So I got the Low Reservoir warning tonight and went to change my reservoir and inset. And… I discovered I don’t have any reservoirs. I had a screw up with Edgepark back a month or so ago and had to buy a box out of pocket from Diabetes Warehouse. Straightened out the problem and Edgepark finally sent my order, which I thought included both reservoirs and infusion sets, but I didn’t actually check the box because stupid, distracted, other stuff going on, just assumed… Anyway, I had finished the box of reservoirs I’d bought OOP, so I opened the one from Edgepark, and… NO RESERVOIRS.
So I’m sitting here with an empty insulin pump. Oh boy. Now what. After panicking for a while, I went and ordered another box from DW, and clicked the box for overnight delivery for an extra $30 (!!!). I THINK that means I’ll get them tomorrow, but it’s almost midnight and this is the week before Christmas, so who knows. Meanwhile, empty insulin pump. Fortunately I do have a box of Lantus injectors that I get every year for pump failure emergencies. But I have NO IDEA how much of it to take! It’s been 15 yrs since I was on Lantus-Novolog MDI. I seem to vaguely recall I used to use about 40 u per day, but I used to take that in the a.m. and it’s 11:45pm as I write this and I have no idea when I’m going to get my pump going again. Lantus is pretty benign but it makes me nervous to take that whole amount with so much uncertainty. So I did 20, hoping that will keep me from going too high overnight, and re-evaluate in the morning.
But criminy I feel so weird. Never had anything like this happen before. I’ve been on a pump for 15 yrs and it’s totally disorienting to suddenly have to revert to MDI without warning starting in the middle of the night. Do I take another 1/2 day’s dose of Lantus tomorrow morning? If I get the reservoirs tomorrow do I wait for the Lantus to wear off, and when is that going to happen? I just feel so clueless how to do this.
Above all, STUPID. How did I let this happen? I’ve usually been great about having emergency reserves of everything but the transition to Medicare and the 3-month Dr visit insanity has really screwed me up in lots of ways. Aggh.
Half tonight and half tomorrow morning is fine. You can find out how much basal you’ve been using recently by looking through your pump history. When you get your reservoirs titrate your pump basal using temp basal rates until the Lantus is out of your system. Thankfully, Lantus is a 24 hour at most insulin. For many of us it seems more like 12.
As @Firenza has said a lot of people actually prefer Lantus twice a day, because it has a tendency to not last 24 hours. When you can look at your pump and get the idea of how much basal you were using per day, keep in mind it has different peaks so you might want to go at a little lower level as you can always take small corrections if needed during the day.
Lantus isn’t so benign, I was plagued with random lows at night even though I took my dose each morning. It seems to be a common complaint.
Wow, never would have occurred to me. I had to rifle the trash and my sharps container for a plunger and insulin bottle-connector thingy from my last reservoir change, but yes! I’m using a Medtronic pump, to answer your question.
Gonna keep any eye on my CGM and see if I need to do a temp basal, as @Firenza suggests, to compensate for having some Lantus on board. But I’m good to go until my order arrives, today or tomorrow.
The few times I’ve needed to be off my pump for a day or two, I don’t use a long lasting insulin (in fact I don’t have any). I set myself up to take a shot every four hours. Each shot includes:
Basal for those four hours (amount calculated from the pump)
Any correction bolus needed based on my BG
Any food bolus I need to take
It’s annoying, but not hard. And I don’t need to worry later about lingering long-lasting insulin in my system. Or having it on hand.
I take my shots at 12:00, 4:00 am, 8:00 am, 12:00, 4:00 pm, and 8:00 pm.
I think this mimics my pump action pretty well. And I’m up every night to use the bathroom, anyway
Thanks for clarifying that this was a Medtronic pump … I was searching my stockpile to see if I could spare enough cartridges to overnight you a fee. But I fear that my Tandem cartridges won’t help your Medtronic pump.
Given the challenges of maintaining an adequate supply of multiple supplies in the face of insurance issues, supplier issues, shipping problems, etc, I’m actually surprised that we don’t see more “ Help, I’m about to run out ifX” messages.
I hope that your new reservoirs arrive quickly and that these various tricks to “extend the life” of your remains reservoirs works well for you.
I used to have a Medtronic pump and now have a Tandem t:slim X2. In both cases, I have refilled a reservoir with no complications. When I change a reservoir, I keep the old one (and throw out the one before that).
My reason for refilling is usually because a complete change is inconvenient, i.e. right before bedtime or sometimes in the middle of the night. Most often these refills are not to the full capacity of the reservoir but just enough to get me to a more convenient time.
The t:slim X2 has a minimum amount of insulin in the reservoir (120u?) and unless you play games always requires a minimum amount to be primed (10.2u). The Medtronic pump didn’t have those requirements.
Thanks! I’m still learning new tricks despite having been at this for decades (dx’d 1983). Hopefully this thread will be of use to others as well. Just never occurred to me to even try refilling one. I’m now officially keeping a coupler and plunger in a baggie in my D-stuff drawer for just-in-case. Save me having to rifle through the trash next time!
When I first started on a pump I had been on Lantus/Novolog MDI for about 10 yrs (after 20 on R/NPH before that), and my Endo made it part of my yearly scripts update to put in a box of Lantus injectors and one of Novlog (now updated to Fiasp) for pump failure emergencies of all kinds. If you don’t mind a long-ish story, the one time this came into play was on my first pump, a Medtronic Paradigm 723, which suffered the notorious button-freeze failure about 4 years in. I was still under the warranty deadline and MT sent me a replacement promptly enough, but I was back to MDI for 3-4 days before it came. I did figure out my Lantus dose from looking at my daily basal total on the pump, but anyone who’s made the transition probably knows that they’re not one-to-one equivalent. I think it’s pretty common to need 10-15% more Lantus than your basal on a pump adds up to.
The best thing, though, is that when I “upgraded” to the next gen of Medtronic pumps, the 670G, shortly thereafter, this situation left me with a pretty fresh-out-of-the-box Paradigm that I didn’t need to return. And when the 670G turned out to be a total frustrating dud for me, I put it aside and got my old 723 out of mothballs. And am still using it, even though I’m two years into being eligible for an upgrade of the 670G. It’s a simple and pretty bullet-proof (I’ve dropped it a couple of times) and I personally just don’t feel like commercial loop systems have reached real maturity yet.
Anyway, that was about 15 years ago and until yesterday I haven’t needed the Lantus injectors since, but the Fiasp injectors come in useful much more often. I bring one along as emergency D gear for camping trips etc., and they’re also handy when you need to extend your reservoir a bit when you need a meal bolus but your reservoir is getting low and it’s not convenient to change it. I gather some insurers don’t cover them if you’re using a pump, which is stupid. Pumps are complicated devices and pump therapy involves a LOT more potential points of failure, so having MDI backup should be a routine part of the coverage.
TL;DR: good suggestions, and again I hope this thread will be useful to other people as well.
I was also on the R/NPH method for 25 years before I started pumping. Never used another long-acting insulin. I’ve used the Medtronic 508, 722, 723, and now I use the Tandem. Fortunately, I haven’t needed to go off the pump for several years. I also will sometimes take a shot before bed if I don’t have quite enough insulin to get through the night. That means turning off Control IQ, setting my temp basal to 5% for four hours, and calculating how much insulin I need for those hours in a shot. Or I could get up at 5:00 to change my infusion set. And oh yeah, I set an alarm to turn Control IQ back on. Sounds like a lot of work, but for me it’s easier than changing out my set right before bed. Plus, I save some insulin!
Ain’t diabetes fun?
Well, I think this is something most of us have done. And I am so thrilled to learned everyone’s work around to these mess ups! We are a very smart and resourceful group!
I found your story line about how to figure out how much insulin to take while off the pump, funny. And on,y because I found myself in the same situation once. I had been pumping for so long, I had no idea what to do. Thankfully my mishap was during the day, so I called my doctor and discovered she couldn’t call in a prescription for Lente (it was a long time ago) because I was in a different state. But she walked me through how to use regular at intervals until I got my replacement pump the next morning. I also learned way back then, I have written down somewhere my pump settings. (Now I take a picture)
But I guess you will now open every delivery as soon as it comes it moving forward!
And dumpster diving can be life saving😁
Indeed! You are NOT alone!
My most recent royal screwup involved traveling. I forgot EVERYTHING! (Grabbed the wrong toothbrush / shaving kit) I was away for six days.
I begged a local hospital for 2 mLs (200 units) of Humalog insulin, (sure, the nurse said after I explained my predicament) which I injected into the already once-used Tandem reservoir. I kept the same old infusion site. I had to pop out my Dexcom transmitter and restart which worked, fortunately. Then the pump battery died but someone had an older phone charger cord so that worked too.
My only other episode was once i pulled out my infusion site and the other one kinked sideways, so I had to revert to my trusty pen. That time injected 3 units every 4 hours + correction and meal boluses.
Just commiserating, @DrBB. I haven’t been able to get pumps in ages due to an insurance company billing bug. Hoping it is resolved and they are in the mail. Have run through all my backup stockpile, but found a box I stockpiled for transport to the hospital during covid. I have three days left.
P.S. I’ve seen some strange mechanical failures in the backup to the backup stockpile. The really odd one was that onmipod didn’t trigger the needle to insert until after I started insulin delivery and then failed. One had a comm failure. Maybe they are just old.
It helps to know that others make mistakes too. I’ve certainly learned from mine and I read sites like this one to get tips so I can avoid them in the future!
Two things come to mind…back before I was on a pump, I was in court for an important hearing. I had left home so early that I took my long acting insulin with me and accidentally took 17 units of Novolog, thinking it was Levemir. I acted pretty quickly and a crisis was averted, but it was quite alarming. How did I mix up green and orange? Lol
Then, once when on the road I pulled over to check my BG with a finger stick. I always took my meter with me. This was before I had a pump and CGM. I discovered the lancet device had fallen out of my case and there were NO lancets in my case or purse! It was raining and I didn’t feel I could drive to look for a store, so I made the difficult decision to use a syringe needle to prick my finger! It worked, but it hurt like crazy. I’d never recommend it. I still keep a meter and lancets at my disposal almost all the time, even though I have a CGM.
Has everyone on MDI done this? I know I have. I was taking about 40 units of Lantus at the time, so that would have made for a pretty hefty dose of Novolog 1st thing in the a.m. The problem of taking drugs before you’ve had your coffee! Lots of OJ for breakfast that day.
