So I switched insurance and pharmacies at the beginning of the year and due to the usual snafus plus a couple screaming pods, I found myself without an Omnipod for a few days. Rather than break out the old backup pump I got a pack of syringes and went to town. Some thoughts from the last few days:
Fiasp responds soooo much faster from an injection than the pump. Never figured out why that is.
Lantus is super sensitive to dose changes. If my daily dose goes up or down by 10% my insulin sensitivity qualitatively changes by much more. Ie, my hourly change in blood sugar is a lot higher than I’d expect from that 10% divided by 24 hours.
Lantus stabilizes blood sugar so well. Typically on if I ate 30g carb on basal pump delivery alone (no bolus, no loop), I’d get the full scale of that with a bg rise within 2 hours or less. The lantus seems to slow that down a lot. Which leads me to my question- does anyone stay on an injected basal insulin while using a pump? I’ve got this idea that if I took 20-40% of my basal dose as lantus, it may have that stabilizing effect on carbs while allowing me to ease off for exercise, etc. Or maybe the lantus at that low a dose basically does nothing.
My son always injects at least 50% of his basal even when using a pump. He started out doing this for sports. Just being able to unplug and have the perfect basal insulin amount for sports was easy and predictable. Now he does this because he has pretty frequent site issues and this results in a really easy to control BG when he has to go a few hours before changing out the site.
It should also do what you are thinking if that is true for you.
There are some people that purposely use partial basal by MDI because it means if you have a pump failure you are not as likely to go into DKA. You always have some insulin. I have thought about it, I have never been in DKA and it seems like a good idea. But I haven’t been motivated enough to try it yet.
@Chris I like that idea because of sports. One reason I keep trying to make my pods work is because of my swimming. Since I swim a lot for 2-3 hours, I haven’t wanted to be without some insulin in my system. I have a tendency to have my BG level go up some after 1-2 hours. Plus I can spike pretty quickly without any insulin. If I have to switch to a tubed pump, that partial by MDI could be my solve. Really good idea!
Hi, I am new here, but this is so intriguing! I used Tresiba up until November as my basal - been on op5 pump since then. It gives me nowhere near the dose I was taking on Tresuba (11-14) versus 7-8 a day on pump. Do you think if I gave just 1 or 2 units of Tresiba it may help my basal/bolus be more like 50/50? I would start with 1, of course. I kept asking endo team about why we couldn;t just use pump for bolusing and correction and also have background. Anyway, regardless, I love this place for the way we are not kept bound up in one box and doing as told versus things that intuitively resonate. Thanks!
First, is the lower basal insulin dose keeping your blood sugar in check? If so, it might be because you are dosing more for food, or really didn’t need the insulin to begin with and you covered with carbs.
Just my 2 cents, there really is no clinical reason you need 50% of your insulin to be basal insulin. That seems like it is a goal for reference when an endo is trying to troubleshoot you when simplifying or starting you out on a pump. Is there a reason you are trying to get to 50/50?
The goal in my opinion is to have the insulin you need when you need it. Your body shouldn’t care whether that is called basal or bolus insulin. It just needs what it needs.
Edit: and we exist to provide an unfettered alternative to information than most of the corporate supported sites can manage. So thanks for appreciating our approach, and glad you are here contributing!
I was interested in 50/50 because I read that was omnipod’s goal. I am waking in 130s to 140s and rising past 180 after meals even with multiple corrections. The corrections (10-20 per day it seems) are counted by OP as bolus. So, no, I think it could do better if I could get more basal. But I am still learning. Even the OP folks told me it would learn me and was aiming for 50/50. I don’t care what the ratio is if it could help me get closer to 110 or even 125 between my 3 meals of 25-45 carbs each. I appreciate the input and have just now changed my I/C ratios by one (more aggressive). I feel they are close to right, but after supper will sometimes drop to a low I have to treat. I am experimenting with pre-bolus times and trying 15 instead of 20 minutes and will also try more time to see what happens. On mdi, I maybe pre-bolused 5 minutes if anything. I just want to maximize the technology and get more level between meals. I exercised hard this am and had to stop a mile in and wait for glucose (2 tabs) to kick in despite having preloaded with a Kind mini about 20 minutes before leaving. I was 99 when I gave insulin for 26 carb breakfast (not using cgm which would have given less insulin - bolused for the real carbs) finished eating about 45 min after exercise and it rose to 186 an hour and a half later. But my pod adhesive had blood, dried, on edge of pod so did change it after breakfast (and found insulin also on the adhesive when I removed it, so who knows how much bolus got in). So today may be a bit of an anomaly, but Ido feel as if I have so e exercise rebound highs a few hours later. That may be in my head, and I will study my own data (I do keep lots of records). And the data will look good, overall, but I automated is not doing the work alone, I am tending and correcting alot. Anyway, thanks for offering suggestions. I am open to help.