Converting Basal for New Pumpers

My son gets his first insulin pump tomorrow. We don’t have his set up class for a couple weeks and I had a question. Does anyone know how converting from lantus&humalog to just humalog works? I know it will be explained at the class but I am worried that his basal rate will be too low to use the pump. They said Animas was a good option for people who use little insulin but I just didn’t want to go for a pump that is on it’s way out.

What type of basal insulin is your son currently on, and what is the daily dose?

Which pump are you getting?

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He is using Lantus now. 3 units. He’s getting the tslim x2. I think it only goes down to .1 unit per hour.

It’s tough to be precise, but my understanding is that because fast-acting insulins are faster-acting (brilliant–yes) that you will need LESS basal insulin when using fast-acting only.

Probably anywhere from 10 to 20% less-- but how much for YOUR son is the problem. The obvious answer is it is better to take less than you need than too much.

I think Gary Scheiner addresses this in “Think Like a Pancreas” in chapter 6 under the heading:

Initial Basal Doses for Insulin Pump Users.

Thanks. I’m just nervous that I have fought the insurance company to cover this pump and we might have to send it back.

You may be able to program a basal rate of zero, for example .1 for 2 hours, then 0 for 1 hour, etc and get a total of < 3 units per day. Check for online user guide for details on how small the unit and time increments can be. It may support .025 unit increments per hour, which I can do on my minimed pump.

I agree Think Like a Pancreas is a great book.

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I hope so but it’s definitely .1 per hour. I didn’t go with Minimed because I wasn’t willing to give up Share on Dexcom G5 and I wanted CGM integration. I just hope it works out.

@T1Mom6 - The Tandem t:slim X2 does allow a zero basal to be programmed for a given time period. (I just tested this and the zero DOES work for a programmed basal time period.) There are 16 time periods available in a given profile. You can have multiple profiles. Profiles are usually for like weekdays vs weekends. Or summer vs school year. Or something like that but whatever works for you. The minimum non-zero basal per hour amount is 0.1 units per hour and after that the increment is .001 so you could have 0.100 units per hour or 0.101 units per hour or something larger. (Or zero units per hour as mentioned.)

If your son currently has 3 units daily of Lanus and hypothetically if your Pediatric Endocrinologist were to say the starting basal on the pump would be 20% reduction of the daily Lantus, that would be 2.4 units basal per day or 0.1 units basal per hour which would exactly fit the minimum per hour.

The Dexcom Share with the G5 is great. You need a Smart Device to run the Share App from. Bear in mind this works from an Apple iPod Touch 5 (in case you were looking for a lower cost option on this device) as well as many other compatible devices per the Dexcom website.

The current CGM integration between the G5 and X2 does not (in my opinion) add a great deal of help for a young child. You can have the G5 transmitting to a Smart Device. In addition to the Smart Device you can choose to either have the G5 transmit to either the X2 pump or the Dex Receiver but not both. For a child who might not be operating the pump by himself, I would suggest you may find it more useful (for now) to skip the X2/G5 integration and just run the G5 to the Dex Receiver (and the Smart Device).

The X2/G5 integration will become substantially more useful (IMHO) when the next upgrade is released from Tandem which will be the Predictive Low Glucose Suspend (PLGS) which currently has a launch goal of Summer 2018.

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BTW - I assume you were considering one of the older Medtronic pumps. The newest Medtronic 670g may not be appropriate for a child with minimal insulin needs.

The thinking by my doc and I when I went onto a pump was to take the long-acting insulin per day and cut it by 20%, as a starting point. That worked out fairly safe and then fine adjustments over time, dialed in a long-term setting. Actually, 6 basal rates per 24 hours for me. Others need only one basal rate.

Thanks for the help. Nice to know! We’ve had Dexcom since around April. He keeps an Ipod with him so it sends the numbers to my phone while he is at school. We have never used the receiver but I think having the integration would be a great way to reduce the distraction of the Ipod in his class. He always seems to lose his Ipod as well, which leaves us scrambling sometimes. It would be nice to have his numbers where he can’t lose them!

Hope it works out for you. T-Slim may be my next pump due to dexcom integration.

I wasn’t aware of that! His best friend has the 670 and loves it so we looked into it. For some reason I thought it had lower minimum basal dosing than the tslim.

The Dexcom is great. Awesome technology.

The Medtronic 670g has two FDA Block Box warnings.
The first states that the device is not safe for children under 7 years of age.
The second is that the pump requires a minimum of 8 units per day to operate safely.

The 670g is FDA approved for people 14 years of age and older however a doctor can could prescribe it as off-label if the doctor considers it appropriate. Some insurance companies might balk at off-label usage.

Note that if your son does not have a Smart Device (within Bluetooth range of the G5 Transmitter) then you will not be able to remotely see his Dexcom cgm data. Neither the Dexcom Receiver nor the Tandex X2 pump have the capability to upload the data to the internet. A Smart Device is required for this.

I am not an Apple guru but I do see that Apple has a “FindMyiPhone feature” which if configured in advance and if the misplaced Apple device is turned on and connected to your wifi would allow you to log into an online application and cause the iPod to play music or make a sound or something like that. It sounds like it might work for you for a misplaced iPod under the couch or something like that?
https://support.apple.com/kb/ph2699?locale=en_US

Good morning!

You have some options and I think you will be able to make pumping work.

As has been explained, you could reduce basal units by 20 per cent and be able to program 0.10 per hour which would accumulated to less than the 3 units of Lantus. @Tim35 further explains that you can set zero basal rates so that allows for a further reduction of .80 (if there are 16 time periods and you use half of them to alternate zero basal, so you’re down to 1.6 units or just more than half of what your son currently uses.

My son’s experience when transitioning from injections to pump therapy is the opposite of what others are describing. He was using less than 2 units of insulin a day including bolus insulin for meals. We had similar concerns to yours about being able to schedule basal low enough. He uses the OmniPod which goes down to .05 units/hour for basal and does not allow for zero basal. We expected that we would have to use diluted Humalog in order to make pumping work. However, his insulin needs just about doubled when using only fast acting insulin so we never needed the diluted insulin. This is an option for you if the programming using zero isn’t enough. You may find his insulin needs increase rather than decrease though.

The most sensitive time for Caleb has been and still is the wee hours of the morning when he is sleeping. Although his insulin needs increased on the pump, his basal needs were not proportionate over 24 hours and I would have to get up and set a temp basal of zero for those early morning hours. An alternative would have been to target a higher bg when he went to bed, I opted for manually setting zero basal. With the t slim, you could accommodate something like this with the basal program of zero, which is nice.

As I recall, Caleb’s pump basal rate was estimated as a straight-line allocation of his injection basal without any adjustment. It’s interesting to me to hear that this is sometimes adjusted for a reduction.

Good luck! I feel pretty good about you not having to return the pump. :slight_smile:

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Yes, we use findmyphone quite often. I know you have to have a device with wifi to use Dexcom Share. The thing is, we only need that when he is away from me…usually just school. When he is with me, there is no reason to carry both the pump and Ipod. He usually uses more than 8 units a day but I don’t know if he still would after converting. At our initial pump class, they did mention ways around the age restrictions. While I like the features, we weren’t willing to give up Share. It gives me peace of mind because we had some initial issues at school. Overall, the Dexcom integration, ability to upgrade features and recharge sold me on the Tslim. The touchscreen sold my son.

Thank you! I really hope you’re right. Including basal, he usually uses around 9 units a day. He is extremely carb sensitive for the first carbs of the day. Every morning at breakfast he spikes above 200 and stays there for around 4 hours. Doesn’t matter how little carbs he eats or how much insulin he takes. We have tried adding lots of proteins and fats with no luck. We tried dividing his dose and that only causes lows after the 4 hours mark. If he has a 0 carb breakfast, he just ends up having the extended high for lunch. The first carbs of the day hit him hard. Endo says pumping will make a difference so we signed up. He hovers right at 80 all night almost every night. He usually stays within range for the rest of the day. His A1C is 5.7.

Oh and he will still have his ipod at school for the wifi but would probably just keep it on the teachers desk. He self treats in class so he needs to be able to see his numbers but every time you pull an Ipod out, every child within a 20 foot radius is distracted. Lol

We have the pump programmed for a 40% basal increase between 5AM ~ 9AM to help with mornings. As well, we need to pre-bolus breakfast by 45 minutes to avoid a huge spike.

Which makes perfect sense to want the cgm data on the pump.

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My endo set up my basal for me. Can you get hold of his doctor?