My 11 year old son was so excited to be getting his Omnipod (first pump). We completed all the necessary paperwork and basic training, got the pump and supplies, got ready for the final training with his new pump only to find out the day before that he no longer qualified for this pump due to him not requiring any basal insulin (his need for Lantus had ended since starting the pump application process and this bit of information slipped through the cracks). He was devastated (he REALLY wanted that pump!) but the good news is that he's just started Lantus again (per his endo) but just 2 Units.
Can someone confirm how this works so that I can understand better when he might be able to start pumping. If he stabilizes at needing 2 Units of Lantus overnight, I think this means that you divide 2 units by 24 hours giving you a basal rate of 0.08333. So would we round down to 0.05 as I would not want to risk going too low at night by rounding up. Just curious. As soon as he has been stable for a few weeks, he can likely switch over to the pump.
Sounds like you've done the math right. Also, keep in mind as he ages his need for insulin will go up. Probably you'll noticed the first big jump around the "teenage" transition. That's when the body will need to process food more efficiently, therefore requiring more insulin. About the time hair and muscle start to really grow.
As a follow-up question to those using the lowest basal rate (0.05/hr) - is it more challenging when you need such a small amount of basal insulin or does it not really make any difference?
I've just started on the Omnipod (am in the UK) and the basal rate was worked out by adding the total daily insulin requirements (short and long acting together), then deducting 30% and then dividing by 24. The deduction of 30% is needed as pumping works in a slightly different way to MDI. You really need your health care professional's advice. Good luck! Pam
Even though your math is almost correct, you forget that the min is .05 PER HOUR, not per day. I seriously do not believe that you will quite yet be able to use the pump. Definitely you will have to to talk with your Endo on that one though.
You've now confused me on the basal rate - surely 0.05 units per hour would equal 1.2 units/day (and he's currently taking 2 units per day)??
We are working closely with his endo but they went so quickly through everything that I didn't understand the basal rate calculation. We are probably looking at 2-3 months before he can switch over to the pump - I am just trying to understand things better :-)
You are correct; given the limitations of the Omnipod the choices are 1.2, 2.4, 3.6 etc IU/day. That's not really any different to Lantus by injection since Lantus is not available in a concentration less than 100IU/ml and it is *really* difficult to inject an exact number of units. Lantus by injection is actually far less accurate than the Omnipod.
Anyway, Lantus only lasts around 18 hours; I ended up injecting twice per day to try to deal with this. The Omnipod is reliable and, in the worst case, the basal can be suspended; try sucking out Lantus once it has been injected!
You can also change the basal rate over the 24 hour period. I need a boost in basal in the morning (just before I wake up) otherwise my blood sugar goes high. I haven't tried it but it's probably also possible to cancel the basal for some hours a day; perhaps appropriate if exercise levels can't be predicted.
In theory maybe they could program in multiple basal rates throughout the day to get something like 1.5 or 2 units if needed. It's not going to be as good, but might be close. Also, insulin needs should be a little lower on the pump. With my switch from Levemir (MDI) to pump apidra for basal, my needs went way down, but I read somewhere that Levemir is about 20% less effective than other insulins.
Seems to me that the insulin syringes are designed for higher dosing of insulin, and accurately injecting exactly 2 units would be a PIA. Maybe the ins. company would buy that argument.
My basal went down as well - from around 20IU Lantus (10IU morning and evening) to 14IU Humalog as the basal on my pod. I believe the reason for this is that I can dose very small amounts of insulin now to correct the high blood sugars that result if I am inactive for a period of time, for example when driving the car. As a consequence I've adjusted my basal to be the minimum I need at any time.
If I go and look at the sum of basal + correction bolus that would push the figure back to my Lantus days, but not all the way. My typically daily bolus is 17IU (though big meals can change this a lot) and maybe as much as 3IU is for corrections.
