Either my pump is malfunctioning or I’m having some sort of really bizarre scar tissue issues, but either way I’m going to have to go back to MDI until this matter is cleared up. I haven’t been on Lantus since 3 or 4 years ago and even then my dosage was horribly inaccurate because I was a) a horrible diabetic, and b) injecting into scar tissue (so most of the shot was not being absorbed properly).
My endo can’t see me until the end of October and my GP is the first to admit that he doesn’t know enough about diabetes to comfortably adjust/create a dosage regiment for me. He is willing to give me an Rx for Lantus until either Medtronics is willing to admit fault and look at my pump or until the endo sees me, BUT he only feels comfortable doing so if I know myself how to calculate a Lantus dosage . . . I told him that I do, but obviously since I’m here asking this question I don’t.
So any help would be appreciated. This is was I can tell you about my diabetes history:
8 grams of carbs equals an increase of 50 mgdl.
1 unit Humalog equals 50 mgdl/8 grams carbs
My basal on pump is as follows:
12:00 am - 5:00 am 1 unit
5:00 am - 9:00 am 0.85 units
9:00 am - 5:30 pm 1.05 units
5:30 pm - 12:00 am 0.90 units
I have a very severe dawn phenomenon at some point between 5:00 am and 9:00 am so I have my pump set to keep my BG at 170 during those hours so I don’t dip below 70 before waking up.
I used to take 30 units of Lantus in one dosage (but I don’t know how relevant that is because I also took 30 units of humalog with every meal, I never counted carbs or watched what I ate, and I hardly ever tested). I had an A1C of 10.8 pre pump (if memory serves me properly) and I have an A1C of 6.6 now that I’m on the pump.
Any thoughts, advice, ideas would be greatly appreciated because I am currently out of options.
Generally when someone goes from Lantus to pump they end up taking less basal insulin. So to be safe, I would start with the exact same amount (the total of your hourlies) which by my calculation is about 22 units. (Check my math, I didn’t bother with the 1/2 hours). Then if you are high, which is likely, you can start adding a unit.
Usually they knock off 20-25% of your Lantus/Levemir dose. When I went back to MDI in March, I added 25% to my pump basal to get my Levemir amounts and that worked out really good. Are you going to do 1 shot of Lantus or 2? If I totaled it right, you are doing 24 units of basal per day. If you add 20% to that, that works out to an additional 4.8 units. If you are going to try just one shot of Lantus, then probably do about 28 units. If you want to do 2 shots (some people feel it works better split), I can give you 2 different numbers based on your basal rates for that part of the day if you tell me the 2 times that you want to use.
I think most people find that they require lower basal doses on the pump, but it is probably reasonable to start by erring on the safe side rather than risking full days of chasing lows. So take your 22 units and start with that as Zoe has suggested. Then check your blood sugar before meals and then correct if needed. If you are consistently high before meals and correct, then you can increase your basal, but only do so after observing what happens over 2-3 days. Lantus can take 2-3 days to reach full effectiveness, so don’t make fast changes. Set your Lantus dose and then see what happens over 2-3 days and correct during that time if needed. Then see if on average you are too high or two low. And adjust your Lantus up or down by 10%.
Since you presumably will only be at this for a month, you don’t need things perfect, just close, but safe.
I guess I’m slow, I’m having a hard time figuring out what your question is. Why are you going away from the pump? Why Lantus vs NPH (or anything else?)
I’ve got to admit, after nearly 20 years on a pump I can’t imagine how I’d figure out MDI again.
If you think that scar tissue is causing you problems, what other sites have you used?
Butt, abs (lower and upper), thighs (all around), upper arms… all gone to you?
What about a different infusion set with a different angle?
If you went from an A1C of 10+ to one of 6, why on earth would you ever go back?
You are using Humalog in your pump? Humalog, novolag or apidra? why not try to change that, first? going from Humalog to novlaog (or the other way) won’t change much, except maybe absorption. Apidra is a little faster acting, but with care you can switch to it as well. I’ve recently switched to Novalog, it’s supposed to be ‘cleaner’.
These are all things I’d try before abandoning the pump!
Many of your numbers sound really close to mine, and I used to take 15 Lente in the evening and 15 in the morning, but I don’t think that info is worth much of anything to you.
TS, I should have been a bit more clear perhaps; I was looking for a way to calculate a Lantus dosage since I will be restarting it as of tomorrow (possibly). I have no plans to go off pump permanently, I just need to figure out what the heck is going wrong right now and since it’s all pump related and I can’t see the endo for another month . . .
Basically what is happening is that I’m really tired of “nightmare days” (that’s what we call the days I have to change infusion sets in my house) because it’s a 24 hour marathon of disasters that include unstoppable highs (500+) erratic “no-delivery” alarms and the fact that I go through an entire box of infusion sets (a box of 10) every time I have to change one.
As of last night my pump has started giving me no delivery alarms even though it seems to be delivering insulin just fine, although a few hours later it will stop delivering again and so on. Scar tissue is really big problem for me. Arms, legs, and butt are completely closed off from all the years of MDI. My arms especially feel like I have rock solid muscles that really are scar tissue. My stomach is closed off now too after only a few years of pumping, and my lower back is almost finished after only two weeks of pumping there. As for changing types of insulin that’s something I am planning on discussing with my endo. Changing infusion sets is a possibility, but again I’d rather talk to the endo about it first and know for sure that it’s not a pump malfunction before making any such changes. All I know right now is that a syringe is not going to scream “no delivery” to me at some random time of the day or night, and that’s what I really need until the “experts” can help me figure this out.
Well, I think you have been given a reasonable starting point with the Lantus, but you have a bigger issue.
I am really confused when you say your arms, legs and butt are all scarred and can’t be used. And now you say that your stomach and back are gone. That just seems way out of proportion for only 15 years. And you don’t scar your back in only two weeks. Scarring builds up over time through the repeated trauma. It doesn’t happen in two weeks.
It really sounds like something else is going on. Maybe your body has developed an allergy to the insertion sets or something.
Some people do build up scar tissue really fast - that is a problem for me. That was a big problem with pumping for me and I only pumped for 8 months. I already had scar tissue from MDI and made a lot more in areas I never used with MDI. I have a friend like that also.