This topic is an answer to a question that @Kimball1 asked me under another thread. Since this isn’t really relevant to the Dex G5 and iPhones, I thought I would start a new topic.
I currently use a daily injection of Lantus along with an insulin pump. This regimen is called the Untethered Regimen and I have written about it extensively on my blog. The latest post gives links to my previous posts and also to 2004 article by Dr. Steve Edelman who as far as I know is credited with “inventing” it or at least giving it a name.
For me some of the advantages of this plan are:
Smoother basal action
Better pre-breakfast blood sugars
Fewer highs from changing infusion sets
Less risk of DKA
Ability to have pump-free time
Has anyone else ever tried this and how has it worked for you?
Hi, @Laddie. I am facing a variation of the problem you cite:
I have been struggling with overnight BG numbers for months, most noticeably spikes in the middle of the night followed by early morning lows. I have tried multiple changes in basal rates with little success. Similarly reducing evening snacks, changing my dinner menu, and giving up alcohol didn’t reliably fix the problem. My guess is that I have been dealing with a hormonal “dawn phenomenon,” but the pattern has not been reliable enough to make huge and somewhat scary increases to my overnight insulin.
I’ve been on an MDI basal/bolus routine using Tresiba and Apridra pens for the last three months. Things have gone reasonably well and the BG performance persuaded me to adopt it as “permanent.” But diabetes has a way of changing. I’ve gained enough weight to make my pants feel tight and for the last week I’ve had overnight highs often starting around 2:00 a.m., going to 180+ mg/dl and not returning to in-range until I wake up and correct. I’ve even done corrections during the night (Afrezza, IM, and sub-q syringe) and the BG hardly budges.
Two days ago, I reconnected to my pump to see if the pronounced dawn-phenomena basal profile could do its magic. It had a good effect the first night, the second night, not so much. I’ve chased this scenario down a few times before. It involves bumping up basal rates from 11:00 p.m. through 8:00 a.m. until I start to get overnight hypos. Then I back off in steps, often returning to my starting basal profile.
What I’m wondering is if some combination of the pump and Tresiba might give me better results. Perhaps I’ll start at 50/50 Tresiba/pump basal with the pump dawn phenomena basal profile intact but at a lower level. What do you think?
When I did a Lantus experiment in late 2014, the endo suggested that when the new super-long acting insulins (Tresiba, Toujeo, etc) were released, they might be a great choice for the untethered regimen. Although I am fine taking Lantus once a day, two injections of it were “too much” for me. Too many alarms (after pumping for so long, I still can’t reliably remember the injection without a reminder). I find that the Lantus is definitely slowing down after 18 hours and I have the basal rate on my pump increased to reflect that. A better choice might be Tresiba that wouldn’t run of steam.
A 50-50 split of pump basal and Tresiba is a great place to start. For sure it is just another experiment in trying to control your BG as well as you can. If you do it, please report on how it works for you.
In general I feel that every time I try something new, it is great at first. Then eventually things settle back to status quo. Most of that is probably mental and settling back into old patterns. But I also wonder if your body initially reacts to new insulins differently than the previous insulin being used.
Curious, @Laddie, whether you worked with your endo to start the untethered regimen or just implemented it yourself? I’ve spent the last three days high almost non-stop and I truly believe it’s at least in part due to absorption issues. I’ve been advised to steer clear of my stomach due to lipodystrophy (and I suppose possible scar tissue, though my stomach seems to absorb the best), and so I’ve moved to my legs. But my legs, for some reason, have never been a good site for infusion sets even though I avoid the area and so it’s not an issue of scar tissue; the sites just always hurt, bleed, or extremely irritated, and don’t absorb well, and this is exactly what’s happened to me now despite changing sites every day. I just switched to another area away from my legs and we’ll see if that works better (if it does it’ll mean I’ll crash, because I’ve jacked all my pump settings up for the past two days). I’m getting extremely frustrated with sites as I feel like they’re a big contribution to these days where I run high non-stop and just can’t get in range.
So I’m considering using the untethered regimen, but my endo appointment isn’t until the end of August. He doesn’t really care what I do, but I just wonder whether it would seem odd to him for me to start on my own, especially since he may or may not have actually heard of this approach. I do have Lantus here, so that would be no barrier, but I’ll need to tell him eventually because I’ll need a renewal of the prescription.
I’m thinking even taking 25% of my basal as Lantus would help take the edge off these highs with the sites that seem to partially absorb but don’t work very well.
I started the untethered regimen myself. My first use of it was for beach vacations where I injected 75% of my basal and could basically leave the pump in the hotel room for hours at a time. These days I am still at approximately 50% of my basal with Lantus. Initially my endo was very supportive of me doing this. At my last appointment she seemed to think I was crazy adding complexity to my D-regimen, but left it up to me. I am still seeing a lot of benefit from Lantus. I don’t get spikes after changing infusion sets. Also my BG doesn’t go up the second an get out of bed. My overnights have been a little rocky recently but that is mostly due to too much snacking in the evening.
