Thank you so much! I love your posts and insight!
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On a more serious (and boring) note, I wanted to bring out a few points for this thread.
These are all thing that you already know. But I just wanted to post them for people reading this who might be new to this sort of thing and are maybe not as familiar with the differences in MDI/basal and a pump. Some of the advantages and disadvantages.
Most any basal insulin like Levemir or Lantus or Tresiba is less impacted by changes in activity or temperature or site. Those basals are in general more consistent than the micro-doses of rapid insulin that are used in pumps. I like MDI and basal insulin a lot for those reasons.
The downside is if you want to go to zero basal, which is pretty difficult on MDI. And if you have varying basal amounts like day versus night, or want to change your basal amounts quickly.
So like anything else in diabetes, there is no perfect solution. We just choose the least crappy.
I can imagine that you have a lot of spontaneous activity with your kids, and your basal will not be as impacted by the activity level as a rapid from a pump would be. Big plus there.
Also all your hay-rolling - no pod to worry about, so another big plus. 
(Okay, couldnāt keep it all serious. 
)
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My basal rates total 9.55 units of insulin each day. Iām almost always running an extra 10-20%. So that puts me between 10.5 and 11.5 units daily.
I chose 10 units of Lantus for night #1 just to be conservative because I want to scale up slowly. The limiting factors for me will likely be finding a balance between the overnight drop/2PM drop that I get and the sticky morning highs and stubborn lunch time numbers. My plan is to supplement with Novolog during the times that my needs exceed the Lantus that Iām takingā¦and supplement with food when the Lantus is exceeding my hourly needs.
Wednesday night I deactivated my pod at 9:30PM and I took my 10 units of Lantus. I went low at 11PM. I believe that was due to the pod basal that hadnāt been used up in my system overlapping with the Lantus as it was kicking in. Thursday was not an impressive day blood sugar wise, but it was safe. I ate breakfast and took a walk and that all went well. Lunch behaved stubbornly. I fasted from 11AM until 7PM to see what the Lantus was doing in my system. It was still in effect as of 7PM when I ate dinnerā¦so I know it has at least 21.5 hours of effectiveness for me. Iāll be curious to test that again later to see if I can determine when Lantus gives up the ghost in my system more accurately.
Thursday night I added a unit and took 11 units of Lantus. I held steady all night with no drop and then climbed upon waking. Today (Friday) has been more manageable on the food front. Iāve eaten more which is nice. My numbers are better today than yesterday.
I will add another unit tonight (12 units total) and see how that goes. Past experience tells me that if Iām not seeing any drop overnightā¦and my morning numbers are this stubbornā¦I need more Lantus. Iām on Day 16 of my cycle which puts me squarely at the doorstep of the ānothing will behave well for the next two weeks and then your insulin needs will suddenly drop without warning one day which is not predictable or consistent at allā timeframe. Maybe Iāll be singing a very different tune about Lantus and pods by then. Who knows?
I continue to love not wearing a pod. The only thing I am able to use the pod for is basal and MAYBE up to a one unit correction, one time per pod site. The truth of the matter is that my body is not āhospitableā to the pod, I think thatās how @Eric phrased it. Soā¦if I can add the Lantus shot and ditch the pod and maintain or improve my control and quality of life, Iāll be the happiest girl EVER. Iām already taking a million shots a day on the pod. Adding a Lantus shot is a non-event. Itās just what happens with that Lantus that Iām trying to get a handle on.
So 12 units tonight. Iāll adjust meal shots accordingly. This is all a game of keeping my balance on shifting sands. Thanks hormones and diabetes. This is so much fun. 
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Alright. Truth be told, Iām also pretty tired from highs and vigilance and not sleeping well the last two nights with these changes.
Iām going back to the pod tonight bc we have a lot of stuff planned this weekend. Maybe I can figure something out. But I do want to get rested again and when the pod works, itās way better for sleep.
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My approach is to swap the pod to zero basal and inject just half of my daily lantus; so I use 12IU/day and inject 6IU. This balances out my 0.5IU/hour pod basal and the āstart timeā of Lantus ends up matching the end time of the *log that Iām using in the pod. Once I worked this out things seemed to work pretty much the with the pod and Lantus.
Keeping the pod on is just me preferring it for boluses; I do this when I dive and the pod fails after at most two dives then Iām trying to micro-bolus corrections with a pen.
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I slept from 11pm until 8am with nice steady numbers. As much as I hate the pod, I do love sleep.
I was religious about not sleeping on top off the pod. I think I succeeded. Thatās weird to train yourself for that.
I will say that Iām proud of myself for jumping onto shots and back off of it safely by myself. I never would have done that before now. I was frustrated enough and confident enough to try it. So thereās that!
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Iāve been following your Pod trials with interest, Allison. I missed something in your attempt to ditch the Pod for Lantus. What were you using for bolus? Or what you relying on Lantus alone?
BTW - I am a firm believer in experimenting and tweaking our treatment to get good results. I see plenty of anecdotal evidence that what works for Moe might or might not work for Jo.
I wonder if endos who should know better discount or disbelieve the problems that hormonal changes every 28 days are so can have on a womanās blood glucose management?
Your gender has gotten the short end of the stick on many medical issues, for example heart disease. Fortunately medical professionals are finally getting it that it doesnāt present itself in the usual male fashion. I mean, canāt they understand the statistics that heart disease is the #1 killer of women?
Rant over, take care of yourself.
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Iāve been injecting Novolog for meals and corrections for the last few years, and using the pod for basal.
Iām the type of diabetic who uses 30% of my TDD for basal, and 70% for boluses. Some pod users on here have discovered that 3 units tends to be the magic line of demarcation for when tunneling and leaking begins. And 3 units does not do much at all for me as far as eating is concerned. So thatās why I inject for eating. I was getting so much leaking/failing/bruising trying to bolus for anythingā¦corrections or meals. So shots it is for that part.
Absolutely. I have yet to find one who puts any stock in it. At least enough to actually have any kind of healthy curiosity about it. My doctors tend to view me as the expert on anything related to my own health. Which is why I just use them for lab work and prescriptions.
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I was religious about this for five years ā¦ until by accident several months ago I slept on a pod and discovered ā¦ the sky didnāt fall. OK, if itās close to a rib it can be mildly uncomfortable, but mostly, if itās between my body and the mattress, thereās no effect whatsoever. No bleeding, no absorption changes. I am back to happily rolling from side to side throughout the night.
There are endos out there who acknowledge this. Dr Jerilynn Prior, in Vancouver, BC, has been a leader in the field since the early 1980s. (She was my endo back then and introduced me to the idea that guys can be affected by hormones too.) I wonder if her outfit, the Centre for Menstrual Cycle and Ovulation Research, would have names of sympathetic endos in your area.
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So after a good nightās sleep and an awesomely huge breakfast with unlimited coffee, I did some digging and am encouraged and horrified by what I did not know.
Doing the Lantus trial these last two days has been a big confidence booster for me. Part of what has made pod failures so scary is the thought, āIf I canāt make this work, what the heck am I going to do long term? How do I limp this along? What if it all gets beyond my ability to pinch hit for it?ā But when I had my pod failure on Tuesday as I was walking into the store, I calmly injected enough Novolog to get me through my shopping trip until Iād get home. Thatās huge for me! And now that Iāve seen Lantus for admittedly just two days, thatās given me some great clarity for how to jump into it, how to jump out of it, and what to do while Iām using it. That is very confidence building for me. I know I can handle issues and keep life going safely through a variety of methods. They may not be pretty or convenient, but theyāre safe.
So, the horrified partā¦
The thing that really pushed me to switch back to podding last night was seeing Lantus give up the ghost on my Dexcom. My blood sugar started climbing at 8PM and I was 90 minutes until my Lantus dose. And that takes 90 minutes to get going. And I had been pinch-hitting with shots all dang day long and was pretty well over it at that point.
BUT, and donāt FUD-judge me for this, I HAD NO IDEA THAT LANTUS DID NOT LAST 24 HOURS FOR THE EIGHT YEARS I USED IT. All of the research and reading and tinkering I had always done on my ownā¦never freakinā knew that Lantus gave up the ghost early. I also had never fasted on Lantus to see what it did throughout the day. No one ever recommended that. Going on the pod and basal testing with Gary Scheinerās group is what taught me what my bodyās needs were throughout the day. Thatās HUGE knowledge to have. Especially when going back to Lantus.
My doctors never ever ever said, āHey, your evening spikes might be from Lantus running out early.ā What they did say was, āYou need to carb count more carefully. You need to see the dietician again. You need to change your meal composition. You need to measure it twice. You need to be more careful with your dosing. You need to get on the treadmill longer/more frequently/etc.ā And sometimes theyād also say, āYouāre diabetic. This is just diabetes and there is nothing you can do about it. Youāre trying too hard. Just accept it.ā
And mind you, I did two high risk diabetic pregnancies with bad ass A1Cās the whole effing time. Without knowing that Lantus was the cause of my late evening spikes. There was nothing I could have done to fix that problem without better knowing the WHY behind the spike.
And I think this is where my irrational fear of lows has been coming from. I was solving the wrong problem that was unsolvable so long as I didnāt know that Lantusā duration was the problem.
I think so often in diabetes we find what works for us and just stick with it because when you change one thing, itās a whole house of cards. At least thatās how itās been for my journey. Until FUD.
I went down to my basement this morning to see which diabetes binders Iād kept from my journey. I knew that Iād thrown most of them out after getting established on the pod.
Fortunately, I did keep both pregnancy binders. And holy hell, I feel so bad for that version of me back then. But Iām proud of her, too. She fought and worked like hell to get those boys here.
But every.single.freaking.fax.cover.sheet to my endo with my weekās logs through BOTH pregnancies say, āMy blood sugar is less predictable at night because of my variation of meals for dinner. I continue to struggle with late evening spikes but will try to keep those in check with corrections and better planning.ā
That. Was. Lantus. Running. Out.
Now I know that. Now that makes meal dosing much less full of voodoo. No wonder Iāve been so concerned about dinner doses all these years. I didnāt know what problem I was trying to solve.
If I were to use Lantus, Iād probably need 11 units up to around 14 units for hormones based on what I know now about my body. Looking through my pregnancy binders, I got as low as 6 units of Lantus (that happens through hormonal shifts in the first trimester). And I got as high as 21 units in my first pregnancy. And I got as high asā¦wait for itā¦44 units of Lantus in my second pregnancy. I was terrified that whole time of falling off of the consciousness cliffā¦but when youāre growing a baby and need to keep it under 130, you do what you have to do.
My endo in my second pregnancy recommended switching from Lantus to Levemir. But he was not at all strategic in how to do that like @Eric is. It was more of floating a balloon over like, well, take something different, but take it the exact same way, and just see what happens. To me, being in my second trimester was not the time to just say, āWhat the hell? Letās do something different without any real explanation of what weāre solving and how this will solve that.ā I figured Iād stick with the devil I knew (or thought I knew) rather than introducing an unknown one. And then I switched endos. And then she fired me as a pregnant patient saying we were āincompatibleā because I would not allow her complete dictatorial control of my meal doses and Lantus doses. Iāve told you all how she fired me over my dosing for potatoes. And under her planning, I went two full weeks in my second trimester without gaining a single pound. Thatās dangerous. She said that was my fault and sent me to a dietician. That dietician apologized to me for wasting my time because I already knew everything she was in charge of teaching me. So we instead talked about hospital administration politics and which endo I should try next.
I think itās clear that I have been carrying around a lot of baggage that I didnāt quite know what it was from. But I feel like this experiment with Lantus has clarified the overwhelming majority of my fears surrounding dosing and lows.
A big thank you to everyone on FUD who has read anything Iāve written, encouraged me, lovingly said some diplomatic version of, āMaybe youāre freaking out too muchā (which is totally fair), given strategic advice, and biggest of all, thank you to @Eric. He has taught me soooo much not only about diabetes management, but much more about living well and living compassionately for others. Thank you.
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Thanks, Allison, my current basal:bolus ratio is 81%:29%. It probably has something to do with my tired Beta cells still have some output. Maybe more stimulated by food, I donāt know. I had to figure it out on my own.
I am currently weighing the pros and cons to pumping, thinking about a T:Slim X2, tubes and all. I think I can manage any entanglements.
Currently I am on Lantus 25u TDD and 7 to 8u of Humalog.
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I think that 24 hours thing is an average, but individuals are not average. Before I started MDI I was splitting my Lantus dose in 2, 2/3rds at bedtime and the other 1/3rd 12 hours later. This was to prevent nocturnal hypos 6 hours after injection. Also it gave me a little leeway on the morning dose. I could delay it until after my morning bike ride.
After I started MDI I noticed a problem with BG ramping up sharply as the Humalog curve declined. It didnāt matter what I ate or the bolus dose. So I started doing 3 Lantus injections, 10u in the morning, 10 - 30 to 60 minutes before lunch and 5 - 30 to 60 minutes before dinner. This really has flattened my BG. The lower dose in early evening is good for the night.
I wouldnāt suggest this to anyone, just an example as how we are different. Do what works.
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Thatās awesome and exactly right.
Iām even more cavalier, in that I donāt carry short-acting with me when I go to the store, in the confidence that missing a couple hours of basal isnāt a threat, just a nuisance. Iāll arrive home and maybe need a rage bolus, but no damage done.
The cavalier part is that Iām depending on being able to get home within a reasonable timeframe in case of pod failure. If I were more cautious, maybe Iād carry an empty syringe, at least in the car, knowing that I could draw insulin out of the failed pod ā hmmm, maybe I should put a syringe in the car, together with a copy of the prescription label to try to avoid a drugs charge if I get stopped by the police.
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It is so great that you are feeling more comfortable bolusing under difficult situations. Definately a high level diabetic skill! One thought for you, if you keep having pod problems switching to 50% of your basal from any long acting, then use the pump for the other half, and to deal with the window that Lantus gives up the ghost may be a nice compromise. My son has frequent site failures, and with always have long acting on board it makes the situation so much easier to deal with than when he went 0 basal.
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Thatās a great idea!
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Not you alone. I was on an ultralente (Novo ultratard) until it was discontinued in the US (see that article; it is only necessary to read the first paragraph at this point.) I was prescribed Lantus, I was told it was equivalent.
For me, with my body, Ultratard will last me a day, Lantus will last me half a day.
Neither works in a way that is able to cover the basal requirement of someone without beta cells. It isnāt just that we donāt make our own insulin; we also donāt regulate our alpha cells, so they keep making glucagon and our livers keep releasing glucose. This is why the pod works for a basal; just as those alpha cells cause the liver to release glucose the omnipod emits just enough glucose (if programmed right) to cause the liver to re-adsorp that glucose.
One apparently weird idea that occurs to me is to use an Omnipod (or, indeed, any pump) to deliver NPH and bolus with a pen, or Afrezza; itās safer because if the Omnipod goes out the NPH will take much longer than the recommended products to wear off (the recommended products wear off after about 8 hours).
In fact, why donāt I have two pumps; one delivers my basal NPH and the other I can use at will for micro-bolusing?
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I just started on omnipod but was on Lantus prior.
I had heavy resistance to Lantus about 4-5 years ago. I mean 50+ units on a split dose. Switched to tresiba and was taking less than half as it last almost twice as long. Then ran out of tresiba after my insurance and had to go back to Lantus and my resistance was GONE.
So my suggestion would be, talk to endo about having you start out with a little lower than basal amount you take. Give body a few days to adjust to being on Lantus again Then adjust accordingly. (I have found split dose is my best friend with Lantus.)
I hope you figure out what works for you if you have not already. I just realised how kind of old this post is 
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So, did we all see my whiplash decision coming? I mean, I kinda did. What I ultimately concluded is that my biggest issue is that Iād like to not be diabetic anymore. But in the absence of curing it, I will continue to adjust to life with a pod because long-acting shots are not dynamic enough for my taste and comfort.
Anywayā¦Iām reading a great book, āRangeā by David Epstein. It discusses the value of being a generalist contrary to societyās increasing push for narrow specialization in everything from kidsā sports to organ specific cancer doctors to really everything, these days.
Itās super timely after my Lantus experiment. Going back to Lantus for just two days answered a question for meā¦and that was accurately identifying a Boogeyman that Iād been inaccurately identifying for a while. The completely unstable evenings that Iād fought forever on shots led me to a lot of incorrect conclusions and inaccurate fears. When you are afraid of the wrong Boogeyman, that makes everything scary. Going back to Lantus for two days turned on the lights, so to speak, and I found out that there were no monsters. And consequently, my bg graph has been the flattest itās been in FOREVER.
One of the concepts thatās been discussed in āRangeā is ācognitive entrenchmentā. It is defined as the act of experienced groups becoming rigid under pressure and regressing to what they know best.
Well, if that hasnāt described my journey with blood sugar management through a string of admitted challenges, I donāt know what does.
Transitioning from pregnant to postpartum, on birth control to off birth control, reacting allergically to Humalog (maybe?) and switching to Novolog which I was SUPER sensitive to at first but then that settled down, and lots of pod troubleshooting for how I can and cannot use it functionallyā¦thatās A LOT of challenges in my estimation. Because this was while working, raising babies, being targeted and pressured to leave my job by my boss for about seven years, and my husband traveling non-stop, and caring for sick family members. Not a lot of breathing room in there!
So, my point isā¦people with SOME experience get entrenched in what they know and are demonstrated to perform very poorly when presented with a new variable or parameter for their task. People with no experience perform better when faced with new challenges because they are not entrenched in one way of doing things.
I find this explanation helpful and forgiving to myself. I struggled for a long time with fear and it is such a relief to have that monkey off my back now. I did not know which Boogeyman was my problem, so everything was my problem. That two day Lantus experiment has really, really paid off for me moving forward. Kind of like a clean slate and fresh eyes for a sometimes changing challenge.
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This is a major tenet in Buddhism: our attachments and aversions increase our suffering. Like you, in my deepest heart, I still long to be gluco-normal and not live in a state of fear/anxiety. A work in progress in my meditation practice, to accept myself just as I am with kindness and compassion.
Thanks, Allison, for sharing your insights and bringing so much kindness and open-heartedness to the forum. 
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