The title says it all. I have been on a pump for 17 years now. Due to a declining pump (it is 12 years old) and the cost to keep pumping out of the question. I am going back to injections for a while.
My Doc wants to put me on Levamire (spell check on isle 2) and keep using Apidra as my fast acting. It has been so long since i used a long acting that I do not know of the options out there. The last one I used was Ultralente. I was the Ultralente/regular until I got the pump. Then went to Novolog, Humalog, Apidra.
I guess I am just looking for views on long acting insulin. I still have enough pump supplies to last me a few weeks maybe a month before going back to the injection routine.
I used both lantus and levemir - after using Lente for a couple of decades. I liked levemir better because it seemed to be a lot more even and although it required 2 injections a day, I didn't have dramatic lows which I did have with lantus. The biggest problem with MDI - and I used it for 38 years is once the basal is injected you can't turn it off or turn it down so for me it made exercising very difficult. I started an Omnipod pump a year ago May and would find it extremely difficult to go back to MDI.
The only reason I am going back is financially I can not afford a new pump at this time. And because mine is a dinosaur of a pump, they can’t fix it. So I will use the money I save from not pumping to help purchase a new one. I have been having to change sites almost daily. Tech support seems to think it is due to a malfunctioning motor.
Is there any way to get some kind of payment plan with your pump supplier ? If you have had the same pump for 12 years then you're obviously happy with the device, maybe if you talked to them they could make it easier to afford ? Or at least allow you to stretch your payments over time.
I've used both Levemir and Lantus for long acting. I have to agree with Clare, two Levemir injections (one morning/one evening) give me the best basal control. It is my favorite insulin ever. :-)
Yeah, I just bought a house and am still trying to catch up to be able to spend money again. Work is slow ATM and so I am not making as much as I normally do. So I will give my body a rest from the pump. I am kinda burned out on it too.
Well, I only used the pump for a short time, but I feel like the biggest thing will be make sure you're aware that the basal on your pump might be lower or higher than what you'd inject with Levemir or Lantus. I use lantus , personally, so I can't give advice on levemir other than this. It also takes a few days for the dose changes to take effect (around 2-4) so adjusting is kind of tedious. I used 4.2 units of novolog as basal on my pump but I use 11 units of lantus, just to throw that out there. WIth levemir it might be a weird thing too because the split dose. From what I understand you can do levemir in one shot but it's not usually as effective that way.
You may need to do basal testing to determine your dose.
Also be aware that your morning and evening doses will not necessarily be the same. ie. I take 12 - 14 units in the evening (more if I ate dinner, less if I didn't), and only 4 in the morning.
Every pumper should have all the knowledge at hand to go back to shots. This is useful for vacations, pump malfunctions and for the experience itself. Over time it allows to reflect whether or not the advantages of pumping are still valid. There are diabetics with specific challenges that can not switch back to MDI. For the others the situation is more in between: MDI and Pump both have their pros and cons. The costs are definitely an argument since pumping is in general twice as costly as MDI.
My recommendations:
1. make the switch and look how it works out for you. You can go back any time.
2. use Levemir as a background insulin and use two shots per day (every 12 hours). Start with an even distribution and test in the middle of the night (3 am) to check for lows. If you tend to go low you should reduce the night shot. One advantage of Levemir is its binding to the hemoglobin of the blood cells. It makes no difference to inject the Levemir by accident into the muscle tissue. In contrast for Lantus this is a problem since it only binds to fatty tissue. Thus it might directly enter the blood stream to unfold its action.
3. get half unit pens like the NovoPen Echo. You are used to calculate the dosages with more precision. Half units are a good compromise. The Levemir vial will fit but for the Apidra vial I am not sure.
4. your pump offers you some very nice features (depending on its age). It has a bolus wizard to calculate the dosage. It can estimate how many units of insulin are still active (IOB = Insulin on Board). It acts as a digital log for reference. ALL this can be achieved with MDI too! Our Glucosurfer project offers all that with its Apps. Just create an account, install and configure the free app and you can test it. Make sure you configure your account correctly since all calculations are based on these settings. There you can also set to use 1/2 units for calculations. The App can be switched to OFFLINE mode thus you do not need an expensive volume contract. If you are back at home you can sync via WLAN with the Glucosurfer server.
5. you can share your log with us via a link. This way we can follow your progress and give you some feedback.
I don't think levemir pen fills are available in the US, Holger. I could be wrong on that, but I think someone on here said they're not available here.
This may sound weird, but I use 1/2 marking BD syringes to extract insulin from both my Apidra and my Levemir pens rather than using pen needles. You have to carry around the syringes with the pens, a bit of a nuisance, but you get more accuracy in the long run.
Yeah, i was on injections for 8 years before i got the pump. I plan on going back once I can afford to, in the mean time, I plan to use my brain versus the mechanical mathematician on my hip.
Even on my pump, I vary rarely used anything other than a full unit. With the speed of my metabolism and my activity level, i can usually burn off anything that a .01-.09 injection would correct.
If this is true the decision of Novo Nordisk would be hard to understand - at first. The disposable pens are of bad quality. They create unnecessary waste. They have no 1/2 units. To make it even more weird the disposable pen acually contains the same vial. What is it then? Pure profit because they can claim more for disposable pens? What ever - I would buy one NovoPen Echo and cut the disposable pens open to get the vials I need.
I'm going through the same situation right now. My Animas Ping broke and was out of warranty. I got a quote from Tandem for the t:slim and it's going to be an out of pocket expense of about 1800 bucks for me. They said they could spread it out over twelve months with no interest, but I just don't think I can do that right now. I use Novolog and just started on the Levemir pen. I guess it's alright. I miss the tight control I had on the pump, but I'm hoping I can get better as I get used to MDI again. Good luck!
