Untethered or POLI? Anyone?

My daughter is 17 and has been pumping for 3 months. She loves the pump (X2) but the downfall of it all is the infusion sets. We’ve tried a variety of different types and none seem to last beyond 2 days. Blood sugars go high with a new site and a site left in any longer than two days also causes a rise and discomfort. I have always been interested in the untethered method and I am wondering about people’s experience with that. She is off to University this fall and my biggest fear is dka when she’s living on her own. I am thinking of starting her with 25% Tresiba and pumping the rest of the basal (eg 8 units Tresiba, 24u by pump) Do you think this will help control the spikes caused by new sites and 48 hrs plus sites? Do you think 25% tresiba is enough to help avoid dka? We will have no help or support from her endo on this so we are flying solo.

You may be interested in this podcast. Stacey Simms is the podcaster mother of a 14-year old T1D son who uses the untethered protocol. She says it has improved her son’s glucose control while enhancing his overall safety.

What is “POLI”?

Reducing the total volume of insulin via the pump might enable your daughter to use infusion sites beyond two days. Have you thought about reducing the number of grams of carbohydrates consumed each day? It wouldn’t require reduction to a low number but eating 200 grams per day instead of 300 grams per day might help. This would reduce the number of total daily units of insulin while hopefully reducing the site irritation that ensues.

Ok, I did a google search on “POLI” and found that it stands for “pumper on long acting insulin.” I was not aware of this acronym.

Hi Terry. Thank you. I listened to that last night in my quest for more info. My DD doesn’t eat a ton of carbs now - definitely under 200. But we’re always trying to lower that.

This will indeed work. I was doing this for about 2 years and only stopped because I wanted to use the X2’s Basal-IQ feature and that requires the pump delivering all the basal.

I was delivering 20% of my basal with the pump and used Tresiba for the other 80%. About half my TDD is basal so this effectively reduced the amount I was delivering by pump to 60%. Pluses and minuses -

Positive -

  1. reduces demand on the infusion site. I had far fewer problems than with 100% pump delivery.

  2. Basal levels are more reliable because Tresiba is taking care of most of it. Little variation based on infusion site quality, age, etc.

Negative -

  1. Can’t effectively use Basal-IQ

  2. Lower ability to vary basal rate by hour and to use temporary basal because the pump only controls 20%.

Letting the pump handle a greater % or basal could help these two, but at the expense or sending more insulin through the infusion site.

Overall I’d say give it a shot. The % you deliver many be based on the basal profile. If you have big changes over 24 hours you have to set Tresiba at the lowest level in the profile and let your pump handle the rest.

I’d play around with it a bit. When I made the change I need more Tresiba than when I delivered all the basal via the pump. Don’t know why.

did she use TruSteel?

I’m going to make up my own acronym: ICKUWATA

Tried them and doesn’t like them she can feel them with every move she makes.

interesting. I’ve worn them for over 15 years and it’s a rare thing to feel them. Cannula sets are the type that irritate the daylights out of me.

I mentioned in another thread that I’m doing the untethered regimen with Tresiba (I’ll switch to Levemir when my Tresiba is used up, though). For me, I decided to take 20-30% of my basal as Tresiba (it varies due to hormones, which cause up to 50-60% increase in my insulin needs) and deliver the remaining 70-80% with my pump. I make any adjustments to my basal rates with my pump and keep the Tresiba at a fixed dose.

I have found that it has helped keep my blood sugar more steady. However, I can’t run an infusion set past two days without going high. I’m using steel needle sets, which are only supposed to stay in for 24-48 hours, and often I need to change mine sooner than 24 hours due to my body reacting to them (allergic). However, I have noticed a definite reduction in the “height” of the highs I experience, although an infusion set run too long will still cause all-day high (out of range) blood sugar. I’m also still able to create a rise in my blood sugar by suspending my pump to try to prevent lows and during exercise.

1 Like

Wanna elaborate on that acronym?

Pumper on long acting insulin

I was asking @Dave44 what his new made up acronym meant.

:smile:

Sorry I missed that.

Sprocket1. I tried a variant of untethering with t-slim running u-100 Humalog and degludec u-200 by pen and the whole thing was not a pretty picture. If you do it, start low and give up on good A1C while you titrate up slowly to find the sweet point. I think it’s too hard to just guess. Also, injection site plays a role as their not all equal. NOT a fan of making insulin changes at same time as moving or other life changes or new high stress. What are you thinking?

I Cant Keep Up With All The Acronyms.

2 Likes