I need help now!

OK here’s the story…My pump took out this morning and MM can’t get one here til tomorrow at noon. So’s I gotta go back on shots til then. Nothing big right??? Should have a back up plan right??? Thought we had covered it all but it’s now 23 years old (I could keep my pumps up til now and none were over a year old but now’s a different story) anyway any suggestions?

Call your endo and ask for flex pens. They should have samples in their office. Tell them about your situation…

Ok just got a call from my Endo his nurses advice??? "Follow your back up plan. Oh wait here’s a sliding scale for you to use’ My dr was sending me into outer space b/c his nurse nor him had called me back after 5 hours and my bs were high when I posted this. I got a vial of insulin here and we’re going to try that for the time being…

I sent this to Acidrock, when his pump recently failed …this time I copied and pasted …hope it will help you Doris :
Temp. removal guidelines : as in pump malfunction and replacement not available …( me talking : you know most /all of this , and you will modify your routine , no doubt !! )
When you are off the pump , stick as close to your " basal/bolus" routine as possible . Check BG more often , including during the night , to assess how this is working .
If you will be off the pump for less than 24 hours during the day , you need to take rapid -acting insulin every 3 hours . Combine : 3 hours basal insulin ; your meal bolus if you eat, and your correction bolus , if needed .
Example : At 8.00 am BS is 14.8 ( x 18 ) you eat 45 grams of carbs . Your insulin /carb ratio is 1 unit /15 grams , insulin sensitivity factor is 3 and the basal rate from 8.00 am to 11.00 am is 0.5 u/hour .
… 3 hours of basal insulin is 0.5 x 3 =1.5 u
…food bolus is 45 g divided by 15 = 3 u
…correction bolus, is 15-6 divided by 3 = 3 u ( personally I would get my numbers down FIRST …you too , I think before adding food to bod
This totals 4.5 u ( 1.5 + 3 + 3 ) so the insulin dose at 8. 00 am to 11.00 is 4.5 u of rapid -acting insulin by pen or
syringe .Another dose is needed in about 3 hours .

There are 2 options for being off the pump overnight :

  1. If long -acting insulin is not available , continue to take rapid acting insulin every 3 hours overnight , as in the previous " day time " example

2 . Take Lantus insulin once a day …( when I received this Levimir was unavailable to Canadians)
Use lantus only if you will be off the pump more than 24 hours . Calculate the total daily basal amount of insulin and take as one dose of Lantus at bedtime or in the morning and then every 24 hours ( I have read to split dose ) During the day , take rapid -acting before your meals to cover the carb and correction .
When you are ready to go back on the pump , you should not have your pump deliver basal insulin until 24 hours after the last Lantus dose . If you want to wear your pump earlier , use the pump for your food and correction bolusses , but a temp basal rate of 0.0 u/hour until 24 hours after the last dose of Lantus .
Take NPH insulin at bed time
Add up the basal amount of insulin during sleep and give 1.5 times this dose as NPH . During the day , follow the " daytime " example as described earlier .

Example # 1 : Hours of sleep are 10 pm to 6 am . Basal rate during this time is 1.0 u/hr
1 u /hr x 8 hours = 8 u x 1.5 =12 u .The dose of NPH is 12 u at bedtime
Example # 2 : Hours of sleep are 9 pm - 7 am . Basal rates during this time are : 0.6 u/hr from 9 pm to midnight , 0.5 u/hr from midnight to 3 am , and 0.7 u/hr from 3 am to 7 am
Calculate : 0.6 u/hr x 3 hours = 1.8 u
0.5 u/hr x 3 hours = 1.5 u
0.7 u/hr x 4 hours = 2.8 u
T otal = 9.1 u The dose is 9 u of NPH at bedtime

ERRRR Nel I kinda have to REALLY watch the rapid acting insulins b/c I will go low so fast that I will go into seizers. Me and the rapid acting insulins are NOT friends at all. The last time a nurse at the ER gave me 10 units of Lantus b/f she got out of the room I started seizing on her. If I had knew what the dr had order I would have said “No thank you” This was the Er dr not my dr.

So what do you use in your pump if you can’t use rapid actings? Do you have any idea what your basal settigs were?

HUH? I consider myself an intelligent highly literate person and if I saw that when I was feeling overwhelmed I’d probably shoot myself! No offense, but that seems incredibly and unnecessarily complicated. In addition it talks about both NPH and Lantus. You would not take both, and there is no reason you would take NPH at all if your doctor can call in a Lantus or Levemir prescription.

  1. Talk to your endo and follow his advice as to dosing. Or if he has no suggestions just do the following:

  2. Have the doctor call in a prescription for a long acting insulin - Lantus or Levemir in a vial as that is what you are used to, and I assume you already have fast acting. Get a syringe if you don’t already have one so you can use the fast acting you already have in vials.

  3. For the fast acting, follow the same I:C ratio you already use. The only difference from your pump is you will have to round up or round down to whole numbers. Round down to be safe.

  4. For your Lantus or Levemir read your 24 hour basal off the pump or wherever you have it noted and use that for your long acting dose either one per 24 hours or split into two. It probably won’t be enough and you will be high, but that is safer and it’s only for one day, so don’t worry about finding the right dose unless it ends up being longer.

End of story. No triganamotry (I can’t even spell it let alone do it!), algebra or geometry required.

I can only use long acting insulin

Problem is most the time when the Medtronic system dies like this there is NOTHING accessible in the pump so you can not look to see what the 24 hour basal dose is. You will have to do the math. The math above is exactly what I did when I had problems (it was only a short period of time so I did not have to worry about Lantus or NPH or anything) and it worked out quite nicely for me. In the low 100’s the whole time.

Doris, I think you’re mixing up what is “long acting” and what is rapid acting. Lantus is Long acting. Your rapid acting that I assume you take in your pump is humolog novolog or apidra.

Zoe nothing wrong with the fast acting insulins for other’s but I found out years ago I couldn’t do them. My system is totally off now I don’t want to scare others about the fast acting insulins it just dosen’t work for me after 38 years. Boy did that take some learning when it started happening to me! That’s one reason I was put on the pump so long ago b/c I just couldn’t funtion at all with the injections. It was take a shot…go dirtctly to the ER. Life huh?

So I am assumiong Zoe is correct: You are mixing the long (Lantus or Levemir) and rapid actings (Novolog, Humalog, Apidra). Do you have any idea what your basal settings were on the pump. Do you get .5 units per hour? 1 unit/hour etc…

Ok, Moss Dog, I’m going to let you take it from here. If she can’t take Levemir (I don’t know how similar it is to Lantus chemically) either, then she is going to have to use her fast acting as both bolus and basal and I wouldn’t have a clue how to do that, so I look forward to hearing you describe how to do that. Always good to know new things! Hang in there, Doris! It will be ok!

Nope not got them confused like I said it’s just life. I get .7 units an hour during the day bolos about 3-5 units to eat. I got my pump settings all lined up here.

So specifically what kind of insulin do you take in your pump? I would like to help but the particular kind makes a big difference in what you will need to do.

Ok, now I’m confused. Lantus is the one that you couldn’t take right? That gave you seizures? Lantus is a long acting insulin. What kind of insulin do you use in your pump?

Your right MossDog it does mnake a big differance in what kinds of insulin I use. Right now I’m using the very weak Novolog in my pump

Zoe I don’t mean to confuse you but like my dr said long ago “I’m special when it comes to d”

Honey, Novolog IS a fast acting insulin. Lantus is a long acting insulin.

But I’ll let Moss Dog help you from here, he knows his stuff!

I know that but it’s weakened waaaay down for me.

Doris: While I don’t really understand all these tips, I know that it is really rough. You have been so helpful to so many on here, I hope their tips have been helpful for you. Be well.