I am creating a thread to discuss diluting of insulin for toddlers. I have in my possession a batch of diluent as well as some sterile empty vials. I’m ready to begin experimenting but wanted to get input from those who have done it.
Best use cases?
Mix percentages and their uses / benefits?
When NOT to use it?
Keep in mind that I’m a novice at this…I know exactly nothing other than the conversations had here over a year ago.
My goal, or what I had in mind, when I ordered the diluent was to somehow control his nighttime lows where even .05 sends him low, but dismissing too long (which happens when sleeping) ends up causing highs. But I’m interested in any and all specific information or use cases where I could test the diluent with Liam as well as any insight into helping me make sure I mix and do things correctly.
I use a diluted pen or diluted syringes for races.
For the pen, I have it preset for 0.10 unit doses. In a race, as little as 1/2 of a unit could knock me out. I would only need 1/2 unit if something had gone horribly wrong. Since pens only go down to 1/2 units, I need to dilute it.
I use the diluted pen as a backup for the pump in long races. In short races, I only carry the diluted pen or diluted syringes.
Sometimes rather than using a pump or pen, I will use pre-loaded diluted syringes. I do different amounts, and color-code them. I have a container that holds them and gives me easy access.
Each of these color-coded syringes has a different amount:
0.075 (green)
0.150 (blue)
0.225 (orange)
and one syringe (the red one), is the “oh hell” syringe and has 0.50 units
Here it is:
Syringes are still the easiest to use when running, so I use them for faster races.
Diluent allows me to have the same granularity with either a pen or syringes
that is available with a pump.
The last thing I have used diluent for is something nobody would be doing, but it was for my IV pump. I used it so that I could bump my basal up to prevent clotting, since it was in a vein. I diluted it down to 25% so my basal would be 4x. The higher basal flow helped prevented blood clots in the cannula. But again, not really something that applies for anyone.
Anyway, I know this isn’t really the stuff that you are looking at doing, but just examples of how it can be used.
My idea would be to only use it if you feel like either a) the programmed basal rate can’t be right, so you need to split the difference between the smallest increments or b) that you need more precision in your bolus increments.
So if for instance you think your son needs a 0.025 unit/hr basal at night, i’d try 50/50 dilution and see how that works.
we used diluent early on in our diabetes diagnosis and found it did make the insulin unstable – you had to remix a new vial every 7 days. So I would then be very strict about not reusing insulin from a pod (not that you do anyways). Diluent might also help with eliminating some waste with pods…
I mixed a batch of 50% NovoLog and diluent on May 20, and it has been unrefrigerated since mixing. I wanted to wait until June 20th and report on the stability.
How would this work in practice, though? Is this a “one shot is good all night” kind of deal or an hourly shot or something else? If given by syringe that is, would this act as a “temp basal”?
I’ve read that you shouldn’t do diluents in PODs. This is from the company as far as I can tell. Has anyone done it? I’ve read (I believe from Eric?) where he actually wore two pods, one with diluted and one without, with 2 PDM’s or something…but we have only a single PDM.
So, in my mind, I was thinking that if I wanted to try a .025 / hr during the night I know I’d have to suspend my basal for the night, but how many shots, how frequently, etc., would he get a shot of this diluted insulin during the night?
Have I posted the details on that yet? I can post on how to use two different pods with 1 PDM, but that probably isn’t anything that would help you with the diluent.
No, I didn’t know it was possible with a single POD. Doesn’t seem like it would even be possible! So, you don’t add diluent into any POD? If it’s outside the scope of diluent, I’d love to see that information in a new thread!
Yes, that makes perfect sense. So it is acceptable to put diluted insulin the the PODs then? It doesn’t “break them” or anything like that? The only problem I can see is that this really wouldn’t help because night and days really are distinct phases for Liam…during the nights he goes low much more frequently than during the days. I wouldn’t want diluted insulin during the days at all EXCEPT maybe to experiment with corrections and seeing if diluted shots give less rebound/roller coaster effect.
Yes it is possible. There are all kinds of back-doors and crap you can do.
There are so many things I need to post about. I am way behind!
I have done that, but as I mentioned above, in the case of IV usage I did it so I could increase my basal rate without actually getting more insulin. Just to prevent clotting.
No, it does not break anything. Diluent is designed to mix with the insulin perfectly and have the same physical characteristics of the insulin.
Just as a for-instance, suppose these are the numbers you want:
At night you want his basal rate to be 0.025 units per hour.
During the day, you want his basal to be 0.05 units per hour
Dilute at 50%.
At night, set his basal rate to be .05 (the pod minimum). That gives him 0.025 units of insulin per hour.
During the day, set his basal rate to 0.10 units per day. That gives him 0.05 units of insulin per hour.
You have met both of your desired basal rates. Make sense?
And you don’t have to necessarily do it at 50% dilution. You can use any dilution percentage to be able to use the 0.05 unit basal increments and make any amounts possible.
Aha, yes that makes perfect sense. I will work up something for a future POD change and see how it goes. For this, I think I’ll need to create a new Basal profile with increased insulin percentages.
I would basically DOUBLE my current basal rates in the new basal profile, EXCEPT for the nighttime basal rates…since I actually want less (.025), I would just make sure it’s set to the minimum .05 for the hours designated.
no you’d use diluted insulin in your pump, and multiply all your usual calculations by 2.
But if the pods are a little different than a regular pump (they’re worn on the skin so I can see how the insulin is warmer), then maybe that’s not a good use case.
Yes, but the other thing to remember is that you need to increase the bolus amounts.
However you think it is best to do it - either change your IC and correction numbers, or just double it every time.
I think changing your IC and correction numbers on the pump might make it less likely to forget, but either way, since you are using 50% insulin (or whatever percentage you use), if you want to bolus 1 unit, you gotta tell the pump “bolus 2 units!!!”
You have to make sure to not mess that up. So that is the risk.
And then when you want to go back to using non-diluted insulin, you need to double check that you have set it all back again.
Write it all down, double check it, and then do a PDM reset so that the PDM setup process walks you through the whole setup again!
Are you sure? If I multiplied the “nightly” basal rate that’s already .05, then it would work out to .05 again wouldn’t it?
.025 (diluted mix) x2 = .05. So, in essence diluting would serve no purpose in this regard, or? But I would want the nightly mix to ONLY be .025, so I would want to keep the current .05 rate for the nights (to ensure I’m getting only the .025 I want). Is my math bad?
But multiplying all the other basal rates I fully understand.
you could try using two pods and put diluted insulin into one of them – that’s if you wanted, say, a 0.025 unit bolus for part of the night, you could have a zero programmed on your normal pod and a 0.050 on the one that has diluent. That way you’re not doing anything different than you normally do – if the insulin doesn’t work you just give corrections like normal.
Might be tricky to keep track of, and I know my son does not love site changes so I’m not sure Liam would be thrilled with wearing two pods.
