Untethering

I’m looking to start giving my daughter her Basal my daughter through pen, but continue to Bolus through her Pump.
My question is… should I keep her on the same amount of Basal she is on now or lessen it? (She’s on a ton of insulin and we’d love to start lowering it) she is 13 and on 52 units of Basal a day.
Any help and input is appreciated.

I know from going the other direction, from Lantus to using a pump, my basal requirement decreased quite a bit. There are a lot of variables here–type of basal insulin, whether you’re going to split the dose over 24 hrs, changes in her metabolism–so you should definitely consult with your endocrinologist and do things incrementally. But it’s not likely to be one-to-one with what she’s taking now.

Just for curiosity, though, why the change?

ETA:

Just to clarify: she’s likely to need more using a pen rather than less.

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I have a question as well. Can one stop a pump from giving basal and limit it to bolus only? I don’t think I can on my Animas pump, and it is pretty much typical of pump functions. I can suspend it for a time, but the time is limited. Same with the OFF function on temporary basal.

Good point. You could try programming a single basal rate for 24 hours and set it as low as possible, but I’d be surprised if the software would accept zero.

I’m guessing that with a 13 year-old there may be a lot of other issues behind this question. It’s a tough enough age for parents as well as the kid even without having T1 in the middle of everything. Particularly for girls, who may skip doses as a way of losing weight (a.k.a., “diabulemia”): https://well.blogs.nytimes.com/2016/02/01/an-eating-disorder-in-people-with-diabetes/

I believe that you may program in a single basal rate for the entire day at 0.0 units/hour. I just tried it on an older Medtronic pump and It appears to work OK. I would worry that the site could stop absorbing without some minimum amount of basal delivery. If it were me I would program in 0.1 units/hour (2.4 units for 24 hours) and then add the long acting insulin from the pen. You would need to add this amount to your pen deliveries for calculation purposes.

Determining the dose of the long acting along with the number and timing of the basal doses will likely require some trial and error testing. Many people experience a need for less basal when switching from basal injections to a pump. That may mean that your daughter will need more total daily basal dose with the pen than the 52 units she now takes via the pump.

The safest technique will likely mean starting with 20% less total daily basal pen dose than what the pump delivers and then adjusting the total daily basal pen dose once she starts. Keep notes and adjust accordingly.

What is the basal pen insulin you intend to use? Many patients who use basal insulins, like Lantus and Levemir, will split their daily dose into two. Tresiba, with its 42 hour duration, can often be used with a single injection per day. If you are using Tresiba, you should not make basal dose increases until at least two days go by due to the daily action overlap. Some patients even recommend spacing Tresiba basal changes by three days.

Your doctor could help with this but I’m sure s/he will need to go through a trial and error period of testing. You will need to discover not only the best daily dose size but the timing as well. Good luck.

The untethered regimen enables disconnecting from the pump for many hours without the risk of ketoacidosis. People involved in water sports and martial arts like the ability to take the pump off when they participate in their sport.

I am adult so my experiences with the untethered regimen might differ from what you are looking for your daughter. I have written several blogposts about the untethered regimen including discussions of the benefits and disadvantages. You might find these posts to be interesting, particularly Building a Foundation with Lantus Parts 1 and 2.

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

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Diabulemia does frighten me for sure and I am always watching out for it.
If I had the choice, I would like for her to go onto a complete pump vacation all together for the summer. She uses almost 300 units of insulin every two to three days. When she gets a correction via syringe it seems to work a lot better and faster for her. She changes her site almost every two days consistently because she doesn’t usually last the full 3. She has developed alot of scar tissue. I am trying many different routes to lessen these factors.
She has been pumping for almost the entire time of DX. (almost 7 years) and it just has never really regulated her like it seems to for many. We work with out endo a lot and have tried many different routes.

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Yes you definitely can have zero delivered. At least with her Medtronic pump. You go into Basal set up and set another pattern (like one can do if they are sick or on their cycle) and program it to 0 and choose that pattern.
We are looking into Tresiba, I have many friends on it and have heard great things, but we also have lantus and levemir so we aren’t locked into one.
We will be at the beach for an extended amount of time this summer and are hoping to try this. I would like her to take a break all together from the pump, but that is something she is still deciding.

@Laddie I will check that out now. Thank you

I apologize for all of the replies this site is all still very new to me.

I don’t believe you can with the Animas pump. It was designed to panic when there is no delivery. On temporary mode, it alarms every 1/2 hour to remind me that I’m on temporary basal. Same deal with suspend.
The way around it will be to set the pump at it’s lowest basal setting. Perhaps that might be 0.025 hourly?
I just now played with my basal settings (Vibe). It did go down to zero. I will try to use that and see what the pump will do. Be back soon.

@Laddie I read your blog post. It sounds very intriguing, yet I am confused on the math (excuse my ignorance)
if she takes 52 units a day basal via pump, how would you configure this?

Then, there are different choices of which long acting insulin to use,

Lantus 20-24 hrs duration
Levemir 20-24 hrs duration
Toujeo more than 24 hrs duration
Tresiba more than 24 hrs duration

Personally, I like the pump basal flexibility. I have 5 different basal rates during the 24 hours day. From a low of 0.925 to a high of 1.450
I’m 67 yrs old.

Remember, kids will have to battle hormonal issues plus dawn phenomenon which the long acting injection basal regimen will probably NOT HANDLE.

@arpida_seru My daughter currently has 8-10 basal settings a day depending on activity. She is on a 1:4 I:C ratio and 1:10 correction. I would love to try and lessen this is any way I can. We are leaning towards Tresiba whether we take this approach or a full pump break.

Oh, I can stop basal delivery with the Animas Ping a couple of different ways but they all are timed and have to be renewed when the timing is up. I regularly stop basal when I take the pump off for showering or if I go low and want to stop basal until BGs return to normal.

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Is she on other medications? Pills that will help lower insulin resistance. I added metformin with my insulin and it lowered my TDD from 65 to 45 a 30% reduction on my daily insulin use.

She is on synthroid but that is all. We have discussed it but he does not think she is ready because she is growing so rapidly

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Animas on zero basal setting. I changed my basal setting for the time period now and for the last hour to zero. I did not get any alarms. ANIMAS WILL ALLOW ZERO BASAL SETTING.
.
With this knowledge, I will set one of the 4 basal choices named “other” in Animas to deliver zero basal. This will be a quick way to swich temporarily to zero basal when treating a LOW or when hypo. Or when anticipating a low to come say, exercise, etc. or Fast drop on the CGM.

CAUTION CAUTION CAUTION.
WHEN DOING THIS, DO NOT FORGET TO SWITCH BACK TO NORMAL BASAL SETTING.

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There is a limit to the time one can set the zero setting of basal in Animas. There is no alarm. But it will go back on after the allotted time has passed.

Are you referring to a temporary basal ?

I think the other comments are related to the daily basal settings/patterns.

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