I am getting an MRI on Friday so I need to remove my diabetes equipment (Omnipod and CGM) for a couple of hours. The lady on the phone says about 75 minutes laying around in the MRI so I probably will be without my pump about 2 hours. I am pumping with Fiasp.
When I did MDI this was an easy thing, now I have choices (Argh…) and I need to choose, so I am throwing it out for suggestions.
Here is what I am thinking after I rip off the POD:
Give a bolus to cover the next 2-ish hours of basal.
Give a shot of levemir to cover the next 12 hours of basal and go pump free for 12 hours.
Option 1 is the most appealing, but with Fiasp I am worried that the basal would drop me low too quickly. And I do not want to be low.
Personally, I would go with a modified version of #2.
The day or two before, I would set things up to have your pump give 40% of your basal, and use Levemir to make up the rest. Then on the day, remove your pump, depending on trend, perhaps give a little Fiasp, and there you go. Better to be a little high than pass out going low in the MRI.
I hate doing MRIs for this exact reason. I always panic at the very last minute and eat a bunch of carbs— out of fear of dropping while in the machine. So I’m glad that’s not on your list of options— the panic and cram carb option—because it doesn’t work.
I agree with @Chris about option 2 being the better one for longer MRIs. Now that I’m not afraid to switch to shots temporarily, I think I’ll keep his plan in mind for my next MRI.
I did not disclose that my MRI is at 4am… (the Canadian health system has its quirks - if you want a daytime mri you have to wait months but you can get one in the wee hours pretty quick.
So probably do levemir at 9pm the previous evening.
Next question of course will be how much
My brain says to to replace 12 hours of basal with levemir 1:1 but my gut says give 20% more levemir.
In almost any situation, I would prefer to have more basal instead of less.
But there are a few exceptions. Like if I am stuck in somebody else’s house, making boring small-talk about the weather, and having no access to food. Or being at some dumb wedding where eating is not easy to pull off.
In those situations, a little less basal is preferable.
I think an MRI kind of fits into the same scenario.
Take a bit less basal, and recover when you are free from the magnets.
HA!!! I can’t tell you how many houses EH has walked into and just went directly to their fridge. Like “hello, we’ve rarely met, but my BG is low and I need something with sugar in it.”
But yes, being low in an MRI machine at 4am sounds like a crummy place to go low.
@Aaron I have a procedure coming up where I have the same issue. I am also not sure what to do. I spoke to my endo about it and she didn’t seem that concerned with me being pod free for 90 minutes. I may be a bit woozy afterwards, so I am thinking of switching to my Vibe so I can easily disconnect/reconnect without having to prepare the pod. I also may give myself a bit of insulin before my procedure depending on where my BG is at. I have to fast from midnight so I don’t think it will be an issue. I really don’t want to do the long acting insulin thing, since I haven’t taken any in 4 years.
A few weeks ago my pod ran out during a visit in a high castle, so I kept on bolusing with my pen for about 3.5 hours. I was nice and flat. I figured out how much time 1 unit took for my normal pump basal, and I kept reinjecting 1 unit over that period of time. The last time, I bolused for about 1.5 hours and it was fine.
My experience with Fiasp is 1.0 to 1.5 hours between basal shots works well to get a flat line.
@Lisa - 90 minutes is probably doable for short acting insulin for me - but 2+ hours is kind of in between me just doing what you are thinking or moving to long acting.
I am going to do the levemir thing just for fun because it has been a long time since I have taken it.
@Aaron my procedure is similar to a colonoscopy where they give you the same drugs beforehand. It’s supposed to be fairly quick but I am afraid that I will be too knocked out to take care of my pump afterwards. What’s your advice on that? Do you think I should go the Lantus route instead?
My wife is terrible at recovering from colonoscopy anesthesia. If you don’t decide to use Lantus, you might want to talk with the anesthesiologist about keeping you on the lighter side of sedated so you recover more quickly.
For all my surgeries where I was knocked out, I was always on MDI using levemir and they went well.
If I was in your position, I probably would just do the pump reconnect. Do you have anyone who could help you with the reconnect? I usually drag my long suffering wife or my Dad to these events to take care of me. (And my dad usually drags me a long to take care of him so there is payback.)
When I am knocked out, I find I am a bit groggy afterwards, so I like the comfort of not having to deal with the diabetes stuff. Either with another person covering for me or with MDI.
My last surgery (for sinus stuff) they hooked me up to a dextrose bag while I was out so low blood sugar was not an issue
No one was around to help me (wife or father) so I was on my own. I did manage to find my insulin pen and get things sorted out with a correction bolus. Even though I was not with it, I managed to figure out the carb ratio for the dextrose based on the infusion rate and time but I am good at doing subconscious math Eventually a nurse was summoned and she eventually got a bag of saline without dextrose.
I saw it was running out, so I waited until the last few minutes and injected a 1 hour bolus with the pod. After that, I calculated how long a unit lasts: for me, it was 0.9U/hour basal rate that day, so 1 unit lasts 1 hour and 6 minutes. I injected 1U with a pen after the first hour. Then, after another 1 hour and 6 minutes, I injected 1.5U, because I knew I could get a new pod on about 90 minutes later. And I did. I never went high.
I use Fiasp right now for some pen corrections, but at the castle I used Novolog.
So - I just switched over to levemir today when my pod expired. I will be MDI’ing a few days.
I just did 1:1 basal to levemir (went with my brain not my gut which said add 20% to the basal) and made it up to 180 (10.0) this morning before correcting. I usually have a high basal rate for a couple of hours after I get up in the morning, so I may have the levemir correct, but need to give a couple of units of fisap to take care of the early morning rise in BG. Trending back down in the right direction now.
I have to say that I am sort of missing the pump, but it is kind of fun to try something different again.
Eventually a nurse was summoned and she eventually got a bag of saline without dextrose.