[Jenn L]

Hey All,

I am going back on a pump after a few years on MDI, I go next Thursday!! I currently take 8 units of Lantus at 9am & 9pm, and bolus with Humalog. My trainer said not to take my am Lantus, and correct as necessary with Humalog that morning (my appointment is at 2pm). She said they figure the basal by taking 80% of the total Lantus dose and divide by 2. Seems like a tiny bit of basal. My average was .7 for most of the day four years ago. I have also lost 15 pounds since then. How did you do it? This is really the only thing I am worried about, otherwise I would have hooked up days ago! HELP!!

[Eddy]

A basal average of 0.7/hr would equal 16.8 daily, which roughly jives with your current Lantus regimen. IIUC, the 80% multiplier is safety margin to avoid a wicked round of hypos, should CSII give better absorption than your basal.

I'm not fond of large, sudden changes. It can be tricky enough to converge on the correct basal rate without major dose changes.

When I switched from 1x/day Lantus to 2x/day Levemir, I gradually decreased my Lantus while gradually increasing my Levemir. I made certain that my total basal was never more than a couple units (out of 35-ish) off. Granted, I was not switching from MDI to CSII, but the principle is the same.

e.g.:

Day 1 : decrease Lantus to 7U/dose; set basal to 0.075
Day 2 : decrease Lantus to 6U/dose; set basal to 0.150
Day 3 : decrease Lantus to 5U/dose; set basal to 0.225
Day 4 : decrease Lantus to 4U/dose; set basal to 0.300
Day 5 : decrease Lantus to 3U/dose; set basal to 0.375
Day 6 : decrease Lantus to 2U/dose; set basal to 0.450
Day 7 : decrease Lantus to 1U/dose; set basal to 0.525
Day 8 : no more Lantus; set basal to 0.600

Consider adjusting as needed, should the above basals be either too conservative or aggressive, but be suspicious of an apparent "need" for any huge deviations from what you might expect. Be sure to write down what you're doing each day! It's easy to lose track!

I like to correct my nighttime basal before messing with daytime. It's arguably easier (no food/bolus stuff), and rather important (long stretch of time).

Once your nighttime basal is sorted, examine your daytime correctional boluses. Average those out over your waking hours as a starting point for daytime tinkering.

FWIW: I'd planned to transition from Lantus to Levemir over three or four weeks. I became impatient, and did it over a week and a half.

[gettingby]

Cool that you are going to try the pump again, Jenn.
When I started on my pump, I was on one shot of Lantus in the mornings. Since I wasn't going "live" until around 1:00, my trainer had me take half of my Lantus dose that morning. Then she started me with a temp rate for the remainder of the day and night. I also started on a low basal rate. I was taking 18 units of Lantus every morning.
Good Luck and I hope things go well for you.
BTW, which pump do you have??? (Yeah, I gotta know )

[notme]

Glad to hear you got a pump Jenn. Go ahead and so exactly what your trainer says. Make changes slowly. Give it a week and re-evaluate your numbers and make changes systematically. If you try to change too many things at once, it will be come very confusing. After you get started, read on here about basal testing. You will find lots of useful information. If you need help, I have some good instructions on basal testing.

[Jenn L]

Mini Med with a cgms....clear btw. Thanks for asking!

[Subby]

Originally Posted by Jenn L

She said they figure the basal by taking 80% of the total Lantus dose and divide by 2. Seems like a tiny bit of basal.

Are you sure on that equation? The 80% sounds like what they did with me, but not the divide by 2. As it turned out my basal had to go up and finally it has hovered around the same amounts as my daily Lantus shot. So, it's about 100%.

If I was you, starting at 40% (or whatever it would become) would have been very tough indeed, I would have been very under-dosed and it would have been a lot more adjusting up (it was more than enough needed, as it was - notme is right, you want to take it slow). That's why I wonder maybe lines got crossed.

As for the actual transition, it's just going to run the risk of being a bit messy, no getting around that. Take it easy and test a lot, obvously. Are you staying in a hospital/clinic? Getting hands on help to get good basals, I:C ratios, sensitivity ratios?

Congrats on getting the CGMS, lucky person. Can't wait til it becomes affordable here. Enjoy the MM, I think they are very serviceable pumps.

[Scratch]

My guess is that the trainer is going to first use a temp basal to cover the time that the nightly Lantus shot will still be in effect, that's why she's dividing by 2. She'll probably instruct you on how to go to the full basal rate at 9 PM. I could be wrong, but that's my guess as to what will happen.

[SGT Shoutmore]

Jenn, math looks right, I use significanly less insulin on a PUMP versus MDI. Remember, using more insulin than necessary equates to you feeding your insulin soon with subsequent weight gain, no fun there.

The cutting the lantus out = GOOD idea, my trainer neglected to mention to me to not take my AM levemir dose on my pump start date and OOPS! What a hypo THAT was! Don't be surprised as time goes on and you begin running several basal rates that you find yourself whacking down your insulin TDD even more to a nice "only what you need" amount, o which the results are very cool!

[Eddy]

Originally Posted by Scratch

My guess is that the trainer is going to first use a temp basal to cover the time that the nightly Lantus shot will still be in effect, that's why she's dividing by 2. She'll probably instruct you on how to go to the full basal rate at 9 PM. I could be wrong, but that's my guess as to what will happen.

It's still a lot of guesswork, considering that one doesn't know the precise glargine profile -- let alone the differences between glargine's and rapid's absolute bioavailability.

I had no interest in playing "guess what glargine and detemir will be doing" when I switched. By switching in a slow, controlled manner, I could be fairly confident that I wouldn't have any large surprises.

Of course, keeping track is more difficult during a slow, gradual switch. I simply made certain that, within a 24-hour moving window, my total basal was never more than 10% (usually less) off.

N.B.: I'm self-managed, except for having friends/family get worried if they don't hear from me "often enough". If I get into trouble, it's an uninsured trip to the hospital... or perhaps worse. I might be a bit more gun-shy and conservative under said circumstances.

[jbrowning2612]

I'm hopefully getting a pump in early September. I take 56 units of Lantus every morning, so what would my basal rate be? I tried using that equation and don't think I got the correct answer. lol!

[Eddy]

Originally Posted by jbrowning2612

I'm hopefully getting a pump in early September. I take 56 units of Lantus every morning, so what would my basal rate be? I tried using that equation and don't think I got the correct answer. lol!

2.33 U/hr

However, if you follow the "cut by 20% for safety margin" advice, you'd begin at 1.87 U/hr.

[jbrowning2612]

That seems like a good bit... I'm ignorant when it comes to pumping though, so I can't make that determination. Thanks though!