Daughter thinking of pumping with Omnipod untethered with Tresiba - can anyone offer advice or input?

My DD is 16 and has spent 5 years on MDI. She never wanted to pump until now. She is on Tresiba, which is working very well, but she finds the hassle of MDI for boluses to be an increasing hassle. We are thinking of getting an Omnipod and going untethered with Tresiba as her basal. Has anyone done this or would provide any helpful hints or suggestions for us?

Are her basal numbers flat? If so, it should work great.

If she has variations in her basal needs, like morning vs nighttime, You can set the Tresiba amount up as the minimum, and she can have the difference added during either the day or night, whenever she needs the higher amount.

The current omnipod has a minimum basal setting of 0.05 units per hour. You can set a zero basal for up to 12 hours, but you would have to keep resetting it. So the best thing would be to reduce the Tresiba dose by the corresponding equivalent amount so that the pump’s 0.05 units per hour does not drop her too low.

For example, suppose her basal rate on Tresiba is about the same as 1.0 units per hour. Once she is on the pump, change the Tresiba amount to be equal to 0.95 units per hour. That makes up for the 0.05 units per hour the pod would be giving.

Make sense?

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I think @Eric2’s idea of using a minimal basal rate on the Omnipod and then adding an appropriate Tresiba dose is a good one. Not only could it help with some variation in basal needs, like dawn phenomena, it will also help keep the site active and less susceptible to impaired absorption and cannula inclusions.

I used Tresiba in an untethered regimen but with another pump. It worked well for me but did take some experimenting to find a workable basal dose for me. I think your daughter will enjoy always having her insulin with her when she wants to eat. She will have to make sure her PDM is available.

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Yes, it makes sense. She takes 44u of Tresiba in the morning (just recently switched from night time and its working far better) So, yes, roughly 1u/hour. I am afraid her diabetes team will look at her like she has 3 heads when I suggest this untethered method. What I like about MDI personally (and I am not the diabetic - just the Mom) is the fact that there is always Tresiba in the background. I really am not fond of the idea of only rapid being used as basal and bolus in the pump. She is gearing up to be fully independent in the next few years before she heads off to university (to get her Bachelor of Nursing Science and then a Diabetes Educator). I guess doing untethered is something we can work out ourselves once we get set up with the Pod - I am just not sure we’d get the support from our diabetes team.

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Yes, I think she might like it too for a change. I think she’s getting a bit of burnout and is getting tired of calculating doses and IOB all the time. She may just need a bit of a break from that.

Yep, with any pump (not just omnipod) there can be variability with the site location, and variability between the 1st day and 3rd day. Using a basal insulin removes a lot of that variability.

On the other hand, one of the nice things about a pump is being able to turn off basal completely when you want to, such as when exercising. So you would lose that feature with the untethered approach.

Could the ability to adjust or turn off basal be addressed by decreasing the percentage of basal delivered by Tresiba vs. pump? Eg. have Tresiba deliver 75% of the basal and the pump the other 25%?

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It could be a partial temp basal. But in the example you gave, the lowest you could get would be 75% (if you turned the pump off completely).

So it depends on how important basal adjustment is for you. For me personally, the only reason I use a pump is so that I can turn it off for exercise. If that is not something you need, then using Tresiba with it can work fine.

Since you are currently using Tresiba and not doing basal adjustment, a pump doesn’t remove anything from your current abilities. It is definitely worth trying, no downside (other than the possible hassle of trying to get a pump approved with insurance and that sort of thing).

FWIW, I think you have a great idea here. We found basal insulin with Novolog different to NPH which is what my son was using when he was 3 and newly diagnosed. It soaked things up in a way that fast acting insulin alone did not. The margin for error seemed more forgiving. Caleb is now 15 and his sensitivity to insulin is nowhere near as extreme as it was when he was on 2 units a day, so maybe it would not be the same today. But when he ventured to Europe by himself, I contemplated doing this. We opted not to bc it would have been a whole new regimen, but I think it’s a great idea if it’s something you think will work for you.

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Tresiba and Toujeo are very long acting insulins. Insulin pumps were designed to use fast acting insulin (only?). I don’t think long acting insulin will work with insulin pumps.

Here’s an excerpt on how insulin pump works:

INSULIN PUMPS
PAGE 1
Introduction to Insulin Pump Therapy
What is an insulin pump and how does it work?

An insulin pump is a small electronic device which provides a continuous infusion of very fast acting insulin (Novorapid or Humalog) into the subcutaneous tissue (under the skin). It is designed to deliver insulin in a way more similar to the pancreas of a person without diabetes, than insulin injections.

Here’s the source:

@arpida_seru

http://www.childrenwithdiabetes.com/clinic/untethered.htm

The idea is not to put Tresiba in the pump. The idea is to use Tresiba for basal, in addition to using the pump for bolus.

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My apologies. The Omnipod was tubeless and untethered. I thought the tresiba was being loaded to the untethered Omnipod.

MY BAD.

SORRY.

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I think we’re coming from a good place because having never had a pump and the ability to set temporary basals we’d never know what we were missing. Haha
I think I would set the tresiba low enough that I would have some room to play with setting in at 50% or 75% tresiba. That way if I had to suspend the basal it would actually make a difference.
I really think with teenage years and heading off to University that extra insurance and peace of mind of having a basal insulin in the background to help avoid dka when high blood sugars happen would be very valuable.

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I love this community. Lots to learn. First time I encountered this un-tethered regimen. I learned NOW that it is an option for pumpers who need to disconnect very often ususally because of physically active lifestyle. Disconnecting temporarily with the pump on long periods will deprive the body of the well needed basal insulin thus causing havoc to one’s blood sugar control. Hence, the solution:

The un-tethered regimen. Here’s the summary for those like me who just heard of this ingenious pumping option. Excerpt from the doctor who prescribed this regimen.
…start…
I decided to try a new approach that I recommended to one of my patients with type 1 diabetes who loved her pump but got “all messed up” when she went scuba diving every weekend. She would disconnect her pump and use multiple injections of NPH and fast acting insulin in an effort to control her sugars, however it was a real rollercoaster ride with every attempt. I have now termed the regimen described below the “Un-tethered” regimen.

I now take 75% of my basal requirements (75% of 20 units = 15 units) as Lantus at bedtime and set the basal rate of my pump at 0.2 units/hour, which makes up the remaining 25% of my basal requirements (0.2 for 24 hours = ~5.0 units). I continue to use my pump for boluses and have the continued flexibility of square and dual wave bolusing and having alternate basal rates. I can take off my pump for extended periods of exercise and have my built in reduced basal rate (the Lantus I took the night before). I do not have to worry about hooking up my pump within 45 minutes or taking frequent injections of insulin to avoid hyperglycemia. I do not have to worry about sudden and unexpected extreme elevations of my blood sugar values if I have disruption of insulin delivery from my pump for any reason.

I can now easily just disconnect my pump and exercise or do whatever for hours without missing a beat. My personal regimen in the summer time consists of wearing the pump Monday through Friday and on Friday night I take 20 units of Lantus and remove my pump for the weekend using my insulin pen for meal boluses. On Sunday night I take 15 units of Lantus and hook up my pump before I go to bed.

This regimen has worked well for many of my young adult and teenage patients who are on sport teams and must disconnect for hours and for a handful of elderly people on pumps who are not too computer or mechanically savvy with their pumps. The Un-tethered regimen offers a real buffer safety zone to avoid ketoacidosis for new pumpers or anyone who disconnects frequently.
…end…

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Tangent - @Terry4, I feel like I saw a cake near your name - did I miss your bday?

No, yesterday was my 9th TuD anniversary.

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Happy 9th TUD anniversary @Terry4. You have been a great help to this community. Thank you.

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I thought that was 3 cakes! I’ll never get this straight - I think bday might be a chocolate frosted cake. Happy anniversary! Sorry to hijack the thread!

Still a supporter of the untethered regime with the untethered pump! :rofl:

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Funny that a cake is used for the celebration icon on a diabetes forum. :crazy_face:

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