Back to MDI

My Ping finally kicked the bucket for good. I’ve had quite a substantial crack in the battery compartment for some time now but have just been living with it even though the pump has behaved strangely at times. Twice last night it alarmed saying it was not primed. Then this morning it simply died (which it has done several other times). Then when I replaced the battery I got one of those “CALL SERVICE” alarms that won’t clear unless you remove the battery. Replaced the battery and the pump was working again, but then a few minutes later died completely.

So, I took Lantus and will e-mail my endocrinologist on Monday to get paperwork filled out for a new pump. I do have my old Cozmo pump which I can fire up if necessary, but I’ve been feeling as if I want to use up some of the Lantus I have sitting around and I’ve been curious how I might do on MDI now that I have a CGM, so I’m giving it a try. I’m travelling to the US next week for work, though, so I may go back on the pump for that if things don’t seem like they’re going smoothly.

Curious, does anyone use the new Medtronic 630G but use a Dexcom for CGM? I’m curious if it’s possible to use a Medtronic pump with a Dexcom CGM and amalgamate the data anywhere. Or is there a way of stretching Medtronic sensors out to several weeks like the Dexcom (I currently get on average three weks out of Dexcom sensors)? I haven’t heard the greatest things about the 630G, but it seems that Medtronic is the closest to the start of a closed-loop system and it seems they also historically have had upgrades that aren’t outrageously expensive. Plus, I’m just not happy with any of the other pumps. The Vibe is already outdated, and the OmniPod isn’t an option for me because of its lack of infusion set options (I’m allergic to the plastic sets and have had much more success with the metal ones). If the t:slim were in Canada I’d go for that, but sadly it’s not available here. I wish that we weren’t on the cusp of a major wave of new pump features. My insurance only covers one pump per lifetime, so whatever pump I get now could be the last pump I get until I change jobs. I was hoping to make my Ping last long enough that I could hold of getting a new pump for the next year or two until a semi-closed-loop system is out.

Hope you don’t have to wait long for a new pump.

Jen, I know the pump trainer in my area for Medtronic and she says that this is possible. I, too, have a Dexcom and don’t wouldn’t want to give it up. The 670G will have an integrated CGM that the system requires for the predictive low function, I believe. CL

Jen, check out my recent post on MDI. I got a lot of good info from it.

I’m doing great with splitting Lantus and NPH.

Thanks, I read through this discussion and it’s provided some good food for thought.

At the moment I’m just trying one shot of Lantus per day. I injected the same amount as my pump’s basal rate, but I think this may be a bit too low, since I’ve had to correct a few times. But I’m also “hormonal”, so that may be why. I’ve managed to stay in range so far, but I’m only eight hours in.

When I was on MDI before I split the dose into two. I never use NPH, but it does seem this would be useful for covering the dawn phenomenon, which for me hits around 4:00 AM, but seems slightly variable.

It’ll be interesting to see how this works for me. I’m curious if it will work better, because I’ll have eliminated the infusion sets that I struggle with so much. I’m curious to see how I’ll cope during periods I typically use a temporary basal rate on the pump, though, in particular every weekday afternoon. If I stay on it long enough, I’ll be curious how I’m able to handle rapid shifts in insulin requirements due to monthly hormones.

The splitting of NPH a few hours apart is very useful because it makes it flatter, much more like Lantus, but without lasting as long. Great for nighttime.

By splitting the Lantus, I am also able to adjust a little higher or lower on certain days, and higher and lower with nighttime Lantus or daytime Lantus. I just started doing that yesterday, and it worked well for me.

And of course temp basals are another thing entirely. Since you can’t do that, instead of cutting off the basal like you do with a pump, you just grab a handful of peanuts or have a bite or two of a cookie. You just “feed” the basal a little bit.

It comes down to how many shots you want to give yourself. The more shots you use, the more flexibility you can have.

If you want to do micro-dosing, I can share with you some tips on that. I use the diluent, and can do micro doses with syringe or pen. How you do that depends on the type of pen you use. But it’s easy.

I’m curious how you do this with a pen. I have a half-unit pen, although I seem to have left it at work because I can’t find it anywhere. I use the reusable pens, not the disposable ones.

Have you ever refilled a pen cartridge? You just take the cartridge out of the pen, and use a syringe and inject insulin slowly back into the cartridge. Then return the cartridge back into the pen.

So to do micro-dosing, you would want a different pen, one that is clearly marked. Mine looks like this:

I take the diluent (available for FREE from Lilly Pharmaceuticals) and inject both diluent and insulin into the pen cartridge. For half unit pens, if you put 20% insulin and 80% diluent into a cartridge, that means each “click” of the pen is now 0.1 units. That’s how I marked mine so it’s easy to remember.

Remember to completely empty the cartridge before doing this, so your amount is accurate.

It’s that easy! Now you have a pen that gives 0.1 units instead of 1/2 units. You can do the math and the mix anyway you want!

One thing to remember. This pen would be lousy for giving a big bolus! If you wanted to give yourself 5 units of insulin, you’d have to inject 50 units worth of volume! So you’d definitely only want to use this one for micro-dosing, not for meals!! :grin:


The 630g is the only pump i’ve ever owned so i have no perspective on this in relation to other pumps. However, in my opinion i couldn’t imagine giving up the integrated CGM even if it were replaced with a dexcom(which is arguably a better one). This is due to the fact that low glucose suspend is, in my opinion, the single most important feature of the pump.

I have heard that Medtronic is supposedly improving the sensor with the 670g substantially. I can’t speak for what medtronic is offering in canada but they are automatically upgrading me to the 670g when it comes out for free as long as i send them the 630g back. I’d hope they are running a similar program for you.

Thanks for the information about the 630G. It’s not out in Canada yet, but is coming soon. I’m going to call Medtronic and see if there’s some way I can look at it.

Lantus so far is not going so well. It was fine for the first 8-10 hours or so, and then it was like the insulin stopped working and I shot into the double digits despite corrections. This morning I woke up to a blood sugar of 14.5 mmol/L (260 mg/dl) and large ketones. I gave myself a second Lantus dose this morning (intending to split the dose with more tonight) on top of the Lantus already in my system and corrected, and mid-afternoon I’m still out of range and still have large ketones. I’m not sure if I just need A LOT more Lantus than I did basal through my pump, or whether the Lantus has gone bad (though it was from the fridge and doesn’t expire until next year), or whether my body just does not like Lantus anymore, but whatever it is, at the moment I am really wanting my pump back!! (Incidentally, I changed battery caps on my Ping and it seems to be up and running again, so if this isn’t working out I can go back to that for now.)

Have you tried NPH for the nighttime yet?

I’ve only been on Lantus for about 36 hours so far, so nope. I don’t have any NPH. It’s not just the nighttime that’s an issue, though. I’ve just been high non-stop since switching over. I’m not even at the stage of fine-tuning, just trying to stay in range and not spill large ketones… At least I finally seem to have gotten the ketones under control after a massive 26 units in corrections this evening, though I’m still not really back in range, but am close.

When I switched from MDI to pump, my basal needs were cut in half. I empathize with having higher #s than what you want. Be careful and don’t go too high to fast with the lantus dose. I hope it all works out for you. :slight_smile:

My basal doses actually went up when I switched to the pump, which seems to be the opposite of what most people experience. I think the main reason for this is that I needed extra insulin to cover the DP which I was previously covering with several units of Humalog given at 3:00 AM.

I just woke up low this morning!! In contrast to yesterday, where I rose slightly from a bedtime reading of 11 mmol/L (200 mg/dl) to 14.5 mmol/L (260 mg/dl) in the morning, last night I dropped steadily throughout the night from a bedtime reading of about 10 mmol/L (180 mg/gl) to a reading of 3.0 mmol/L (52 mg/dl) this morning. Quite a dramatic difference there. It’ll be interesting to see what today brings. I did 20 units of Lantus this morning because I’ll likely be walking more than usual today (I also walked quite a bit yesterday, maybe the reason for the low).

Let me know what you figure out. My combined basal for MDI (Lantus and NPH) is close to what it was with a pump.

I have done a lot with old Humalog, but I am not sure I have ever tested old Lantus. I don’t recall. But I have a vial that expired 2 years ago. I can try it out and see if there is much difference and let you know.

That’s the weird part. The Lantus I’m using was from my fridge with an expiry date of 2018. So I wouldn’t expect such erratic results. But I’m back up to 15.9 mmol/L now, so I hope I can bring that down without going low.

Why do you think that is going on?

Did you translate the total basal units directly to Lantus units? Mine was roughly the same.

Are you using a shallower injection with the pen needles than you were with the pump infusion? I have notice that for me it takes less bolus insulin when using a slightly longer needle (8mm) than the very short ones.

Are you using the same insulin you were using in the pump?

Good luck with figuring out your MDI needs. It’s probably something we all long-time pump users should do from time to time just to keep current. I hope more moderate BGs will soon appear for you!

It would not surprise me if hormones are playing a part in this, as it’s right around the time they are usually surging and causing chaos. When using the pump, typically during this period I up my basal and other settings by 30-50%. I’d already upped them by about 30% prior to my pump dying, but I’m guessing they need to be upped another 20% at least, and maybe even more since many people say they use more insulin with MDI than they do with the pump. But next week they are likely to crash back down again, so given that Lantus takes days to adjust, I’ve reluctant to raise it too much and then suddenly have to lower it again.

I’m using the same units of Lantus as my TDD of basal was on my pump. I’m using 8mm pen needles. On the pump I was using 6mm and 8mm needle infusion sets. I’ve been using Apidra all along for rapid insulin.

I find that lately I don’t seem to have a dawn phenomenon—my lowest basal rates on the pump are overnight, and the highest kick in at about 4:00 AM and in the evening around 6:00 PM. So it could be that the low at 5:30 this morning is just reflective of me needing a lower basal at night, and the highs the rest of the day (especially in the morning and evening, it seems) are reflective of me needing a higher basal amount at that time.

At this point I am thinking I’ll probably be back on my pump (either Ping, if I trust it, or my Cozmo) for heading off to the conference next week. I think travel combined with trying to figure out my doses combined with probable hormones will just be too much. One of the major downsides of not having a pump is that it’s going to take days to figure out my Lantus dose as opposed to a day or two with the pump’s basal. I am off for two weeks for Spring Break shortly after I get back to Canada, and that may be a good time to give the Lantus another go (and as it is, I’ll stick with it until the weekend just so I can finish up this vial).

Here’s something I find baffling.

Last night at dinner I really wanted to use the bolus calculator on my pump and also wanted to see whether my pump would be functional with the new battery cap. So, I reconnected it and bolused for dinner. My blood sugar finally came into and stayed in range. So now I’m wondering if the Apidra in my pen isn’t working (it ends up going in my pump eventually, so I’ll find out).

But here’s the really weird part!

Due to dropping so much overnight the previous night, I decided to not take Lantus. My plan with that I’d just turn on my pump’s basal (which was suspended) if I went high overnight. But…I didn’t go high. I stayed perfectly flat. I woke up to a reading of 6.2 even though the only Lantus in my system was the 20 units I’d injected the previous morning. Twenty units is less than half my pump’s basal!

So, I did the same this morning: injected 20 units of Lantus and have kept my pump’s basal suspended, but did use the pump to bolus. So far, my blood sugar has stayed in range.

I really don’t understand it. I’ve heard people say “less is more” in regards to insulin before, but we’re talking about using 55% less basal. Seems crazy to me.

In other news, my pump with the new battery cap seems to be back to normal, which makes me very happy!