing that would be nice. No, I won’t see my endo for five weeks at my regular appointment and I will talk to her again about a pump then. I am getting a spinal epidural of cortisone hopefully next week then my pain level should drop and my BG may be closer to normals.

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I would not have any qualms trying U-200 or U-500 with an Omnipod, or any other pump for that matter.

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You would not feel uncomfortable, but I imagine physicians might balk at that unless they understand you know how to handle yourself.

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