Actually if you are using very small amounts of Lantus, you’d really need to do it 2x a day for decent 24 hour coverage. I think you’d be much better off in either strategy with Tresiba–doesn’t use a pH difference to work, so might work to mix, and also has a much longer duration, so even at a very small dose should still provide fairly even 24 hour coverage if you inject.
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Just out of curiosity. Since a pump is pretty much delivering insulin constantly, is it not the ultimate continuous “stacking” machine? How can it be OK for a pump to deliver insulin continuously but a dire sin to MDI every hour or so? I view my CGM as my “stacking” monitor to frequently tweak my doses to near perfection.
Yes, this from @CJ114. I emphasize the M in MDI, so with a CGM, it gives me great control. No sin there, all virtue!
Also a shoutout to the wise @cardamom who succinctly described the main, large reason I dislike Lantus - I once hit a blood vessel which resulted in the equivalent of a really big and unwanted bolus. Didn’t know it of course until a bit later dealing with a massive hypo event. This got me to switch to Levemir for basal, and I’ve since moved on to Tresiba.
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Yes since the lantus I was injecting was so small, I didn’t worry about stacking. If you run it for 24 hours the old will be used up and the new will be delivered.
Because exactly what you said, pumps are designed to stack, so the point is the doses are calculated with that in mind, distributing the insulin accordingly. There’s nothing inherently wrong with stacking in MDI except that most people aren’t doing all the math and factoring in of durations to stack accurately, and that’s when it can easily get dangerous and unintended hypos happen. If you can keep in mind how much insulin from your prior injection(s) should still be active and dose accordingly, stack away.
No problem, my digital pen, which I have been on for the past 10+ years, holds my last 200 injections for instant replay giving Date/Time/units to the nearest 1/10 of a unit taken. I keep BG’s high enough to maintain my A1C at 5.6 rather than in the 4’s range to avoid unintended hypos. That allows me a very varied diet. To be down in the 4’s range and avoid unintended hypos, I can only do that when on a low-carb high-fat diet. Dexcom would need to allow me a greater tolerance on where to set alarms to do better on a varied diet.
Yeah the no stacking guideline is definitely not aimed at someone like you, but rather the more typical patient on insulin, who is not at all like that either in level of control or tracking.
Stacking is a weird thing. Because I think it’s meant as a warning to not double or triple dose for a high blood sugar.
There are times when I have a bad pump site that just isn’t absorbing and I’ll stack bolus after bolus and it has no effect.
I guess taht doesn’t really happen with injections