Lantus is Lovely and Amazing

I drew this from memory.

I drew this from memory.

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

and

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)

After our recent pump failure, this seems so, so, so much safer. Of course this idea has a name. (Why, it’s Steve Edelman‘s Untethered Regimen.) Check the infogram! That’s what I meant to say.

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.

PROS:

  • 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.)

 

 

Advertisements

15 responses to “Lantus is Lovely and Amazing

  1. Funny you should mention Dr.Edelman, I just went to TCOYD <2 weeks ago in San Diego. ❤ him. I had no idea he was the one with the published untethered regimen. We did untethered for Florida vacation over the summer, but it was the whole basal from levemir during the day, boluses from pump, basal from pump at night type of untethered. I hope whatever you decide to do works well for you and Bubs.

    Liked by 1 person

  2. I’ve written about the untethered regimen because I use it on beach vacations. That way I leave my pump safely in the hotel room and have basal coverage without it. I give about 80% of my basal by injection and the rest through the pump. It works so well that I’ve often wondered if I should do it all of the time.

    Many months ago Melinda Vahradian was interviewed on DSMA Live. Her son is an adult now but she indicated that he used the untethered regimen through adolescence and still uses it as a young adult. He was and is very active in sports. This wasn’t the whole focus of the interview and I think the discussion of this was in the second half. http://www.blogtalkradio.com/diabetessocmed/2014/06/17/dsmalive-rents-grown-kids-with-melinda-vahradian

    Melinda is on Facebook if you want to try to contact her.

    The main danger I see with always using the untethered regimen is that losing the pump becomes a possibility if the kid is constantly taking it off and putting it on.

    I’ll be interested to see what you and Bubs decide.

    Liked by 1 person

  3. mollyjade

    I’m curious to hear how this works if you do it. There’s a lot of exaggeration of the benefits of the pump vs. MDI. And Lantus was certainly amazing when compared to nph.

    I remember when I was getting (horrible) pump training and I complained about how long it takes to toggle to the right number and that I could do the calculations faster in my head and the CDE said, “the whole point of the pump is that you get to avoid doing math.” We obviously had very different views about both math and diabetes care.

    Like

    • Ha! Oh my gosh—me too! I told our endo that I never use EZBG/EX carb anymore, because I can do it faster in my head…she had the same response. Not even like a warning about human error, just “why would you want to put yourself through all that math?” I said I have to do the math anyway, to make sure what the pump is saying makes sense.

      Like

  4. Melanie

    The thing I like most about the pump is that it lets me set the basal rate to near zero temporarily. I find that my insulin resistance varies widely with my activity level, so turning the insulin down or off in anticipation of exercise is a great help.

    Liked by 1 person

  5. skchrisman

    A full year after stopping Lantus, my programmed watch (that sat in a tray in the dining room) would still alarm at 9pm and someone would shout, “It’s time for Lantus!” followed by, “Oh yeah! Okay…right!” Giggle, giggle. It was annoyingly funny and I was sad when the watch was reprogrammed. I am very curious to explore the untethered regimen further. It could actually be a benefit for those bullish lows that Pip gets from days of back-to-back activity. Regardless, it seems we’re always doing a ton of head-scratching predictions for the next 12 hours. #T1Dguessinggame #needcrystalball

    Liked by 1 person

  6. Forgot to mention that when I do the untethered regimen, I take Lantus twice a day. Back in the days that I took Lantus before pumping, it was common practice to take just one injection a day. Many patients and docs have discovered that it doesn’t last 24 hours for many people and therefore have better results with two injections.

    Also, Lantus wasn’t perfect by any means although it was tons(!) better than NPH. Whenever I had unexplained highs, I didn’t know if the Lantus had gone bad or wasn’t absorbing well or whatever. Of course maybe using the untethered regimen with Lantus and some basal by pump, you have two chances to get it right.

    Liked by 1 person

  7. Zak

    I need to research this untethering because Zoe did a runway show (subtle humble brag) and she had to take her pump off once she was dressed and waiting to go on which took HOURS. She was 457 after the show, live and learn, but untethering sounds promising.

    Liked by 1 person

  8. Pingback: The Grouch is Back! | Test Guess and Go

  9. So interesting … you are very clever indeed

    Like

  10. I have read a little bit about this before. Very interested in it. Pretty sure it’s the only way my son will ever consider pumping. He was in DKA at dx and even a slight chance of it terrifies him. Thanks for sharing your insights!

    Like

Please say things:

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Bigfoot say other thing

%d bloggers like this: