I pump with Omnipod, going through about 3000U a month.
I’m very expensive, and this is something that weighs on my mind. I could cut a ton of cost out of my treatment by administering via MDI instead of pumping. However, in the past managing IOB effectively was just too much of a burden compared to pumping, so I’ve stayed with the pump.
Enter the community hacker-sourced Android smartphone app, xdrip (I’m using the xdrip+ variation). This app’s main purpose is reading Dexcom sensors from an Android phone and presenting the data, however xdrip+ has all sorts of other great features including treatment management. I’ve been using xdrip+ to track insulin for last 2 weeks (ignoring what the Omnipod bolus wizard suggests), and have had very good results.
So, I’m thinking of tossing the pump for a month, going to MDI, and letting xdrip+ manage everything. I think it’s going to be MORE convenient, easy, and less impactful on my life overall now that this technology is available and integrated on my phone. That, and becoming comfortable with the bad habit of reusing a pen needle all day and injecting right through my shirt – bad habits that others here have made me feel good about – changes the situation for me.
Send email to my endo today to get a scrip for Tresiba. Hopefully she’s not going to make me come in for an appointment for this.
I’m hesitant to try that on two accounts (at least for now): First, I went on a pump because my basal needs didn’t work well with the relatively flat basal profile of a long-acting insulin. Of course, I never tried Tresiba, and some have reported better results despite having similar issues on other long-acting insulins. Second, my ongoing out-of-pocket costs for pumping compares favourably with my OOP costs for a supply of long-acting insulin (in addition to rapid), plus more needles - the difference for me is virtually zero.
For me, overall, the pump has been more convenient and beneficial than burdensome.
I have to laugh here. I completely agree that the xDrip+ IOB is pretty awesone, but, while you are considering a pump vacation because of xDrip+ I am considering getting a pump because of xDrip+. It is pretty obvious that my morning and afternoon basal needs are significantly different and I just can’t seem to figure out a morning levemir dose that will work for the whole day. Right now I get a fairly large BG rise in the morning (which I take corrections for if I am not in a meeting or something) and then a slow fall in the afternoon and then a rise about 3 hours after dinner before my night levemir does kicks in. (A reminder - Canada is NOT Tresiba ready).
I got a couple demo pods from Omnipod last Friday and have been wearing one since to see if it annoys me. So far no big issues except a little bit of an itch under the pod sometimes. I don’t get that itching with the G4 sensor I wear. Just have to get over my pump phobias and take the plunge.
@AE13, that’s so funny! I’ve on the Omnipod for about 3 years, and absolutely love it. However, it IS a little annoying to always have a barnacle attached to me somewhere (usually back of arm), they do catch on things now and then and get ripped off, I had two pods occlusion on me last week, and I have to haul around another device (the PDM) all the time.
The thing most attractive to me about the pump was the ease of micro treatments to correct, and IOB management, and basal programming for Dawn, and Evening Phenomena.
When I started this, MDI was more of a pain in terms of QoL impact than the pump. xdrip+, providing smartphone integration of the CGM data, and really good treatment and IOB management, combined with learning to be comfortable with a bit less OCD attitude about injections* may have tipped things in favor MDI being less of a QoL impact.
We’ll see!
*I used to be rather rigid about new needle every time, cleaning the area with an alcohol pad, injecting into a bare area. Now, I’ll reuse needles for the whole day, don’t worry at all about the alcohol pad, and inject right through my shirt.
Do you have a highly variable basal need throughout the day? Like @Thas, my primary reason for going on the pump was that Lantis could not cover my basal needs nor respond quickly enough to needed adjustments rather than being a matter of convenience. I’ve heard Tresiba may overcome some of these issues, so will be interested in your progress (even though Tresiba is not available to me in Canada yet).
With T2 and a weakly functioning pancreas, my basal needs most of the day are not an issue. Most of the day, I have it nearly turned off at 0.05U/hr.
In the morning and evening, however, I turn it up to a varying ramp up and then down to a peak of 2.5u/hr, over about a 3 hr period. This I’m guessing I can handle with a fast-acting injection or two in that time period.
Btw tresiba u200 appears to be more bang for the buck… unfortunately there’s only 3/ pens per box rather than 5 like there is with the u100— so they’re still duping us, but at least it’s the equivalent of 6 u100 pens
I maintain that the “varying basal needs” are a function of the rapid acting insulin that pumps use in many cases more so than a function of individuals actual physiology and metabolism… that’s why I truly think tresiba is the game changer that it is. Lantus was crap, there really is no way to maintain a state of equilibrium with it… it can’t be realistically compared to the state of equilibrium achieved with tresiba IMO
The pricing is voodoo. Nobody understands it. But in a Nutshell it’s priced per box of 3 u200 pens vs 5 u100 pens. What you actually end up playing of course is all based on the black magic of your insurance plan
We all know that everyone has different physiologies. Why would basal requirements be any different? You’re basically saying that everyone has a stable basal need despite differences in diabetes, age, activity, hormones, medications, lifestyles… I don’t think things can possibly be that simple. Most pumps deliver basal insulin every three minutes, which should make for a pretty stable delivery of insulin throughout the 24 hour period, so it’s not like there are wide variations in delivery. Plus, those of us who started on pumps often had variable basal needs all along, they didn’t suddenly appear once we switched over. It doesn’t make sense to me that such a large number of people have varying basal needs artificially “created” as a manifestation of the type of insulin delivery they use as opposed to real physiological causes.
Im not saying that varying basal needs aren’t real or are a figment of anyone’s imagination— I’m just saying that I think they are necessary because of the types of insulin that are being pumped, and yes I understand everyone’s body reacts to those insulins differently, with the short half life of rapid analogs and people’s varying metabolism-- of course they need a million different ways to tweak it to make it fit. Basal pumped in a couple hours prior is wearing off currently— the time frame between injecting and it wearing off varies throughout the day for different people and different situations— that’s the “variable basal need”
With tresiba, what my observations are (and I’ve been paying a lot of attention) is that it just doesn’t work that way. it reaches a true state of equilibrium… where the right amount is in the body at all times and never in a state of “wearing off” unlike with rapid analogs delivered with a pump-- which are always on a state of “wearing off” and the varying basal rates are a never ending tail chase that’s always one step behind. Of course that’s all just my perceptions… but I encourage everyone to try it and I’m happy to compare notes
When I was on Lantus, I don’t think my basal needs were a result of it being in a state of wearing off… One of my biggest issues was that at around 3:00 AM every morning I’d have to get up and inject several units of Humalog in order to cover the DP and avoid rising to >180 mg/dl by monring, yet at other times of the day like midday I’d be prone to lows. I took Lantus at 10 PM, so there’s no way it was wearing off at 3:00 AM… I also wouldn’t describe pumped insulin as “always wearing off” since it’s delivered every three minutes, that’s like taking 480 tiny injections of rapid-acting insulin each day, and rapid insulin isn’t even peaking at three minutes, much less wearing off. Actually, I’ve had pump failures where I’ve taken Humalog/Apidra every two to four hours for more than 24 hours, varying the dose based on my basal and bolus needs, and although it was annoying, I found the control that provided better than Lantus, I’m guessing because I was still able to approximate variations in my body’s basal needs. I do think there are plenty of people who do have quite steady basal needs, but definitely not everyone. I’m curious, did you feel you had varying basal needs while using Lantus/Levemir (having to wake up in the middle of the night to dose insulin, for examlpe)? I’d be curious if there’s anyone who did have to do this every night with Lantus/Levemir who doesn’t have to do it with Tresiba…
Yes, the entire reason I ended up at the doctor was to complain that I was having afternoon lows with lantus… even though I take it in the evening, so when it should actually be fizzling out I was experiencing lows— which made no sense. I wanted to wring my doctors neck when he insisted that what I really needed was one that lasted much longer. Clearly he wasn’t listening! But it turns out he was right. I’m using “wearing off” as a figure of speech with lantus… the real problem with it is that it’s never in a true state of equilibrium even when people inject it multiple times daily… I don’t understand how it all works these are just my musings, but I’m really curious to see more and more people who require complex basal rates with a pump try 1x daily tresiba and discuss their results… I think I am convinced that the majority of them will be quite pleased…
[quote=“Jen, post:14, topic:57197, full:true”]Most pumps deliver basal insulin every three minutes, which should make for a pretty stable delivery of insulin throughout the 24 hour period, so it’s not like there are wide variations in delivery.[/quote]FYI… the Omnipod delivers 0.05U with each “click” of its SMA wire-driven pump. The controller in the pump simply distributes these little doses evenly over the hour to achieve whatever basal rate has been set.
For example, if basal is set to 0.05U/hr, the pump will click exactly once each hour. 0.10U/hr it clicks once each half hour. 1.0U/hr clicks every 3 minutes.
I expect that other pumps function in essentially the same way – i.e. delivering their smallest metered dose in even increments over the hour to achieve the set basal rate.
I’ll be interested to see people’s experiences, too. FYI, when I was on Lantus I did find that splitting the dose into two shots a day made a dramatic difference for the better in my numbers (and prevented the spikes that were happening when Lantus worse off in the evening), but didn’t affect the DP issue at all. I’ll be interested not only in those with varying basal needs throughout the day, but also those who use the temporary basal feature on pumps (i.e., I reduce my basal rate by 10-20% for eight to twelve hours after moderate to intense exercise) and those who have sharp rises and falls in basal needs due to hormones or other factors (this month my basal needs rose by 12 units due to hormones, and will suddenly drop back a similar amount at some point). I’ve found that when I’m keeping my A1c around 6.0% I’m using way more frequent basal adjustments and temporary basal rates than when I’m keeping my A1c around 7.0%…
@Jen, I also wonder how well a Tresiba regimen works for those occasions where temp basals would otherwise come into play. Lately I’ve had very few lows; however, those few mild lows that have happened have been easily managed by setting a -50% (or more) temp basal for 1.5-2 hours, On an ultra-long-acting insulin that would be impossible. I wonder, though, would those occasions prove so rare with Tresiba that it wouldn’t be a concern?
I completely agree that the xDrip+ IOB is pretty awesone, but, while you are considering a pump vacation because of xDrip+ I am considering getting a pump because of xDrip+. It is pretty obvious that my morning and afternoon basal needs are significantly different and I just can’t seem to figure out a morning levemir dose that will work for the whole day. Right now I get a fairly large BG rise in the morning (which I take corrections for if I am not in a meeting or something) and then a slow fall in the afternoon and then a rise about 3 hours after dinner before my night levemir does kicks in. (A reminder - Canada is NOT Tresiba ready).