Ok, I had a few "repair jobs", when pumps blew up but last weekend and this week and, well, we'll see, maybe another week-10 day of it. We're going on vacation (ok, Maui...) and I want to go surfing, jump into waterfalls, etc. without having to worry about "oh, gee, I have to stick a new set in" since my Medtronic pump isn't waterproof.
I had a lake weekend (Grand Lake, OK...) and it was fun but the Levemir leftover from the Labor Day pump failure was not up to the task. I got through a day but I think I covered missing basal with overbolusing carousing. It caught up with me with a 372 this AM so I got rid of that and stuck my pump back in as I had a 9-10 hour drive home. Still, I didn't want to give up and had called in an RX (which, oddly, or perhaps suspiciously, Walgreens didn't call me about but was ready!) for Levemir so, about 9:00, I went to pick it up. I gave it a heavy hand (14U as the 10 on Saturday #failed, although perhaps it was dead insulin...TDD is around 22U basal but I was shooting 20 and thinking 10 at night. This weekend was pretty thick debauchery though...) and we'll see what happens. Junior has the dentist tomorrow at noon but I have 3 days off so perhaps I can get it in order and figured I'd share while I have the time to do so.
If anybody wants to share their own observations, that would be great! I'll certainly consider them all as I have very little experience at this! I'll let you know what I find out!
The first night, I went with 14U and shut my pump to % basal (figuring it will be easier to "benchmark" with the bolus wizard doing the math rather than me....). I had a fairly mild evening, tired after long car ride and all that, and woke up at 112 which is not perfect but not too bad either. Now I'm move towards the split shot with 16U for the AM and stick a sensor in so I can watch this unfold...hmmmm....
14U at night, 16U for am. Ok, got that but the timing is equally important: potential overlapping, gaps in coverage, combination of gap with dawn phenomenon etc. All that said I congratulate to 112 - quite remarkable for the first shot.
20U of levemir every evening works well for me. As Holger has posted previously and the product insert says way more obliquely, this dose is high enough that (for me) it doesn't need to be split...PM and AM BG's are pretty close, although sometimes i see weak DP. I do find that changes in dosage take 3 days to equilibrate, and I change it 3U at a time. Admittedly as a newbie I've only calibrated twice...once initially, and a dose reduction when it gor warm.
ZZ
PS... Hey, AR: post about your trip! Don't lock your car keys in the rent-a-car like my technician did!
Let's set basal now Everybody's learning how MDI surfin' safari with me!
Thanks zzyzx! The evening might be a good time as if there's a point in the time when the insulin might tail off, 3:00-6:00 might be ok as, at least with my current rig, that's when my basal rates are a whiff lower as I seem to run low at that time of day.
I will not lock the keys in the car, I will not lock the keys in the car, I will not lock the keys in the car!!
Ron Sebol of the Diabetes Self Management Forum was an engineer. He created this excellent graph that shows the activity curve of Levemir for different dosages. For this he used the data that has been published by Novo. Sadly I have learned that Ron passed away some years ago:
This graph shows two important properties of Levemir:
1. its activity is not evenly distributed 2. the dosage determines the duration of activity
With two shots per day the dosage is split in half. This reduces the duration and thus helps to reduce the overlap between the two shots. Often the overlap is just enough to keep the activity at the same level while one shot fades out and the other fades in. As the graph shows it makes sense to try different dosages to find the combination of two shots with an even distribution. This is important to have unbiased I:C ratios. With unbiased I mean that the bolus dosage is really for carbs and not for the coverage of gaps in basal coverage - this bias would make it hard to skip meals for example. Or seen from the other side the basal is not misused to cover carbs - which would force you to eat at specific times.
Wow, that's spectacular! I will have to get my bifocals on to figure that out.
I got up, had the 16U and a .525U correction for the 118, along w/ .625U to cover 7G of carbs (egg beaters, pancetta, spinach...mmm...) and then was 112 @ 8:42, figured I'd go for a run and it kicked down to 99 before liftoff at 9:07 so about 8G of carbs worth of jellybeans and a handful of cereal and ran 4 miles (34 minutes...I took a break from running and am trying to get back into it, I was *very* pleased to run faster than I have for several months, maybe since the fall!) and *finally* got the METER BG NOW on the CGM at 92 after the run. Seems to be going ok so far!
I haven't taken a pump vacation, ever. I'll follow your experience with interest as I think all of us pumpers should probably make a concrete back-up MDI plan. I somehow think that a vague notion that I can use MDI if I ever need it is much different than actually doing it!
Good luck with your real-world experiment. Have fun in Maui!
Very interested to hear how It goes… I’m wondering how many veterans out there went strait from R / NPH strait to a pump and never got to know the modern analogs with mdi— not sure if you’re in that group but I’m interested to hear how this goes for you
The perfect vacation would include the Glucosurfer App (I know I repeat mself ;-) Just enter your I:C ratios, target and so forth in the settings of your account. Then after the configuration of our App you can calculate the recommended bolus and your IOB - plus you get a nice documentation.
Interesting day so far, a couple of lows although I'm not eating much either as junior had a lengthy dentist appt. It's safe to conclude that 30U / 12 hours is too much so I will cut it back. I was disappointed in the old bottle last weekend not working and wanted to be sure I found some teeth in the stuff. I'd had a low there and it was at 101 with .3IOB so I ate a can of tuna and rode my bike to return some junk to the library. I was like "hmm, IOB, I'd better have a handful of cereal" and it's ballooned up to 149 now that I'm back so perhaps the AM shot is wearing off? I guess it's a bit soon for that but interesting. I'd sort of like to ride it out but am correcting it so we'll see where we are in a couple of hours.
Things are still moving right along today, a bit high in the AM, 141 or something, so I am trying 9U tonight to see if that will cover that. I also cut back on the AM shot to 14 which is pretty close to my usual 22U of basal, sort of eerie that it works like that! I'm pretty optimistic that everything seems poised to work really smoothly although it seems like I'm doing a lot more work, fiddling, etc. than I do with the pump/ CGM and, of course, I'm totally cheating by using the CGM and pumping boluses!
So far so good, the nose-dive was from lifting weights aggressively (to get in shape for the beach, of course....) with IOB and I was running around when it went up but it was 82 meter vs. 115 so I dunno what to make of that. Turbulence...
my experience with levemir is one really needs to wait at least 3 days to make changes (some endos say 5 - 7). also, this notion that splitting up doses is the best dosing for levemir, IMO, isn't always true. charts, graphs, etc...don't and can't represent each individual. splitting doses can lead to not only overlapping but, for those who take small doses, we run out on each dose leading to high blood sugars in both AM and PM. It's all very individual.
I figure it's more modulated with 2x smaller shots. Dr. Bernstein cites a study that shots> 6 or 7U, I don't recall which, take longer to absorb, which is kind of what Holger's graph shows, although I am not organized enough to do that particular math. With the two smaller doses cooking, it's sort of a more pump-like effect. It's felt very pleasant so far, although I haven't tried any gonzo cardio stuff yet, or long cardio. I did a crazy workout today and it went fine, very flat, no spiking but only 1/2 hour. I also like 3 changes but I could tell the first day (16 and 14U, or 30, more than my usual dose...) was too hot of a rate so I wanted to scale it back. It seems to be working ok:
So, it appears that you’ve transitioned from pump basal to Levemir fairly easily. Thanks for documenting this. I think I would also choose to start out with a split dose and minimize duration extorted by high doses. I’m hoping that your Levemir total daily dose (TDD) settles at your pump basal total daily dose. That would then confirm that the pump basal TDD is a reasonable place to start in the switch-over. Good luck!
