Lantus is amazing. What I’m thinking: if it were invented after the pump, wouldn’t everyone would be raving about this newfangled Lantus? Wahoooo! I don’t have to have anything on me! I inject it once and it works all day! I never have to worry about dud sites or dying batteries! I am like a person from the future!
2011: switching from Lantus/MDI to a pump scared me. It was the CDE/pump teacher’s warning that a child could go into DKA/die if the infusion site stopped working for X number of hours before the parents noticed. At the time, it felt like it would be c r a z y to take that risk.
After the pump lessons, I asked our endo if we could use our pump for boluses and continue with Lantus. She told me no. Because no one uses Lantus concurrently with a pump, because practically the whole point (emphasis mine; not even her words) of the pump is fine-tuning basal to match the person’s needs through the day. (This.) Maybe she also thought it would be too complicated mathematically, but didn’t say, because she didn’t want to hurt my math pride.
However, now (three years later) this burning question has risen to the front screen of my brain:
Why not give the minimum basal rate the child uses per hour x 24 in Lantus, and then program the basal rates in the pump to tweak/fill in deficits with Humalog from there? So you’d have a cushion of super-reliable coverage, and then could do all of your frilly fine-tuning (and corrections and boluses for food) with the pump. For example, I think Bubs’s smallest basal dose 0.375u/hour. So I’d do Lantus 0.375 x 24. That’s 9u.
So why not have a basal program of:
9u Lantus 1x/day
Humalog via pump:
+0.625u/hour from 4am – 8am (he uses 1u/hour at that time)
+0.025u/hour from 8am – 8pm (a speck to keep the juice flowing)
+0.5 from 8pm – 12am (he needs more again at that time)
+0.025u.hour from 12am – 4am (for flow)
ALL OF THE UNTETHERED REGIMEN CONS I CAN THINK OF:
- Can’t turn down basal to avoid a predicted low.
- Getting (ouch)/giving (sorry) a shot.
- Remembering to get/give shot.
SOLUTION FOR EACH CON I.C.T.O.:
- More snacks (not a good solution for someone trying to lose weight, but for a skinny kid…?)
- Bubs doesn’t mind shots. He likes giving himself shots.
- Set iPhone alarm(s) to repeat daily at Lantus time.
- Pump failures would be less dramatically horrible/dangerous
- NBD to disconnect from pump to go snorkeling or whatever
BONUS EVIDENCE OF AWESOMENESS: At a TCOYD conference, I saw Steve Edelman propel himself down an Up escalator with security guards yelling at him (security guards who were completely thwarted in their attempts to give chase, because the Down escalator was clogged up with conference attendees and the security guards couldn’t very well break the rule they were attempting to enforce) (also the security guards were not agile like Dr. Edelman, who was arm-swinging down the >>moving>> Up escalator’s handrails like a gymnast on >>moving>>parallel bars.)