FUDiabetes

Omnipod for basal, Kwikpen for bolus?


#1

Anyone who is using this combination?

I am a type1 for 30 years this summer and pretty decently adjusted. So far I am using Lantus insulin as the basal insulin but suspect that Lantus to have some unwanted sideeffects. That is the mainreason for switching to the Omnipod and Humalog 100 as the basal insulin. I really don’t like the BDA Omnipod controller and in order to maximize the reservoir of the Omnipod to the max days to stay on I would like to use the Omnipod just for the basal line. Any bolus shots I would do from the Kwikpen until I am convinced that the Omnipod is faster and better.
Anyone out there who does that already and has some experience? Particular with 2 Humalog prescriptions, Humalog100units/ml and Humalog KwikPen200?


#2

Why not just try a different basal, like Levemir or Tresiba?


#3

I just know Humalog inside out. If it turns out that mentioned side-effects will not change with getting rid of Lantus, Humalog will be the next thing to be switched out. But I do not want to change 2 medications at the same time. It blurs the picture.


#4

What side effects are you experiencing? You don’t have to change from using Humalog, just try Levemir instead of Lantus for example and see if it helps.


#5

I have done something like this on occasion. It hasn’t been a daily thing, but there are times when it makes sense for me.

I think injections are faster, because they are deeper and you can also do them IM if you want. And sometimes it is easier for me to use pre-loaded syringes instead of the PDM for injections. Particularly during shorter races (5k and 10k), I can do a syringe injection at a faster race pace than pulling out the PDM and doing all of that while running. For longer races, like half’s and full’s, I stick with the PDM.

And since the basal management is easier with the pods, I keep the pods on for basal.

Anyway, this is definitely something that can work. No reason not to try it.

Please share your thoughts after trying it!

And welcome to FUD!


#6

I am suspecting Lantus after long-term use to be responsible for weightgain on very low calorie intakes. It might also interfere with the pituitary gland or cause benign tumors on it, throwing it out of whack. This is just totally unconfirmed but it has a very suspicious feel to me and it is something you can easily push off to aging and less activities. But I am actually testing now for 2-3 years with strict calorie intakes, very close monitoring of activity levels and found that with a calorie intake of 1,600 calories I just maintain weight, anything there over gains weight. I am always been a “big, square” guy, 6’ with 220#'s. But now the weight is creeping up and it is just not explainable anymore with aging at my activity level.
Plus, you would be exchanging one long-lasting insulin with another which defies the purpose of the Omnipod and blurs the lines if the long-lasting is indeed responsible for the weight gain.


#7

I will let you know. I might change my mind but that Omnipod PDM is looking like something out of ancient times and I really don’t want to touch it more than I have to. Also a challenge to Omnipod and Dexcom to have the BGM and that Omnipod work together over a neat little App without that legacy ballast.
And I agree. What is easier on the fly? Pulling a cap of and clicking through the units on a pen or typing on that gadget? I go with the pen for now, updates to follow.


#8

Have you had a testosterone panel done? Low testosterone is also autoimmune and something I’m dealing with as well as hypothyroidism and hashimoto. All three can contribute to weight gain or lack if being able to lose weight.


#9

There are a few things you can do to make it easier. First of all, if you get rid of bolus calcs, and just have preset bolus numbers in it, there are a lot less button pushes needed. You can have general bolus amounts preset and then select one that is close to what you need and scroll up or down to increase or decrease it.

Also, if you take a look at this post - omnipod-getting-past-the-confirm-button-and-doing-stuff-without-looking - you can actually give yourself a bolus without even looking at the PDM. Once you memorize the key sequences, it’s pretty easy. The push buttons make it easy to use without looking, like when driving or if it is under the dinner table.

Anyway, try it without the bolus calcs turned on. You might like it better. That’s how mine is setup.


#10

The prolactin and testosterone panels were done and a tumor on the pituitary gland was removed. The panels are back to normal. The prolactin levels were the supposedly the give away for that and are also a reason for weight-gain usually found at those levels in lactating mothers. Simultaneously I heard of 4 other Lantus users with benign pituitary gland tumors and with similar weight gain. It just seems that Lantus could be related to those weight-gain effects and be related through the pituitary gland or the thyroid?
Are you or were you also using Lantus? or if not, what Insulins are you using?


#11

I’m all for trying a pump, I think it is the most logical form of therapy aside from site/absorption issues. If it doesn’t work out for you though the other basals are very different from Lantus. Levemir for example has been found to be much more consistent and doesn’t cause as much weight gain from what I’ve read.


#12

I use the t:slim for basals and humalog pen for all of my boluses. Somewhat differing reasons. I am highly insulin resistant and use U500 in my pump. It works great for my basals, but it is just too slow acting for boluses. The combination works for me.


#13

Wow, U500 for basal, that is a bunch of insulin. How long does a cartridge last for you?


#14

A cartridge will last about 6 days. I fill them with around 160 units. I change cartridges every other site change.

So ya - I use about about 120 units of U100 in basal daily, 24-ish units in U500. Pumping was a PITA using that much in U100 bc I was having to change sites basically every 36 hours when I included boluses.


#15

I think that the main reason is in situations and units like that to find ways of optimizing the length of the site the pump can stay on. For me with the Omnipod it is certainly a reason to use it only for basal and kwikpen for bolus to have that Omnipod as long as possible on one site. Just in the sense of putting it on and forget about it for 3 days.
It also eliminates hat one issue to remember of what you just have done. Injections are so automatic with me that I put the syringe down and can’t remember which vial I just had in my hand. Separating bolus and basal Insulins this way should help on that issue of being “too normal” with your T1.


#16

Can you get a prescription for 2 day pod changes instead of 3?

There is actually a way…:crazy_face:…where you can have one pod that just does basal, and the other pod you can use for bolus. One PDM and 2 pods - 1 doing basal, and 1 doing bolus! :smiley:

I don’t know that anyone wants to go down that crazy road, but it is possible.


#17

Leave it to Eric to come up with an approach I hadn’t even considered…


#18

I am wondering why the Omnipod reservoir size is actually given in unit numbers? “Units” are by all means not a volume measurement. That would be milliliter or ml.
There are obviously different “strength” or concentrations of insulin than the regular 100units/ml, as in: a 200units/ml Kwikpen or the one floreksa is using, U500/ml.
The Omnipod, with integrated Reservoir Size: 200 units (delivers U-100 rapid-acting insulin). The actual volume capacity should obviously be 2ml. Expressed in units for an U500/ml that should fill the Omnipod with 1000 units with that Insulin.

And I really don’t know if I would go down Erics “crazy road” with 2 pumps changed every other day but it certainly should be possible. I am lazy and the main benefit of the pump to me is to slap it on and forget about it for as long as I possibly can. Probably because I am so comfy with injections that it is so automatic that I frequently don’t have a recollection of “did I or did I not” with distractions in restaurants? Maybe it is age and forgetfulness? That is possible too.


#19

We started using the Novopen echo for my sons’s levemir. It has the little thing that tells you how long since the last does and how much is left. Not sure which insulins you are using but aomething similar may be helpful.

I started to get forgetful with my levemir shots before I switxhed to a pump. I blame a busy life and lota of other things to remember :grinning:


#20

Just a quick check-in after the first 2 weeks on the Omnipod and the Dexcom. I maximized the lifetime of the Omnipod with changing it every 3 days with just doing the basal on it. We started with a typical basal of 24 hours at 2.8 u/hr but that didn’t work and led to nighttime highs and kept me pretty low during the day. Tweeking the settings slowly led to a basal of 3.1 u/hr from 12am-8am and 2.6 u/hr 8am-12am which leaves me with exactly 3 days/199.2units. Perfect!

However, if you are doing lower units, administering the bolus on the Omnipod PDM is actually quiet easy. It really comes down to personal preferences and everyones personal situation.

And of course, really anything is possible but be very, very careful. You could fill the reservoir of an Omnipod with the Kwikpen 200 or an Humalog500 u/ml but you have to account for reducing your basal and bolus according to those units not to double or 5 fold your insulin dosage. This can be deadly! You are dealing with units per ml (u/ml) with those Insulins not units per hour (u/h) with the Omnipod.

The insurance company played along and I have prescriptions for Humalog Kwikpen200 and the Humalog Vial 100 for the Omnipod refill.

With that, I most likely will stay with basal=Omnipod, and Kwikpen = bolus. I net a little bit of freedom from instead of doing one Lantus shot per 24 hours to changing the Omnipod every 72 hours even though it might take the same amount of time. But I got rid of one medication. And results are looking really good and seem to be even more fine-tuneable with different basal options and of course extended bolus possibilities. Those results show the 1st week with the original basal and using bolus on the Omnipod and in comparison the 2nd week with the tweeking of the basal still in progress for about 3 days into that timeframe and all boluses from the Kwikpen. Next target is to reduce “deviation” even more and adding more percentage into the “green” even if the 'average" goes up slightly.