Well, today is my first day of using Lyumjev 200.
I am using it in my Omnipod 5. And as we all know, there are very few things we can change/adjust ourselves with this pump.
Well, changing the strength of the insulin itself IS one of the things we can do.
Initial approach is to just cut all my numbers in half.
Anyone else made this switch?
Any insight or advice?
This is my first concentrated insulin I have used. So I don’t have any real experience that would correlate, even if it was a slower acting insulin.
@Hammer & @Eric I just checked the Insulet website and didn’t find anything that indicates Insulet asked for or received FDA approval for Lyumjev, let alone U200, for the O5, though I could have missed it. Of course Insulet, like other pump makers, likely only advises the insulin’s they’ve conducted clinical trials with and gained approval from FDA on. That being the case, they probably haven’t incorporated a setting for Lyumjev U100 or U200. I’m not sure of what settings are required for the O5, so please make sure you’re doing all the math required…(MATH! Nobody told me there’d be MATH!)
Nope, definitely NOT a setting in O5 for any U200 insulin.
The numbers I cut in half are carbs and correction. So the calculator should be closer to the truth for boluses.
I will let the O5 figure the rest out on it’s own.
I have had problems with the O5 not being nearly aggressive enough, and my overnight numbers almost always gradually rise.
With the U200, I still rose, but maybe not as much as normal?
Either way, the O5 is far too conservative with what it thinks I need as a basal profile. And using U200 is my next attempt at tricking the system to work for me.
Oops! I misunderstood this comment! I thought you meant you could change the strength, meaning U100 versus U200.
The idea of putting in U200 scares me, because I don’t ever use any pump recommendations for anything.
It puts out basal for me, based on my program. So yes, I could certainly program the basal differently.
But for corrections or meal boluses, I just look at my BG number or the food and put in what I think I need. I would have to retrain my brain to put in 1/2 of the normal number.
I know I would never be able to completely retrain myself that 4 units is actually only 2 units now. I would be making so many mistakes with that.
If you ever do manual numbers, maybe put a sticker on your PDM with a big
I like to see what the pump recommends for a bolus, but I always calculate them myself anyways. I’m good with the math in my head, but have the pump calcs with the new numbers is my backup.
The pump still thinks it is using U100, so the basal will be affected, but for how basic the O5 does the basals, it hasn’t been as noticeable as I had imagined it would be. I thought it would have to reduce basals to keep from going low, but that hasn’t been the case.
Too soon for any empirical data, but it seems like my curves don’t go as high and come back down sooner. Eating mostly the same diet for a good comparison. But not drastic differences so far.
I think using the Lyumjev U200 in the Tandem pump with Control IQ would be a game changer though!
I will see how far I can take it while using the O5, as that is what my insurance covers. If I cannot get better control, I will go through the VA for Tandem supplies and go back to that route.
Mainly, I just think of half the bolus compared to what I would normally give. So, figure the bolus, then cut in half.
I am pulling it back a little more than half right now though, as I am still trying to be a little cautious of using the U200 version.
I am finding that U200 is not just twice as potent.
It seems to be faster acting, and I am definitely more sensitive. So I am increasing my carb ratio more to adapt.
I have had to eat a number of times to correct for a low.
It also shows the O5 will not adjust enough to keep me from going low from these boluses. I haven’t delved to deep into that part yet. Tandem was much easier to see when and how much it slowed/stopped basals to adjust for impending lows.
Learning as I go. So I thought I would keep notes for others to see my results.
It would make sense that it would be faster too, because the surface area of the bolus that is exposed to tissue is higher per unit than it would be for U100. And the surface area of the bolus is what gets absorbed. The middle of the insulin blob does not get absorbed until after the insulin surrounding it has been absorbed.
I’ve been using Humalog U-200 in my Tandem t:slim X2 for almost a year. I switched because my nighttime basal was 3.4-3.6u/hr and Tandem in their infinite wisdom limited the basal to 3.0u/hr all the time (instead of only under the conditions set forth in the manual). By using U-200, I tell the pump my basals are 1/2 of what they are for U-100 and 1.8-1.9u/hr at night is well under the 3.0u/hr limit. Of course, I also altered my carb ratios and correction factors. As long as I don’t enter or adjust the units directly, all the necessary calculations are handled by the pump.
With U-100, I needed to refill the t:slim every 2.5 days and now with U-200 I refill every 5 days, much more reasonable, IMO.
The “downside” is Medicare was paying for U-100 completely under part B but since U-200 doesn’t come in vials, Medicare pays under part D and I have a copay. Recent changes to insulin pricing has reduced that to a maximum of $35 per month.
I also had to get the pens instead of vials for the U200 Lyumjev.
The Omnipod5 doesn’t let you set basals, so I had to let it figure that part out on it’s own. I only changed the carb and correction factors.
I also changed my time on board and pushed it back out to 3.5 hours. It seems like the U200 takes longer to fully flat line compared to the U100 at a little less than 3 hours.
Glad to hear that you have been successful using the U200 for so long!
It looks like changing both my carb and corrections ratios by 2.5x greater is what I needed to balance it out. My IOB is set for 3.5 hours now as well, which is definitely longer than before.
That is not exactly what I was expecting to make the changes this far above the 2x starting point. It does make sense that it being more concentrated will affect the absorption rate, etc. But I figured it would also not last as long because I was giving physically smaller boluses, and would not linger around as long like larger boluses would before.
Anecdotal, but just my findings so far.
It does make up for the smaller amount held by the Omnipod5 limit of 200ml. I don’t fill it and I can get my 3.5 days out of it now consistently.
They have improved some with the use of U200.
No lows, which is a good thing. That was my only real concern, which didn’t end up materializing.
I still had much better control with Control-IQ, but the switch to U200 with the Omnipod5 did help some with my night time highs. Not to a great amount, but enough to notice a difference.
I imagine someone that is a lot more sensitive to insulin would see more changes (both good and bad really,) than I am seeing. The O5 is just not aggressive enough for those of us that require more insulin. But having more potent insulin does help!
Thx for letting us know. This is a fascinating experiment!
I’m finding that it isn’t aggressive enough at night time for even some of us who use lower amounts. My TDD is around 12 to 15 units and it has a hard time keeping me under 130 at night. I usually set a high alarm and bolus once or twice a night. I’m definitely going to think about tandems smaller pump when it comes out.
Cut your units in 1/2 