Untethered or POLI regime

#1

Hi :slight_smile:
I have read posts in the past about untethered or poli - pumpers on long acting insulin - and was wondering if anyone currently using this regime could share how they find it. I’ve been off the pump for over a year and back on injections as I was having adsorption issues and kinked cannulas. I feel I could benefit though from the extended bolusing which I used on the pump as this helps with my gastroparesis. I prefer my basal injected and currently use levemir. My endo is happy for me to ‘give it a go’ if I want. I thought 70-80 % basal via levemir and 20-30% basal via the pump. I was planning on using the sure-T metal cannulas this time to avoid kinked cannula problems. Any thoughts or experiences ?
Thanks

#2

I don’t currently use the untethered regimen but I did use it a few years back for about three months. I used Tresiba as my basal and I split the total basal as 10% pump/90% Tresiba.

I found this tactic relatively easy to manage and it had some distinct advantages. During this three month period, I enjoyed a holiday at a tropical resort. This made possible long soaks in the hot tub and extended pool or beach time while remaining disconnected from the pump. While disconnected from the pump my blood sugar levels didn’t rise.

I know that Stacey Simms, parent of a T1D teenager, uses this method. She employs a 50% pump and 50% Tresiba regimen. Here’s a podcast where she talks about her experience using the untethered technique.

The untethered topic is discussed at 44:30 of this podcast.

By the way, if you do a TuD search (click on the magnifying glass icon in the upper right of this screen) on “untethered,” it will return an extensive list of threads where this topic has been discussed.

#3

Its unorthodox. If you try it, you should write about it here for others.

#4

I have read and met people that use the untethered method, but it always makes me wonder why they do it. In our case, I love having an insulin pump because we can modify basal needs throughout the day.

I’m guessing when untethered you do not administer the entire basal dose with a syringe and use the remaining one to manipulate if needed with the pump?

#5

Stacey Simms who runs the Diabetes Connection podcast has talked about her teenage son using this method to handle the high amounts of insulin many teenagers need. The amounts were just too much for his site to absorb so the injection of Tresiba has helped giving him a baseline and than the pump runs at a reduced basal rate and meal doses.
You might want to check out her podcast because her son talks about his experiences.

#6

YES! Use the Sure-T’s. I had so many kinked cannulas I can’t recall how many. It sometimes happened a couple times per week. I hated it! I’d get very high, and was just disgusted with pumping to the point of doing the unthinkable: going back to (ugh) MDI. Then I found out (online) about Sure-T’s. It’s been smooth sailing ever since–roughly 15 years now.

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#7

When people regularly experience impaired infusion site absorption like the classic “third day fade” many witness, a daily injected basal insulin can help with managing hyperglycemia caused by a degraded infusion site.

One of the risks of only using a rapid acting insulin injected by a pump is that if the insulin delivery is blocked or not fully absorbed, diabetic ketoacidosis or DKA can follow in a matter of hours. The untethered regimen adds a layer of protection against DKA.

DiabetesMine’s Wil Dubois wrote recently about his unexpected bout with DKA and the speed with which it overwhelmed him.

What happened? I still don’t know. A lot of it is a blur. Something made me sick. I did throw up, but my sugar was at a normal level when it happened. But then things went south. My blood sugar level started rising and wouldn’t stop. I threw insulin at it, but it all happened so fast. So frickin’ fast. It only took a few hours, coasting just below 300 mg/dL, to send me into a full-blown metabolic crisis that left me in the hospital for three days, two of them in the ICU.

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#8

and u don’t think that the fade is caused by using cannula sets?

#9

Maybe, but not always. Kinked cannulas are a source of a failing infusion site. But I’ve seen many sites without any evidence of a kinked cannula just become resistant to absorbing insulin well. This may be due to scarring or some theorize that the immune system plays a role.

I see two distinct factors in play here: blocked insulin delivery or impaired insulin absorption or some of each.

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#10

which would you rather do if having “fade”: switch away from cannula sets, or add the cost and complexity of taking long acting insulin as well as continuing to pump? I think I’d follow the KISS principle.

#11

I think this amounts to a personal judgment and choice. In my case, I only experience impaired infusion site absorption in maybe 1 out of 20 sites.

My Silhouette infusion sets (angled with plastic cannula) have given me great performance and consistently last 72 hours. When I tried the steel sets, I had to change every 48 hours due to site pain. This is one of those “your diabetes may vary” items.

By the way, every infusion set contains a cannula. Some are made with plastic, some with steel. I think a better descriptor for the sets you prefer would be “steel cannula.”

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#12

I have used the untethered regimen for short periods and for months at a time. My diabetes numbers are better when I use it, but it is expensive with my insurance and adds complexity to my diabetes life. I would recommend no more than 50% of your basal by injection if you want to keep taking advantage of your pump’s temporary basal features.

Here is a link to many of the blogposts that I have written on the untethered regimen. BTW I haven’t used it in a year or two.

https://testguessandgo.com/?s=untethered&submit=Search

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#13

I did the same for about 18 months. For me the advantages were a more stable basal level independent of adsorption site quality/age. It also reduced the total amount of insulin delivered through the infusion site by half, which for me, reduced irritation and made adsorption over time more stable.

Downsides? Less flexibility in changing the basal profile by the hour because 90% is fixed. For the same reason, setting temporary basal to 0% in the pump only reduces the actual basal by 10%.

I recently moved back to 100% pump delivery so I could take advantage of my Tandem pump’s Basal-IQ feature. The algorithm suspends basal to mitigate low blood sugar. Consequently the pump needs 100% control of the basal amount to work properly.

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#14

Thank you Terry. Great info there. I’ll check out that podcast. :slight_smile:

#15

Yes I certainly will post about it if I decided to trial it. :slight_smile:

#16

I did always love my insulin pump but had way too many issues with it before I went off it to now trust it fully for my basal. A bit of pump anxiety is a factor here. :roll_eyes:

#17

Yes I’ve heard if her podcast. Will check it out. Thanks. :slight_smile:

#18

Thanks so much. I will read those links :slight_smile:

#19

Yep. Looking forward to using sure-Ts. Extra piece of mind with steel canulas.

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#20

I beg to differ. https://www.medicinenet.com/script/main/art.asp?articlekey=11092

there is no retractable core in a steel set.

I lifted the following directly from Medtronic,“At the end of the tubing is either a soft, flexible cannula or a stainless steel needle.”