Hope you all don’t mind the discussion but this whole thing is scary. I thought I had decided on Levemir, Novolog pens and a nice (?) vacation. Most people have done ok off the pump, from the replies I get or blog posts I see. I am very insulin sensitive these days. I’m getting a 200 point drop over night from one tenth of a unit before bed (if I bolus for a snack or high). My Bg in the morning drops from 9 to noon. I’m at a 12 unit basal now, and wondering if this is even going to go well on MDI. The same low basal is causing occlusions to not be detected, thus too many hours with high BG not knowing sites have failed. The new FlowSmart sets from Medtronic are not ready to be offered to the public yet, so there went that idea. It’s sort of a scary place to be in, and I have to say my family doesn’t get it, they just want me to go off the pump. Which I still question…confused.
@Laura_S, this seeems exceedingly high, impossibly high to me: 1 unit of insulin would swing you 2,000 mg/dl? Are you sure this is not an issue of basal adjustment at night?
I don’t mean that I am doubting your words, of course. I am wondering if it is not more likely that the drop you describe would be due to other factors than the 1/10th unit of insulin you might have injected.
At night I get 150 to 200 point drops from one unit. Was heading to bed last night and was 270, so I took .15 and woke up at 60 three hours later. We just put my bedtime basal to .475, and today I changed it to 0.425 to see if that helps. Frustrating. I pretty much get 1;150 all day long.
Hi @Laura_S, it is possible that you still had some IOB when you went ot bed, and that some of that IOB was invovled in the drop? My son typically eats about 3.5 hours before going to bed, and he may drop up to 40-50 mg/dl in the first 2 hours of the night due to IOB (Insulin on board). His DIA (duration of imnsulin action) is a little over 5 hours, so he can keep dropping for a bit more than 5 hours after a meal.
I am mentioning this because, early on, we had thought his DIA was only about 3 hours (in fact, one endo had told us it would not be over 3.5 hours…).
So for it to go to 150-200 for night would not be absurd. Other things that impact my kid a lot are stress, lack of sleep, exercise and sickness, as possible sources of variation from day to day.
If you are that sensitive to insulin, it seems that going back to MDIs could be hard. My kid’s insulin sensitivity varies between 1:30 and 1:70 and I find it hard when it goes up (he is on MDI).
For sure.
Hey Endo, how much insulin have you injected?!?!
I don’t know how an Endo could say that. It really depends. I mean, you could give a best guess for someone, but really the only way to find the actual DIA is through a lot of time injecting and looking at results! I think DIA is one of the hardest things to accurately figure out.
What they should say is “probably would not be over 3.5 hours”, or “generally it is not over 3.5 hours”. When medical professionals make these blanket statements it is maddening. Sorry, side-rant.
Happened last night again. Bolused at 10, ate a snack around 1 am. I am a late late night person. Didn’t bolus past 10 and lowered my overnight last night to that 0.425. Woke up at 60. I don’t get up too early, so this was around 8:30 am. Got up for my dogs at 6:30 and was not low at that time, but by 8:30 I sure was. Menopause? Stress? Whatever. Been really experiencing rapid drops from highs and now I do not know if Lantus will help or would make it worse.
I moved mine to four hours…
It sounds to me like your basal is too high. This may be making it seem as if a bolus is lowering your blood sugar more than it is. If you went low more than 8 1/2 hours after a bolus, that’s not likely to be from that bolus insulin. Do you take advantage of the pump’s different basal rates throughout the day? This is one of the main advantage of a pump over an insulin like Lantus.
It really puzzled me, because it was in the context of my quoting research stating that kids seem to have similar DIA as adults. In fact, it seems from literature that, generally, DIA is not often below 4.5 hours, except if you only consider the fast-moving part of the curve.
Yep. We were using.60 as the highest at dinnertime, and .5 most of the day. Now went from .475 to .425. Maybe the .6 needs to go next. I only weigh 105 and am a very light eater, so it makes sense to not need too much. Which is all another reason I can’t get occlusion warnings, because the pump isnt getting enough basal to recognize early occlusions. I think the MDI wont work well, and my hubby is thinking Lantus/Levemir is smoother than pumping. Of course, you cant shut off a shot of Lantus/Levemir…
Hi Laura_S,
I think maybe I missed some stuff from your original post. Why are you going off the pump? Why does your family want you off?
It seems from your original post that maybe you are having occlusion problems.
Have you ever been on MDI before? If not, I have some suggestions that perhaps might help you. Especially if you are extremely insulin sensitive.
Diabetic 46 years, pumping for 16 solid years. Because my daily dose is about 16, the pump (scientifically speaking) doesn’t detect occlusions early. I believe I read somewhere it can be 19 hours or so. So highs may show up and it isnt going to sound the occlusion alarm. I used Ultra Lente and NPH in the years prior to 2000, when I was on pens. Now I am getting this dreadful drop of 150 to 200 points per unit, almost without fail unless, the high is from the occlusion. Then the drop in BG is very slow.
I don’t know if Lantus or Levemir works in this sort of situation. Hubby just thought I should go for it.
I’ve never had a diabetes emergency or hospital visit in 46 years, so I don’t want to start now! And I don’t feel lows or highs anymore. Open to tips or thoughts on this…
Am using Silhouettes, with no luck with metal sets or Quick sets. Medtronic not sure when the new sets will officially be available to us. I’m not into CGM or necessarily able to afford it, but I did just get better pump supply and pen benefits. I think it confuses and frustrates my hubby and for sure my elderly Mom who is used to daughters on NPH and Lente!
@Laura_S, we are not experienced compared to most on this forum, so others’ suggestions will be more valuable I think. I do have three thoughts that may or may not be useful:
- Tresiba is a new, long-acting insulin that lasts longer than Lantus and seems smoother. If it is on your formulary, since smoothness is important to you, it may be worth looking into rather than Lantus/Levemir?
- To deal with occlusion issues, you may consider going “untethered with pump”, i.e. with [art of your basal taken care of with long acting insulin (Tresiba, lantus or whatever) and part of it done through your pump? This way, even with an occlusion you would not be totally out of insulin?
- since you don’t feel lows or highs, a CGM would make a big difference I think - although I understand that this may not be possible for you. I am not sure if you are on Medicare - last week the news were that Medicare will now accept CGMs on a case-by-case basis. I am guessing that not recognizing lows would probably qualify.
My son is 12 and is T1D. The CGM has changed our life.
Are you having frequent occlusions?
The time it takes for most pumps to detect an occlusion is based not so much on time, but how much insulin it has tried to deliver but was unsuccessful with. So if you are taking a very low amount, it can be 19 hours. But if someone was taking much more, that same occlusion would be detected much sooner. Does that makes sense?
First, let me ask - are you sure you are having high BGs because of occlusions? And are the occlusions frequent? If so, than I think a switch to basal insulin(s) would absolutely help you! And there are ways to enable lower micro-dosing with syringes or pens that would help you a lot, I think.
Yep lots of occlusion or some reason for no delivery (my basals dont go much over 0.50). Like I said, those highs go down very slowly. Over-eating highs drop in super fast time, that 150 to 200 point drop in one hour on one unit. Hubby thinks I might really do better without the pump. I’m curious. And I just changed HMO’s so it is a good time to try the pens, since they have no record of a pump or anything on file.
I did research the Toujeo (I dont see Tresiba on the plan). Not quite sure about that. I have discussed the untethered approach with a former doctor, but not this one.
And the CGM is a little daunting to me, since my skin is feeling worn out lately…lol…Very good suggestions tho!
I think basal insulins are great. I actually think they can be more stable and predictable than pumps (depending on the person). I also think they are less dependent on the site, and the insulin “unwinds” in a much more predictable rate.
I did MDI for over 44 years. There is nothing to be worried about there. I mostly used BD brand of syringes (only started pens a little bit later in my MDI career). In 44 years, I never once had to call BD and report an occlusion or a syringe malfunction. They were so dependable, reliable, and consistent!
The tricky part is that dosing from a pen or syringe, by design, doesn’t give you the small dosing ability. BUT…you actually can micro-dose with pens or syringes. I set my stuff up to be able to give 0.10 units with a pen or syringe. That was such a huge breakthrough for me.
If you need small dosing, I can give you info on how to do that.
I’m seeing my CDE at the end of the month to get my prescriptions. They are having to secure some prior authorizations so I have to wait to see if I get what I want (askef ro half unit Novolog pens and Levemir pens). I’ll post back here after that to update on how they set me up. I appreciate the info, it all makes a lot of sense to me! 
From what you posted, it seems a 1/2 unit would be a lot. For me, there were times when a 1/2 unit was WAY too much. That’s why I started doing micro-dosing. I initially did 1/2 from the syringes, then I went down to a 1/4 unit, and finally got to where I was doing 1/10 unit injections (from syringe and from pen). That gave me so much flexibility to do corrections without fear of going too low.
If your CDE doesn’t know how to do that, post or send me a message and I can help you out with setting that up.
ok thanks. I really only use less than half after dinner, and that is even causing lows. So I dont think the half units during the day will bother me, but overnight is tricky. Hopefully all my supply requests will go through. Hate waiting, but no appointment until month end. Appreciate all the replies from everyone.