How do I deal with my split Lantus dosage when starting the pump?

I am meeting with the Omnipod trainer for the second time tomorrow. To be honest, I didn’t really know that I was supposed to OFFICIALLY start it tomorrow because the appointment is in the afternoon and I figured that it would just be easier to start Wednesday morning and she would tell me to do a temp basal to balance out my PM Lantus dose, but anyways…

The trainer just emailed me saying for me to not take my AM Lantus dose (26 units in the AM and 6 in PM) and just correct with Novolog until I start on the pump at 3 pm. However, I also emailed my endo about this the other day and she said for me to take HALF my morning Lantus dose (so 13 units) and that should decrease the amount of overlap between the basal rate of Novolog in the pump and the Lantus.

So, I’m not really sure what to do. Both of their suggestions seem a bit odd to me. If I don’t take my Lantus right when I am supposed to, I rise up very rapidly. I’m a little concerned about injecting myself with my Novolog pen (which doesn’t have half unit marking) every half hour because that would probably make me crash nonstop, but would have to figure out a temp basal rate for the second option and have no idea how to calculate that.

I’m almost at the point where I’m not really sure if I want to switch to the pump anymore because I’ve been doing really well with MDI lately (except for stupid DP) and I’m just thoroughly annoyed about the whole thing. So, what the hell am I supposed to do here? Anyone have any suggestions as to how to deal with the whole initial Lantus/pump overlap?

It’s really no big deal,you don’t have to overthink it.Skipping pumping over this is really not worth it so don’t worry.
Your total basal rate is 32,I’d suggest taking 16 in the AM,correct as you go,meaning only take Novolog for food or highs.
I think that may work for you,the problem is you have a split dose so it’s not smart to add them up,clearly they were split for a reason :confused:
Another way to go is do what they said,only correct every two hours,that might work.
From my experience,everything went very smoothly.My dose was 26 in the PM,so I just took half the dose in the AM-because I’m being connected then the same time tomorrow-.Corrected for food and highs.
And hey,what’s a day of highs compared to the hopefully many perfect BGs overtime after the pump,and your DP,believe me,I didn’t have it personally but the split basal feature in the pump will cure that right out of ya.
So congratulations on the Omni pod,and good luck tomorrow,happy pumping :smiley: .

I totally agree with Asma… the worst that can happen is that you’ll have a bunch of highs for a few hours. When I started on my Ping I totally skipped my levemir the night before (I used it once a day). Either way will work, just pick one. It’s sooooooo worth pumping!

This actually sounds exactly the scenario I was in when I started the pump. I was on a split Lantus dose and got connected to my pump at 3:00 PM. I was also told not to take my morning dose of Lantus, so I didn’t. I corrected with Humalog up until lunch, and when I started the pump three hours later I was a bit high (14 mmol/L, 250 mg/dl) so my first bolus with the pump was a correction bolus, and it came right down. It wasn’t a big deal at all.

If you just skip your morning Lantus and correct with rapid insulin then you don’t need to do a shot every half hour. You would only need a few corrections as the rapid insulins usually last 3-4 hours. Spending half a day slightly high is better than trying to fiddle with temporary basal rates when you don’t even know for sure what your basal rates on the pump will be yet (takes a few days to work that out).

Well, in truth, it doesn’t really matter. Why? Because Lantus works slowly, it doesn’t even reach a peak until 5 hours, so whether you injected a half dose or just skipped it, your morning levels would pretty much be the same. And the standard advice for adusting to a delayed or skipped dose is to cut back on the dose proportional to the time. If you are 3 hours late with your morning shot, you would subtract 3/24ths from the dose. In the same way, you cutting back your need for basal after 3pm, so you subtracting 9/24ths from your morning dose, which gives you about the half.

So what is my advice? Take a deep breath. You will be fine no matter what you do. I would just skip the Lantus in the morning. Check your blood sugar before lunch. If you are a tad high, add the necessary correction to your lunch bolus. Then when you start on the pump at 3pm you will be totally fine.

I’d go w/ the docs recommendation. I would not want to have no basal and 1/2 a 1/2 basal shouldn’t be too unmanageable. It may produce some anomalous data? When I did mine, I had my appointment at 10:00 AM I think so I just blew off my morning shot (NPH…). For 1/2 a day, I’d go w/ the 1/2 shot I think. It will likely cause some odd data during the early phase, until the Lantus wears off so I’d make sure the trainer is on the same page as the doc? My doc when I got my pump sat in for the installation appointment but 1) she said she hadn’t done one before (eeek, she was really cool, very sharp at math, I had no problems with it…) and 2) she was the newer doc of the two @ the practice b/c I blew off the old, heavier white doc/ head of the department guy b/c I figured he’d have more patients and be harder to see. Up here, the doc wasn’t too involved when I got my CGM and I’ve kind of observed people in the waiting room who thought the doc would be more involved and didn’t seem to be? Re the multiple 'log shots, when my pump blew up, I considered that but just went out and got some NPH and it worked ok.

Well, it may be a bit too late for the advice now, but I’d follow your doctor’s advice and not the trainer’s advice (it’s a shame both aren’t from the same office). Taking no basal and only correcting would make for a difficult few hours, and a rather sleepless night. (Even your “Correction” calculations would be assuming your regular basal rate is in effect!). When I switched over from split Lantus (which wasn’t a 50/50 split, it was more like 2/3rd in the evening and 1/3 in the morning) to the pump, my doc gave me a “sample” bottle of NPH. Since it has roughly a 12 hour lifespan as opposed to the 24-hour effectiveness of Lantus, he calculated the amount of NPH to take the night before I began (instead of Lantus), and then I started on the pump the following morning.

I should also note that I didn’t start on pumping insulin on the day I was trained. I had pumped saline for a period of time to get used to it, and then began filling the reservoir with insulin instead of saline on the day I was ready to begin. I don’t think that’s possible with the Pod, though.

One more thing… I had just begun a new job around the time I was starting the pump, so that’s why I didn’t start pumping insulin right away. I wanted to form a bit of a routine and comfort level at work before throwing the complexity of the pump into the mix.

However you do it, it’ll only be a day or two of “confusion” and wild numbers, worst case. Patients before you have tried the trainer’s advice, and patients before you have tried the doctor’s advice, and they’ve all come out OK in the end. Good luck!

When I started on my pump, I skipped my morning basal dose. But I started on the pump around noon, so it wasn’t that hard. I also cut my previous evening dose in half. Really, you should not stress about this. One day of higher BGs isn’t going to hurt. When I started on my pump, my BG was 215, so my first “bolus” was a correction. You’ll only be doing a few corrections before starting on the pump. And, for me, the pump totally got rid of my dawn phenomenon!! Trust me, it’s worth it!

I agree with AR & Scott about following your doctors advice. I started about 9 AM & normally take my Levemir about 7 so that was not a big deal for me. What they can also do with a pump is put a temp basal in of zero and have the basal start up at the time you would normally take your nighttime Lantus - you could still use the pump for bolus & corrections. The basal would then turn on without you having to remember to do it.

When I started I took half my morning Lantus dose. However, I had training and began with my pump in the morning, and didn’t have to wait until afternoon.

Thanks everyone! Obviously I wouldn’t skip pumping over this alone, I’m just annoyed at a bunch of little things that have delayed this process, including having to meet with the trainer again when I already met with her to figure all of my rates and even wore a saline pod for a few days. I resisted pumping for years and now that I’m ready to go, I’m ready to go!!! Also, this has been holding up my job search because I want to be comfortable with pumping by the time I find one. Anyways, I know pumping will be awesome for my DP, which mysteriously disappeared for 3 weeks, and then has come back with a vengeance this week!

I guess the difference in opinions with the trainer and endocrinologist might have been avoided if I just had the trainer meet me at the doctors office. However, while the doc is only 30 miles away, I never know how long that trip is going to take at any given moment with DC metro area traffic. I’d rather just stay here!

I’m still not sure what to do, I woke up at 7 am with a bg of 300 for no apparent reason except maybe not drinking enough water + dawn phenomenon, and have been hovering around 99-110 for the past hour. I took my nighttime Lantus at 11 pm and usually do my morning Lantus around this time or 9:30 AM. Since it seems like I am stable for the meantime, I think I will skip the morning dose for now and see what my bg is an hour from now. If I start going really high and can’t seem to correct properly with the Novolog pen, I’ll take half my dosage and figure out what to do with the pump later. Thanks for your suggestions though!

How did it go ??

i was in the same situation a few years back when I started on the pod, and my trainer figured it all out for me. I didn’t take my lantus that day. I personally love the pod, and the little bit of issues I had with my sugars was well worth it. Good luck!

When the OmniPod Infusion System is working well it is a gift from Heaven. When it is not, I take a time out, with the approval of my endo and diabetes educ. Listen to your endo. Then advise the rep that you took 13u Lantus as per your endo. the rep will be able to show you how to do the temp basal untol the 13u leaves your system. I did this when I had to stop pumping for a weekend and will have to do it again this week when I go back on the pod. Yes, I have been having problem with pod failures since the new pods and have been in constant communication with OmniPod Corporate, their rep, my diab edu and endo. As I stated above, I want to go back on the pod because it helps me have a better quality of life and ease in controlling my blood glucose numbers.

I completely understand how frustrating the whole conversion to the pump can be. Personally, I started my pump in the morning at the time my am dose of Levimer was due. It was an easy transition and I am so happy with my pump.

When I started the pump I was told by my Endo to take half my evening dose and no morning dosage because my appt was at 9am. I would start on Novalog after insertion. I would probably go with your Endo's suggestion.