Pump to MDI conversion tool help?

Type 1 and LADA
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Warning: Long post!

I have a request for any computer/tech savy folks here with spare time.
I might have created a useful tool for other insulin dependent people needing to go from pump to MDI. It would be cool to make it digital and writable! Or even a printable template, better than my hand drawn one.

Story is:
I’ve been using a T-slim pump and Dexcom CGM for a long time. Had T1 for 56 years now. Recently I developed a bad medical adhesive allergy, big itchy welts on all the stick-on things. I’ve tried lots of work arounds, anything I could find through research. No go. Tegaderm helps enough to wear a CGM.
Anyway, I decided maybe a “pump vacation” would let my system calm the heck down. Going back to MDI is what this post is about.

Plus, there’s a another simultaneous and ongoing issue about the fragility of the supply chain for for stuff we die without. A cluster bomb of bad sensors from both Dexcom and Libre made me look at the most generic insulins, etc. to help me feel sturdier, in case of a bigger Global Crisis. Paranoid, I guess. Hang in there, we’re getting to the point I promise!

My basal rates on the pump are super tough to duplicate with shots. 8 segments with a ten fold variance.

So, I made up a 24 hour diagram made of circles to try to figure it out. It’s helping me to figure it out so much, I wondered if it might help others in my predicament? I’m using Humalog and NPH by the way. Could sub in Regular for Humalog in a crisis though. Others could use whatever suits them. Here’s the current layout:

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The circle is 24 hours (12/12 am/pm format). The segments in the ring outside the hour numbers are my pump basal rates. Between the last two rings is my “in range” zone where I record what I do and what happens to my blood glucose as each day unfolds.

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For example, this is today’s graph, H is Humalog, NPH is, well, NPH. The bg #s are from my CGM. I write food or exercise or whatever around the outside in the correct time place.

What do my fellow T1s think? Is it just me who finds this format useful? My husband, not diabetic ,says he can read what’s going on with me well with this.

Thanks for reading and thinking about it. Any thought appreciated!

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I like the circle! Yours is the first I’ve seen and I can see how it helps figure out day to day patterns visually. I am useless for tech help though. My version of “tech” would be to print off hundreds of blank circles and punch three holes in them, start a three ring binder of daily circles.

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Thank you, John! My version is about like yours minus the tidy binder and rings lol. Papers in a messy stack. I’ve only been at it a few days so far. I’ll have to look in the shed for a three ring among my kids ancient school stuff.

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i highly recommend tresiba for your basal, and using xdrip or xdripios for your cgm program(works with dexcom or libre). xdrip has many watch options, predicted low warnings, unusual bg rising/dropping, highs, persistent highs, and you can customize each warning, or easily snooze them if you want to…having a nightscout account set up will also help track everything you are doing, as you can input your basal, boluses, meals, etc, and then see everything on a nightscout report…i apologize in advance if any of this is information you already knew about, however, these apps help me enormously…

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Thank you Roger. I didn’t know much about Tresiba insulin. Definitely I am interested. What I’m doing now is way too many shots for sustainability, emotionally, for me. So I’ll give Tresiba a study. I’m used to Humalog U100 in my T-slim x2 pump. For 20 years. Being off pump, I’m spending SO much time writing down every little thing I do, and when, and the effect, I barely have a life. Most insulins disappear in my system sooner than the literature suggests. NPH is gone in 4-7 hours after injection , for example. I’d need try Tresiba to see what it does. No peak sounds great!

Good to hear these apps help you so much. If they can help me track my basal insulin requirement changes, which happen constantly in my system, I’d appreciate it hugely! On the pump, I’d get my basal nailed for a few days, then Ha! No longer working.
Anyway, first of all I’d like to work out a way to use the non-prescription insulins available at Walmart and not die. To nourish my sense of self sufficiency in a supply chain crisis, I guess.

Then I’ll look at less demanding regimens; insulins that can make my life less diabetes related, more about doing things I care about. If that makes sense? Anyway, thanks again for your input!

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I switched from years and years on Omnipod to MDI about 6 weeks ago, due to the same problem. I’ve always had adhesive reactions, but also was REALLY reacting to the cannula as well. The dexcom sensor doesn’t bother me nearly as much so I am still using it. Anyhow, I second the recommendation to try Tresiba. It is vastly superior to any long acting I used years ago.

I also got an InPen, which comes with an app that does much of what your pump did: Bolus calculator, Insulin on Board, etc. You use it for your fast-acting only, but it does give you reminders for your long acting. I really like it! I’m enjoying being pump free for a while. Not sure when/if I will go back, TBH. The new insulins and the app make it far easier to get good control than when I was on MDI years ago.

Lows are different now…without the ability to shut your pump off for a little while, and with the long acting in the background, I have to use more carbs to get my blood sugar back up, but I am no longer afraid of carbs, so that doesn’t bother me.

Good luck!!

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Thank you so much for sharing your thoughts and experience with me. Relevant and useful! Sorry to hear about your cannula/omnipod allergy - though it sounds like you’ve gone right ahead and made lemonade out of lemons. Good job!

Looking at my former pump rates, the basal issue for me is the period around midnight when I need almost no insulin at all. I will ask for Tresiba at my coming doc appointment so I can try it. NPH leaves a lot to be desired, though it’s working ok for nights just now. The long onset of action fits pretty well through the low requirement hours.

I too looked at the Inpen. It looks great and I’ll be bugging my doc for one. Now I’m using a humapen Savvio (not smart) for fast acting and syringes for NPH.
What’s bugging me about all the shots is writing it all down, calculating insulin on board etc. - Hadn’t realized how much IOB and “history” in the pump mattered to my mental peace! I also notice the slower rise out of low bgs you mention. :face_with_diagonal_mouth:
At least I’m tolerating the Libre3 sensors if I put tegaderm under them. Hard to go back to hourly finger sticks again!
Again, thanks for your input.

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Re: the time of day where you need very little basal… similarly, I need less than half the basal overnight that I do during the day. We dose my tresiba for the overnight. During the day, I increased the amount I take at meals to cover the difference, and I will also take a bolus three hours after each meal. In your case, you might also need to eat a bedtime snack with protein/fat in it to carry you over. But there are ways to work around all that. Hopefully your endo will be agreeable.

The inpen also imports your CGM info, and it pulls together a nice report with EVERYTHING on it: your blood sugars for the day, the boluses you take, your long acting dose(s), the carbs you eat, etc. So no more writing stuff down. :slight_smile:

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The Mysugr app does all the calculations for you. You still need to plot the insulin you give, but it´s all in one place and does the work your pump used to do for you. There are other apps that does the same, but I find this one easy to use.

Thank you for making this a topic. It is or will be relevant to many of us.

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So, Sarah, I have a cousin with multiple autoimmune diseases, like me, as does her daughter. She told me about Mast Cell Activation Syndrome, MCAS, and it’s a thing.

I have/had a lot of these symptoms. Bruising, itching, overreaction to, well everything skin related. No respiratory stuff in my case. Anyway, she mentioned an OTC med that helps. It’s called Zyrtec, an antihistamine. And there’s a generic of it, also OTC, and for about 1/4 the price. I bought some and, in my case it’s making my life livable again. I can wear the pump again, so far only for basal so as not to overwhelm my site. And then I take boluses by pen. My skin looks bad still under the tegaderm when I change sites, but no itching. Tomorrow I see my doc. I’ll ask for a change to Novolog insulin and pens. I’ve always used Lilly insulins, Humalog, pretty much, but maybe I’m reacting to something in it? This will help me to know.

Grateful for your input Sarah!

Yeah, I’m kind of glad I tried the most basic insulins, NPH and R from Walmart, so I know I can sort of be ok if supply chains get unreliable anytime soon. But for control that allows me time for an actual life, the pump is essential. Sigh.

I will check out the mysugr app. Sounds good. Thanks for the help. I’m using paper and pencil now. Works, but :frowning: