You wouldn’t think after only two and half years on a pump that this would be such a big deal, but… I just got the infamous, infernal “Button Error” on my Medtronic. This being Sunday, they can’t get a new one to me until Tuesday at 10:30 a.m. So here it is dinner time Sunday evening and suddenly I’m back to Lantus/Novolog MDI for a day and a half. I have the stuff in the fridge for emergencies so I’m ok there but… I’m actually kind of clueless how to handle it. Anyone else been in this situation? Did you have a formula for how much Lantus to take? I used to always take it in the morning but with my pump being kaput I obviously can’t do that. Last time I used it I think I was taking 48 units/day. I guess start with that, then see how it goes, do another dose roughly this time tomorrow…?
Any experience-based advice welcome. Hey, this Type 1 thing can be complicated, who knew.
how much basal was your pump providing over 24 hours? That’s where I’d start just for the sake of keeping it simple. What a great opportunity to try a tresiba trial if you can get your hands on some…
I would take less than 48, the upshot being that the there IS a difference between Lantus basal and Novolog in the pump. I would take about 35. It’s better to be a little high than basally low–especially for such a short time. You can make up any slack short-term with Novolog. Come to think of it, that’s what you’re doing with the PUMP, so there is that.
A few times I’ve been without my pump for a few days I didn’t bother with Lantus. I took six shots a day, four hours apart, of my short acting insulin (8 am, 12 noon, 4pm, 8pm, 12 midnight, and 4 am). My shot would include basal for those four hours, insulin for carbs, and corrections. It seems to work well for me and when my pump came it I could go right back on it, without having to account for Lantus lingering in my system. Yes, I had to get up once in the middle of the night but it was only for a day or two. That way I wasn’t throwing out an unused bottle of Lantus every year. I’m kind cheap that way.
Complications complications. So ok, I thought I’d refilled that backup Lantus pen prescription but it turns out not. The ones I have are kinda, um, out of date. Still, they always exaggerate about that expiration stuff, right? Because the pharmacy is closed so… Guess I’ll use what I have and just keep a weather eye on the old BG. Good news is that I have a CGM–that still works–and I’m a light sleeper. Guess it’s going to be one of those nervous nights.
That’s the standard recommended proportion but I eat low carb and my basal TDD has always been much higher than my bolus, even when I was on MDI–like 70-80%. And Lantus isn’t equivalent to Novolog as @Timbeak48 points out, so it’s not a simple conversion. Not to mention my back-up Lantus is of dubious potency (I really thought I’d filled that prescription back at the start of the year) so if anything I feel like I need to err on the high side.
I’ve read many comments here about people who find out they use less insulin on the pump than they do on MDI. Since this will be a one-off solution anyway, I say watch your CGM and respond accordingly. Maybe do a few extra fingersticks just for confirmation.
I’ll be interested to read what works when it’s all said and done. I’m thinking it’ll be more art than science. Did Lantus usually last you a full 24-hours? How’s your seat-of-the-pants IOB calculator?
When I was doing MDI my regimen was one shot a day but after reading peoples’ experiences here I think I would have tried splitting the dose if I hadn’t switched to a pump because it was definitely crapping out on me before 24 hours. Complication tonight is that I don’t particularly trust my Lantus (ok, yes, another instance that I am a Bad DIabetic: I didn’t get my prescription refilled this year. The evidence is overwhelming and I plead guilty). I’m already seeing the BG drifting upward more than it usually would at this time, so I’m expecting it’s not going to be a great number in the a.m. If it’s really out of whack overnight my CGM should wake me up. I’m a light sleeper anyway, and especially when I’m keyed up about something like this.
Did you take your dose of Lantus within two hours of stopping the pump? If the Lantus was refrigerated the whole time and you’re confident it was not frozen, I wouldn’t lose faith in it. Keep your eye on the CGM and don’t hesitate to add Novolog when in doubt.
So… 130 when I checked at 2am, 176 when I got up. Lantus was never able to deal with dawn phenom very well for me but that’s higher than I used to see. Considering I had taken a couple of Novolog adjustments last night my confidence in the quality of my out-of-date Lantus is not running real high. I expect the numbers through the day today will make that pretty clear one way or t’other. Since I seem to be on a 6pm-6pm schedule with the stuff I can hopefully get my prescription filled today and have more confidence the next dose is doing its job, and then I should be back pumping again.
Sitting here trying to figure out how to calculate my correction and coffee bolus manually instead of just plugging in the numbers–how do I do that again? Funny how this was so normal to me for ten years that I hardly thought about it–not to mention 20 years of R/NPH before that, how did I even DO that? --and now I feel all knocked off balance because this one piece of advanced technology crapped out. My wife says, “Just deal with it you’ll be fine” Which is true of course, but it’s funny how this stuff gets absorbed into your daily routine and even your body-awareness to the point where you more or less take it for granted, like any other organ you rely on, and when it fails it’s disorienting. Like it’s suddenly not asphalt under your feet but one of those rickety-rope-bridge-over-a-chasm things from an Indiana Jones movie and one of the planks just made a disturbing cracking sound. But it WILL be fine of course. It’s just kind of a pain-in-the-a**.
I’m a little late to the game, but I am currently on a short pump break after 2 bad site failures in a row. When I started on my pump my basal insulin was decreased by 25% as a starting point. So, when I went back to Lantus, I increased by 25% to start. I split my dose and ended up having to add one more unit to each injection, I take 11 at night and 11 in the morning. I also have a very pronounced and perfect 6hr Lantus spike, so I take my injections 6 hours before DP and 6 hours before lunch. (Though I don’t always have DP, so i have had some lows in the early mornings).
