I’m on MDI (humalog and basaglar) and I’m thinking of switching to the pump in a month or two. Is it worth reordering humalog pens and basaglar pens before getting the pump so I have a backup just in case I am traveling or decide to take a pump break?
For those of you who have pumps, what kind of backups does your insurance cover? I haven’t used insulin/syringe in 20 years, so my preference is to get the pens before switching to the pump in case insurance will only cover vials as a backup later.
I have Cigna if that matters.
Also, there’s a chance my insurance might change soon - does anyone know if I start with a t-slim now and change insurances, will a future insurance company cover supplies if I already have the pump itself?
Absolutely get back up long term insulin. You have to have that, as a pump user, or someday you will experience a terrible crisis. I had many terrible events before I just gave in and bought the back up supplies. Doc should write you an Rx. Should be covered by insurance. As a new pump user, I would carry backup basaglar in case of pump failure. I would keep it in my purse all the time.
Thanks! I would definitely have backup supplies, although I’m wondering if it’s worth refilling my current pen prescription now (before I got on the pump) just in case insurance would only cover vials after I got on the pump. I’ll suck it up and do vials as a backup if I had to, but I’d strongly prefer pens and I wasn’t sure if that was usually an option. I have one friend with bad insurance who only has a vial as a backup, which is what prompted the question.
I have been pumping since 1990 and only have my vial of regular insulin. In all that time, I have only once had to do injections after a dropped a pump on a tile floor. I just called my endo in a different state. She couldn’t prescribe a long acting across state lines so she talked me through using regular for the 24 hours until I got the replacement delivered. I have never really thought about using a long acting insulin. The last long acting I used was ultralente. Those were the days!
I switched to a pump 6-7 years ago, and have a yearly prescription for 1 box of Lantus pens and one of Fiasp pens for emergency back up. I’ve only had to make use of it once when my pump suffered a button-freeze, but I was glad I had it. Inevitably that kind of problem is going to happen going into the weekend, and even in an emergency situation it took 3 days to get a replacement pump to me, so having my MDI backup was a big deal. Though it took a bit of guesswork to do get the Lantus dose more or less right, not having been on it for years.
How are you supposed to use short acting for a 24 basis?
I’ve winged it in the past, but I’ve never been taught how to do that. I usually just take a unit an hour, and mimic the pump. That’s not great for sleeping, so sometimes I take 4 units and sleep for 4 hours, then get up again.
I did it for about 2-1/2 years between ‘89 and ‘91 because I has having significant problems with NPH including two trips to the ER unconscious. If I recall correctly I was taking about 10 injections a day, including overnight. Then I got my first pump and gladly kissed that technique goodbye! Although I don’t remember, I can’t imagine my control was very good using the technique.
I also don’t remember how I did it with details. But my doctor just did the math with what my total daily dose was and divided into shots through the day. It meant a lot of testing and I don’t remember her calculations but it worked and got me through the next day until my pump arrived. I would need to check my diabetes library to see if any of the older books I have might have the how to. But I would imagine your doctor could also help with it. I mean, if this were to happen again to me, I would just call my doctors office.
For the past 1 year+ I only use Humalog short acting insulin 24/7. As long as I don’t eat after about 4PM, I only need 1 shot to cover me through the night. I dose that shot based on CGM and where I want my lowest BG to be during the night. By skipping dinner or eat light low to no carb meal by 4 PM, I can ride through the night fairly flatlined. I stopped taking Lantus/Levemir over 1 year ago because I was getting 3-5 low Dexcom alarms a night that drove me crazy.
I’ve done this a couple of times, for up to 2 or 3 days. I take six shots a day, at:
12:00 am
4:00 am (yes, I get up in middle of night)
8:00 am
12:00 pm
4:00 pm
8:00 pm
Each shot consists of:
Basal Insulin for 4 hours (should have rates documented somewhere so you know how much)
Food bolus
Correction bolus
This keeps me under decent control, not great since most people use more insulin through injections than on a pump, and I can go a little high, but then I correct at the next shot.
I wouldn’t want to do this for long, but for a day or two or three, it’s doable.
And, I choose to eat before a planned injection.
I used to have a supply of Lantus and probably still have a vial or two of expired Lantus. I live in a major metropolitan area and also have an Animas pump and Omnipods as backup for my Tandem pump. So I am not too worried about needing long-acting insulin in the event of a pump failure. If I were to travel out of the country, I would definitely carry a long-acting insulin with me as backup.
When I see my endo next month, I may ask for a sample of Lantus, Levemir, or Tresiba to keep on hand.
Thanks all for your tips. I’ve been on MDI since 1995 and have a good understanding of how Lantus/Basaglar work with Humalog, so luckily I think I could manage to easily switch back to it if I wanted a pump vacation or had an issue.
One of my main questions (which I might not find out until I get on the pump) is whether insurance is likely to cover pens as backup vs. vials and syringes. I’m super used to pens, so I was just wondering how common that was. My understanding is they’re more $$ for the insurance companies.
I haven’t had any problems. But, you might. They always try and give me pens, although I prefer vials because I think its a bit simpler for me to manage supplies.
Quantity-wise, after you start using either a vial or pen of Humalog, officially you are supposed to throw it out after 28 days. So for a backup choice that is only occasionally used for short durations (day to a week), it makes more sense to use a 300-unit pen than a 1000-unit vial because of less wastage.
So for example you could get a box of 5 pens with an expiration date 2 years in the future, and use them for 5 week-long pump outages spread throughout those 2 years. It would take 5 vials (following official 28 day expiration date) to do the same.
List price for 5 vials of Humalog: $1250.
List price for 5 Kwik-pens of Humalog: $500.
I agree the vial is cheaper by the unit but after accounting for wastage due to 28-day expiration, the Kwik-pen actually wins.
I suspect the insurance company pays a lot less than the “list price” for our insulin but that’s all protected and none of us know what the price they pay actually is.
I think under some circumstances pharmacies will break the 5-Kwikpen box and can sell them individually. Like the way pharmacies can also sell single quantity or bag-of-10 syringes but usually don’t.
Absolutely! When I first got the pump, I took a job two hours away and went without backup insulin. Sure enough, my pump kinked and I wasn’t getting insulin and my boss got irritated that my CGM was going off every few seconds because my bg hit 500. I had to run home and got fired. Fun times. Always have backup!!!
