For those who are scared to try the pump (or who tried it and hated it) because of reliability issues or fear of DKA, have you thought of using the untethered regiment:
It basically eliminates the risk of DKA while still having almost all the benefits of the pump (save being able to suspend completely). I was seriously considering it when I was having huge problems with infusion sets "dying" unexpectedly and not absorbing insulin well in general due to allergy issues. Those problems have largely disappeared since I began using metal sets (I've had a handful become super irritated and stop working before 48 hours, but not every second site like before). In fact, I love the metal sets because today I pulled my set out by accident and just went to the washroom and stuck it back in at a new location. :)
I wonder if the combo basal routine, Lantus + small pump basal, gives any better control or maybe just equivalent. This changing up of the routine may have some vacation-like feel to it.
I'm not sure. I have some Lantus sitting here in case of pump failures, and since it just keeps expiring on me without using it, I've thought about trying this regimen just for the heck of it.
Personally? I see this a HUGE waste of supplies unless the person uses a LOT of bolus insulin . I considered this for 5 seconds while I tried the pump but I realized I'd probably be only putting 10 units for a sure T in every 2 days . Very marginal benefit of dosing, but completely ruined by the discomfort of wearing the pump and the sure-t's (medtronics metal sets) being uncomfortable to me. It'd be a $7,000+ monthly supply costs waste of money that I could spend on years worth of MDI that is easier to do and more cost effective.
Like I'm thinking if someone uses as much bolus as some type 2's I've met on here? Sure. Maybe. But not for me.
That seems sort of backwards to do basal long-term and pump boluses. To me, the hugest advantage of a pump is ditching the basal insulin entirely and pumping short term for basal rates you can fine tune with much greater precision.
If anything, I'm always surprised by how reliable my pumps have been, compared to other electronic gizmos I've had, particularly considering the mech elements involved.
If it's an issue of the infusion sets being uncomfortable, and you get just as good control with shots as with a pump, then you're right it would be a hassle. If I found control from shots plus the pump equal, then I'd find the pump in general a hassle even without this regimen and probably would just stick with shots—I had no issue with shots except that I could not get satisfactory control with them. For me, the pump gives MUCH better control than shots. When I was having horrible site issues, then perhaps my control was equal to what it was like on shots, but I think even then it was still better since I wasn't having very many lows.
I'm not trying to push the pump or say the pump is "better", I just noticed that some people cited the risk of DKA as (I thought) one of the primary reasons they were hesitant to use the pump, and thought they might find this regimen interesting. Maybe I was completely wrong in that assessment, though.
I don't think this regimen is any real waste of supplies compared to regular pumping (other than using a pen needle and Lantus, of course). You can fill a cartridge and use it for as many days as needed, there's no reason it has to be changed every two days "just because". When I used a pump with 300 unit cartridges a full cartridge used to last me about 6 days and I had no problems using one for that long.
I think if I did something like this I'd do a 50% basal with Lantus. I agree that 75% sort of takes away some of the flexibility of the pump. But personally, I rarely lower my basal rates more than 20% and also rarely disconnect/suspend completely, so 50% of my basal is always there anyway. If you suspend your pump or decrease its basal rate by a lot on a regular basis, then yeah, even 50% could be annoying. (And if you don't have concerns or issues with ketones then using this would make no sense, anyway.) I know some people disconnect their pump during exercise, but I've found when I do that or when I decrease my basal too much, even just for an hour, I'm apt to have huge ketones and a 300+ blood sugar an hour or two later, which I don't get if I stay connected.
