Using Lantus for Basal and Pump for Boluses, Anyone Tried It?

I was on the pump for over a year and a half, but never got my A1c below 7.2%. I started having trouble with the infusion sites (rashes, etc) so I took a “break” from the pump that turned into more of an indefinite stay on MDI’s using Lantus/Humalog.

But lately, my Lantus is giving me some trouble with boluses and I miss the ease of bolusing on the pump (easier to remember, easier to calculate irregular carb ratios, and getting out of the whole number range). So the thought crossed my mind about using my Lantus as my basal and the pump for my boluses…has anyone done this? Did it work well for you?

I know I don’t want to go back on the pump full time…yes I understand that multitudes of people have great results with it, but I never could and it was always more trouble than it was worth. So I’m sticking with Lantus for my basal for an indefinite amount of time.

I think you might want to research on this. I cant remember where, but I think I have read about people doing this before.
You’re maybe in an opposite category though, because usually people have trouble with the long lasting insulins in their system, and no way to cut that down. You might want to ask on some diabetes sites, including

Hmm. One of the things you might want to consider is that some pumps (I think) have a minimum amount you can have in the reservoir and/or a minimum basal rate you can program in (while I think some let you program in 0.00 units per hour). The other major issue would be that without a regular flow of insulin through the tubing and cannula, occlusions and clogs will be a nightmare.

Have you considered instead going to an i-port (infusion set style syringe port) in combination with syringes (or better yet, pens) that allow you to dial half-units? I think that a pump isn’t going to give you smooth performance as a bolus-only device. But that’s just my two cents. If you feel like you have better control on your Lantus, find a way to streamline or detail-work your Humalog through injection as well. I know I heard Kristin mention half-unit syringes as some point.

Yes, I have heard of people doing this. I believe it’s referred to as “untethered”. I do not have any personal experience with it however.

Hi Melissa,

The minimed paradigm pump allows a 0.00 units/hour basal and I’m not sure about a minimum in the reservoir (the lowest I’ve loaded it without before was about 40 units). Does the absence of a regular flow really cause a lot of occlusions and clogs? I guess it makes sense, but it still seems like it’d be roughly the same since there’s still insulin sitting in the tubing.

Thanks for the other ideas!

If you use the pump for boluses, you’d have to wear it all the time and might have the same issues with the infusion site regardless of not having a steady dosing going on. Are you thinking that less insulin entering through the site will be better absorbed?

Thanks, Lorraine! I’d seen that article along with several others about that. And while I don’t think I need a basal through the pump, it is pretty close to what I’d like to achieve with it.

By just doing boluses with the pump, it’s not mandatory that I wear the pump continuously as long as my infusion site is accessible for bolusing. I don’t think it’s anything with absorption going on with my blood sugars, so no, that’s not what I’m seeking through bolusing with the pump. Basically, it’s easier to calculate the boluses through the pump, I can easily use an extended bolus, and easily keep track of where I’m bolusing, etc to give me a better idea what my boluses are actually doing.

Lindsey. I was on humalog and lantus for more than 8 years and my. A1C. Was. 6%. Now I am on a minimed 722. For almost 8 months and my A1C. Is 6.5%. So pumps or multiple shots are tools you can use the way is better for you or any one
My recomendation for you is review your diet and excersise routines with. A new diabetes instructor and a new endo for 8 months and make a new test for your A1c there is nothing beter to control your basal insuling that a pump
Take care

No problem. I’ve actually considered doing this for Caleb. When he was on injection therapy it seemed like the NPH would soak up so much “loose ends”. With only Novolog, I see him very sensitive to whatever variables (food, growth, whatever) that would cause him to go high. On the pump, we saw our first 300s since dx, but we were also able to correct very easily. Ultimately, I decided against it because it seemed to go against the whole point of pumping and to ask Caleb to endure shots AND the pump insertion seemed unfair. Nevertheless, I can relate to wanting to use the approach if it helps stabilize your BGs.

I have heard of people wearing the pump part time. They take their minimum basal level as an injection of Lantus or Levemir (the equivalent dose for the lowest basal insulin per hour amount), then wear the pump only part of the day (for example, wearing it only at night etc). But you still need to re-connect to bolus.

Honestly, for me it makes the pump not worth it. I have considered taking 1-2 units of Lantus a day, just to avoid DKA caused by bad infusion sets, but I think this would be too expensive as I would need to throw out a lot of Lantus, but I have thought about doing this during pregnancy to guarantee that I have some insulin in my system even if I experience pump problems.

Yes I have. My numbers were probably the best they ever were when I used lantus and the pump for novolog. The biggest thing I did was just trying to figure out what my bolus ratio was on the pump and eventually started doing it manually off the pump. I don’t know if I could see me doing that 24/7. I didn’t know there was an actual term for it until I read this post. I personally just can’t get use to the pump, almost like my body rejects it…I guess I mean using a basal on the pump has never worked right for me. Then again I have LADA so that could explain it. Lantus shouldn’t have anything to do with your bolus. I have learned everyone is different and reacts different and their diabetes is different, so it might work for you and it might not. One thing that is important on the pump is finding the right infusion set that works best for you and causes less problems. Another thing is I’m sure the cost of doing both of these treatments might not be available for some… If you try it, let me know how it works. I would like to know others who have had great results doing the untethered regimen like myself. BTW, never had a problem with with occlusions or clogs. I use the sure-t and don’t have to prime or make up for not wearing it 24/7.

I’ve tried it for almost two weeks now. I’m definitely seeing better post-meal numbers (even experiencing a few lows while getting the carb ratio adjusted) than I do with injections.

Not sure how long I’ll keep it up. The infusion sets still bug me (before when I was on the pump 24/7, I developed rashes because of them)…but not as bad as before. I’m hoping my body will adjust back to wearing it. No occlusions or clogs either.

I was on vacation for 1 week out of the 2, so it’s hard to say if this will keep up. I’m definitely continuing it for a little while longer. Just wish I knew why I get such better numbers with bolusing with the pump than injections…absorption? accuracy? both?

I’ll keep you guys posted on it!

Good question. Lows are normal I had those to until i got my bolus right. Could be an absorption problem. If you have pens that go by .5 increments, it should be about the same as using the bolus wizard I would think. I would go on a pump vacation for about 3 months. We are definitely in the same boat. Have you thought about changing sets?

Yea, I don’t have the pens with half unit increments…do have syringes but haven’t used them (got them the same time that I decided to try the pump for boluses). I went on a pump “vacation” in April, thinking I’d do it for like 3 weeks…but couldn’t bring myself to go back on. I never could get the basals to work. Lantus drops my A1c much better than the pump ever did. Lows are definitely normal for me…prone to severe ones and seizures. So I try to limit them as much as possible, hypo unawareness is way too scary.

I tried another set (on a Minimed 522)…the Silhouette. But had the same problem with the rashes/itching. I have super sensitive skin (can’t even use normal soap!) so I think it’s just that. The set I put in today seems to be less itchy/red…so hopefully I’ve adjusted.

I was on Lantus. I started at 20 units a night, I kept getting krazy A1c above 7 like you. Eventually I was up to 45 units a night. To me, that was a painful shot everynight. I was also on 3 shots of apridra every day with my meals. I am now on a medtronics 722 pump and I love it. I am only using Novolog in my pump. This of course for both basal and bolus. I was scared of this at first, but it worked out to help control me, when I was out of control constently.

Hal Goldstein