I decided to take a pump break. Any tips out there for keeping track of iob, etc? Anyone know much about inpen and if it’s worth getting a prescription for? I had a miserable go at a new Tandem pump and need to recover with MDI for a while. Thanks for any and all tips you can give. I haven’t been on shots for some time…
Don’t know about Inpen except what I’ve seen on the Interwebs, but one of the big disadvantages of going back to MDI is not having your delivery system keeping track of things for you, so it seems like something I’d want to do if it were me. I definitely had problems occasionally remembering whether I’d dosed and how much back when, and I’m sure it would be worse now. Older, forgetting stuff, etc. Fun.
If you don’t mind my asking, what was the problem with the Tandem? I’m still a few years out from a new pump but I’ve been pretty interested in those after having a crappy experience with the MT 670G.
ETA: meant to say there are a lot of apps now that can help. Only problem with all of them is that you have to, y’know, remember to enter the info into 'em, which is sort of the basic problem to begin with…
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My blood sugars were running just fine (actually a little low) up until I switched to the Tandem; yesterday at 2:00pm. After the switch my sugars starting elevating. Ate 24 carbs for dinner, walked 3 miles, ate string cheese and a few almonds before bed; sugar jumped to 250 for most of the night. Changed site at 3am and bolused. Woke up at 150. Not great; but an improvement. Sugars began skyrocketing again. Soooo I changed my site…again. Not knowing what to do and watched my dexcom reach HIGH. After 4 site changes; finally called endo gave 7 units of novolog and I’m finally at 117. I’ve felt horrible for the last 24 hours and need to recover with insulin that I know is getting injected 
I’m not going to fully say that it was the pump just yet; I’ll give it another go round when I get tired of shots.
Tresiba is key…levemir, basaglar, and lantus all feel like nph to me and always seemed to peak every 6 hours and last 12 hours, which meant am and pm injections. If you eat, you’ll have to worry about iob, however, otherwise, your only iob will be your basal or corrections, which might take a little while to dial in, but once you decide on the dose that causes the least issues, it’ll be easier than the pump… at least in my opinion. I used a Medtronic pump for about 5 years, and have been on MDI the past 15, the cgm helps, but the pump did not help me. I have problems keeping my cgm connected to Bluetooth continuously, I don’t have the meter or in pen Bluetooth, just seems like too much. Right now im stuck with humalog, so I use the Owen Mumford autopen 2-42, but I use my savvio more (had to purchase from Canada). Novolog echo for fiasp or novolog , but having the right pen and cgm will help along with knowing the right correction numbers and carb ratios. Any questions will usually have well researched answers here, so ask away.
I don’t use the InPen but have been using the Pendiq digital pen for over a decade. The Pendiq pen keeps track of everything on your pen which you can scroll through and you can download management software to have all the information you could ever use on your computer as well if you wish.
The upsides of the Pendiq pen over any other is that insulin can be delivered in 0.1 units rather than the InPen and others that deliver in 0.5 units. Pendiq, to my knowledge has been in the digital delivery pen business longer than any other company. I have been using Pendiq pens for over 10 years (1 for bolus and 1 for basal).
The downsides are that it is not FDA approved and therefore not available in the US although there is a pharmacy in Germany that deliver to me by courier and pen takes abut 3 weeks to arrive from order date. Since it is not FDA approved, I doubt your insurance will cover it. I just pay for these out of pocket.
I have been able to consistently achieve 100% Time in range for 30 days which my endo says would not be as close with a pump so I stay on MDI. MDI is also more friendly for International travel.
Any questions about this pen, just ask me. I am a consumer and have no financial interest in the company that makes or sells these pens.
http://shop16.pendiq-shop.com/Digital-insulin-pen-pendiq::1.html
Look at both links
Thanks! The last pump break that I took, a couple of years ago, I did try Tresiba, and if I memory serves, I had horrible side effects from it. Might be worth trying again…
I would recommend just not ‘stacking’ your insulin.
So, don’t deliver correction dosages more than once every 4 hours.
Don’t deliver meal insulin more than once every 2 hours.
That will achieve the same goal in a simple way.
Take a break. Talk to us about basal testing before pumping again.
Its most likely that your settings were set incorrectly by the Doc (which is always what happens - your Doc doesn’t want you to go low and will give very conservative settings). You will need to set your settings in the pump. Start with the basals.
While on manual injection, you can run some test on your bolus insulin at meals and correction insulin dosages, so you feel good about those, at least, when you start pumping. Try to figure out your ISF. This may take you a couple of weeks.
Thank you! So far my bg have been nothing short of horrible. I’m enjoying a break from my pump but am already feeling frustrated with bgs. I was at 20 basal units on pump and my doctor told me to inject 20 of Lantus…welp that’s not enough! My novolog shots seem to be like injecting water…uuugh. I really hate this. I do want to persevere and figure out mdi…I think…
Completely disagree, Levemir is useful because it can be adjusted every 12 hours to address changing basal needs, which is much closer to how a pump works. Dosing twice a day makes sense, if you’re able to dose once a day as a type 1 I’m envious and that’s awesome but it limits the ability to adjust as needed. I don’t understand how Tresiba benefits most type 1s honestly, except maybe people who have simpler basal needs for a variety of reasons. Otherwise, I think people take it expecting miracles, thinking that somehow a basal that lasts 24+ hours on a single dose will replicate what a pump can do, and when it can’t, blame MDI rather than trying different basal insulins and regimens.
Can you post the data? Its a good idea to figure this out on syringe insulin first. Thats because, if you make a mistake, the results wont be as catastrophic. Can you make an excel spread sheet like this one? Try not to get frustrated (I know that’s impossible). Focus on fixing this. Start with the basals.
I’m an almost 6 year Tandem pumper and I’m on a pump break. Nothing wrong with my pump except the usual frustrations over sites and occlusions. I just needed a change as I was spending a lot of time at the beach and in/around water.
This break was supposed to last 2 weeks but I’m kind of liking MDI and will stay here a while. Much to my surprise my reasonable control hasn’t changed. I’m using slightly less insulin than when pumping with a TDD of 40u (20 is basal and ~20 is coverage). I’m using Lantus for basal and giving it as two evenly split doses, 12 hours apart.
For software I went with Diabetes:M and once I got over the learning curve I’m very fond of the program. It calculates my dose and reports IOB. And the full reports are awesome. Below is a screenshot of the main screen. It has a smartwatch app that I’m not using. My Contour Next One data comes over almost instantaneously, without fail, via Bluetooth. For $2.99 a month it’s all I need and for those wanting to test it out most features, with ads, are in the free version. At some point I hope it allows Dexcom data to flow on Android like it does for iOS, but that’s not a deal breaker at this point.
Travel is so much easier - something I hadn’t really thought about when making the change. And I seldom inject insulin anywhere I would have put a pump site. I think I can hear my body thanking me.
Before going off-pump I looked into InPen and the reviews were very mixed with users finding the Bluetooth connection flaky. If I had to futz with a diabetic device I think I’d stay with the X2, honestly. If you go with the InPen I’d be interested in hearing about your experience.
I think most people realize they have the opportunity to have better control on the pump, however, pump vs MDI vs cgm …cgm always is the better option and the key to a better hba1c. I personally rarely changed my levemir doses, because I was always afraid I’d have to continue to bolus…plus I did feel some stacking twice a day on lantus and levemir… they are supposed to last 24 hours, but probably last closer to 12-18…at any rate, my endocrinologist recommended tresiba, and I think it works great…I’m sure its not for everyone, just like eversense, but for my high deductible insurance plan, a pump would cost me roughly $8000 annually, and I never liked pumps, mastisol, skin TAC,iV prep3000, 1 hour phone calls to the mail order pharmacies, etc…plus after 40 years of shots, if I can take 1 instead of 2, I’m OK with feeding the insulin if I really need to, but that’s just me.
I could never get my hba1c lower than 6 on a pump. I am using what could be called injection looping or open looping without the pump. I stopped using pumps permanently and went back to MDI. Long post short: I use xdrip+ with dexcom g5. It not only has iob it has predictive carb and predictive insulin graphs, not to mention far better algorithms for calculating cgm SG data. It is like looping but I must inject myself (with far better absorbtion). I highly highly recommend using xdrip+.
I agree with edward2 on using xdrip…I would also recommend different MP3s for predictive lows, low, high, etc. I was able to use xdrip with eversense, but it was difficult, time consuming, but well worth it…you can even set it up with insulin carb ratios and it will tell you his much you need, if any…I also hated carrying around lbs of extra pump supplies in case it stopped working on the 2nd or 3rd day…
Wow! That’s really amazing! great job on your spreadsheet! I’m impressed!
Everyone,
Thank you for all your replies! They are most helpful and make me feel like I’m not alone in this struggle. I increased my lantus and used a site that I wouldn’t normally be able to use as an infusion site and was eating smarties every 3 hours last night. Still woke up at 47 as a result missed my class at the gym…sigh. I’ll keep soldiering on as I’m still liking my pump break. Every day is a new struggle…er…adventure. As always, Thanks so much. Keep bringing on the advice…
What is xdrip? An app? I tried searching for it in the app store…hmmm…
Its an app I would imagine most people on this forum either love, or have an Apple phone, but you will need to download the apk then allow unauthorized apps to be downloaded, I have nightly test updates, but you can choose more stable options if you prefer… also maybe on a day off or after work, as it can be time consuming, but doesn’t have to be…there’s just a lot of options. It works with the Cgms, but each one is a little different, so you can ask for help here or github, you can search Google for xdrip apk and it should pop up…the algorithms for the Cgms are usually independent, but you can calibrate if you need to.
You can always split your Lantus into 2 separate dosages - one at night and one in the morning if that helps. Sounds possible that you need a little lower dose at night. Sometimes splitting into 2 dosages gets you by. You can see in my spreadsheet that I have 5 basals running, but I could get by with 3, or 2 if I had to.