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# How To Switch From Pump To Shots

## Back To Shots

There are a number of reasons why switching from your insulin pump back to shots (MDI), using insulin pens or syringes, is sometimes necessary. Reasons can include Pump malfunction Losing or misplacing pump Forgetting pump or supplies at home Hospital visit or surgery Spending a day at the beach or in water Taking a break from the pump all together Short term pump breaks If you will only be disconnected from your pump for a short period of time, your doctor may provide a guideline for you to use only rapid-acting insulin (i.e.: Novalog or Humalog) incrementally, every 3 to 4 hours until you can get back on your pump. Example (off the pump for less than 24 hours) Short-acting insulin doses while off the pump are necessary every 3-4 hours. To calculate, combine a food bolus and the insulin you would normally receive as a basal rate via pump. Here’s an example for a calculating a breakfast injection while off the pump for less than 24 hours: Step 1: Calculate breakfast bolus. Morning blood sugar value = 170 mg/dL Insulin to carbohydrate ratio (ICR) = 1 unit per 15 grams of carbs Insulin sensitivity factor (ICR) / Correction factor (CF) = 50 Breakfast is 60 grams of total carbohydrates Breakfast bolus = bolus for carbs + correction bolus. Cover carbs: 60/15 = 4 units Correction: (170-120)/50 = 1 unit 4 + 1 = 5 unit breakfast bolus Step 2: Calculate amount needed to cover basal rate. Basal rate (s) MN = 0.60 10:00 a.m. = 0.85 5:00 p.m. = 0.70 Combine sum of basal rates from 8 a.m. – 11:00 a.m. = 0.6 (8:00 a.m.) + 0.6 (9:00 a.m.) + 0.85 (10 a.m.) = 2.05 units Step 3: Combine breakfast bolus and amount needed to cover basal rate – this will be your breakfast dosage! 5 units (breakfast bolus) + 2.05 units (basal coverage) = 7.05 units Dose 7 units. *Reminder – repeat th Continue reading >>

## Dumping My Horrible Pump - Switching Back To Injections : Diabetes

Got a couple of requests for clarification as to why I think injecting will work better than Pump when my control right now isn't good. I literally feel like it's not delivering insulin to my system. I wish I had a better way of explaining it. I change my infusions more often than recommended, use insulin that's well within it's sell-by date and refrigerated, prime for any bubbles/issues with the delivery system multiple times daily but if I bolus for a high blood sugar the sugar DOES NOT GO DOWN. If I inject - it goes down immediately. My basal profiles are useless because I'm either running high for days on end or I'm low constantly and I have to drink juice like it's my job. I've spent hours and hours with my diabetes team and endo working on carb-insulin ratio and the various basal rates and I can't figure out why it's not working. I believe it's actually the pump model (Roche Accuchek Spirit Combo) but as I explained in my OP I can't actually change models for another 2 years for insurance purposes and I'm not willing to stick it out. Got another suggestion that it may be scar tissue. I tried to use longer canulas and I've changed infusion sets that I'm using but it's still a 1-2 weeks out of the month where everything goes to shit. I posted here a couple days ago because I have been just destroyed over my lack of control and completely unpredictable readings. Today was the last straw and I'm ready to dump my insulin pump and move back to Injections. I injected from age 5 to 21 and I had decent control - without doing much work for it. The pump was great for the first 2 years I had it but I have had it replaced with the same model 5X in the past 15 months - and the insurance will not allow me to change models for another 2 years. I'm fed up and I want to go back t Continue reading >>

## A Day In The Life: Mdi Vs. Insulin Pump Therapy With Cgm

As someone who has lived with diabetes for over 11 years, I have experienced life with multiple daily injections (MDI), as well as an insulin pump therapy and continuous glucose monitor (CGM). Either way, I am still living with diabetes, but these two lifestyles are fairly different in the way I manage my disease, and also my day. Let’s go through my typical day, from waking up to going to sleep, on MDI versus an integrated insulin pump with CGM. Morning My first alarm goes off, typically followed by a few snooze buttons. MDI: Wake up, check blood glucose (BG) to see how well my basal insulin worked overnight. Pump: Wake up, view my sensor glucose (SG) on my pump, and check my BG to see how well my basal settings on my pump worked overnight. Meals and Snacks MDI: Check BG, count the carbs I’m about to eat, do the math to determine how much insulin is needed, draw up a syringe of insulin (or the proper amount in an insulin pen), and take the shot. Pump: Check BG, count the carbs I’m about to eat, input my BG and grams of carbs into the Bolus Wizard, and press ACT. Throughout the day, I’ll often pull my insulin pump out of my pocket to glance at my SG levels. I look for trends on the graphs provided by the CGM to determine if I need to wait a little longer to eat or if I need to take a BG and have some sugar sooner rather than later. Post Meal/Snack BG Tests MDI: Take a BG. If I’m high, I draw up a syringe of insulin, and take the shot. Pump: Check my sensor glucose (SG) on my pump, and if I’m high, check my BG. If my BG is high, I put my BG into my Bolus Wizard, review the Bolus Wizard recommendation, and press ACT. Mid-Day MDI: Do nothing until I start to feel my BG levels dropping, so I test my BG and am low, so I have a snack. Pump: The Predictive Low aler Continue reading >>

## Pens Vs. Pumps – Why I Choose Daily Injections Over An Insulin Pump

There are several methods for delivering daily insulin doses to manage type 1 diabetes. The most often prescribed being an insulin pump. While this method is widely considered the most efficient for managing Type 1, I opt for “old school” insulin pens. When I was first diagnosed two years ago my health care team and family insisted I get on a pump immediately. They presumed it would be the most effective way for me to manage my blood sugar while carrying on with my already busy lifestyle. After six months with the Omnipod insulin pump system I decided to go back to the traditional daily injection method and have stuck with it ever since. Before I get into my decision for ditching my Omnipod I’ll share my opinion on the pros and cons of using a pump. The following is taken from my experience with the Omnipod which is a widely prescribed system. I have not tried other pump systems but much will apply to the variety of available models. Insulin pumps are extremely accurate, capable of delivering doses in increments of 0.01 units. These devices are currently the closest available thing to an artificial pancreas. This precision greatly decreases the chances of hypo and hyperglycemic episodes and improves hemoglobin A1C levels in diabetics. The onboard computer calculates dosages based on settings input by an endocrinologist, eliminating much human error (as long as the user is efficiently counting carbohydrates). With a pump there is no need for multiple daily injections, just a single inset insertion every few days, diminishing the frequency of pain experienced. The device also gives warnings and reminders to check blood glucose levels, great for a newly diagnosed patient learning to cope with type 1. Pumps eliminate the need for two different types of insulin. With t Continue reading >>

## The Art Of The Pump Break

Memorial Day weekend was a good reminder to me that bathing suit season is coming up, and along with the obligatory five pounds I try to lose every year for this season, I also started thinking aboutsummertime pump breaks. I dont mind wearing my pump at the beach people tend to take a look, raise an eyebrow, and move on. My OmniPod looks medical, so most folks assume it does something important, and thats it. Occasionally, someone will ask what it is, to which I usually respond Im the bionic woman, its mybattery pack. More raised eyebrows. Ahem. Moving on. There are times however, when I just want to be pump free for a weekend. I think most people with diabetes that wear a device or two relish a day without a plastic and metal device stuck to their skin. Aside from not having to deal with any questions or looks, it just feelsgood. Although we get used to our gear, it doesnt mean we dont like a little break now and then. For me, living in Southern California, summer weekends can mean lots of time in a bathing suit, which are the times when Im most tempted to take a day off from the hardware (I actually have a CGM sensor tanline right now from a few weekends ago. My dermatologist busted up laughing when he saw the oval shape on my hip. Then he chided me for not using sunscreen. Hes right. Digression). Although we are lucky enough to live in a time where we even have the option of taking a break, Ive found that going back to a basal-bolus regimen of multiple daily injections (MDI) is tougher than it sounds. Youd think you just take a shot of Lantus, remove your pump, and voila, inject your rapid-acting as needed. No dice. For one thing, I was on a split dose of Lantus before my pump. Although it claims 24 hour control, I did better when I took half the Lantus I needed for Continue reading >>

## Taking A Pump Vacation

Right now, I'm on vacation. To be more specific, I'm on an insulin pump vacation. Which, to be honest, it's not much of a vacation (still have the ole diabetes to contend with!). What is a pump vacation? It's taking a break from wearing an insulin pump for short period of time. I'm not switching back to shots permanently, although I do know of people who have done so after taking a pump vacation. Sometimes it's done because absorption isn't working well due to overused skin "real estate"; sometimes it's done seasonally (the freedom to wear dresses and skimpy bathing suits, for example); and sometimes it's done in advance to prevent damage to an insulin pump, like for a rafting trip. Some people even do it every weekend! My pump vacation started kind of by accident. When we last left off, my insulin pump had spontaneously combusted in Arizona while at a family wedding. As it turns out, the exact same weekend that my insulin pump broke, the insulin pump of my friend, Katie Clark, also broke! She signed up for a pump vacation, taking a respite from technology in favor of injections. When my new insulin pump arrived, I decided to take a cue from Katie and delay my pump hook-up a little longer in favor of a pump vacation. With the summer season around the corner, I started thinking that others might be considering a pump vacation and I want to share my experiences thus far. I should note that this is not my first pump vacation. In 2007, I spent four months attempting to do Dr. Steve Edelman's "untethered" regime, but it didn't work as well for me. Going "untethered" means using Lantus and using the insulin pump only for corrections and meal boluses. It's good for people who don't want to wear a "tethered" insulin pump, and who aren't sold on the patch pump either (at the tim Continue reading >>

## Why You Don’t Need An Insulin Pump

Tags: Perhaps my most controversial post ever, let me begin by saying this is not about bashing insulin pumps. I think they are a nice tool and a great piece of technology. They’re just not great enough for me to use. Nothing can compare to a fully functioning pancreas (duh) but, I find it interesting that most people I have talked to who have insulin pumps say they couldn’t live without it. They mean it, too! I understand. I used to feel this way. Yet, now that I’ve been off of the pump for a few years I realize I felt that way because of fear. I can assure you there is nothing to be afraid of. Please read on to find out what exactly I’m making a fuss about. I recently heard someone say, “if you aren’t on the pump you must be crazy!” Oh really? Let’s be more open minded here. First of all, why does it matter to me that people out there feel this strongly about having a pump? Well, because of the negative power these words might have on an individual who cannot afford a pump or who for some reason or other cannot get access to one. People should know it is very possible to manage their diabetes without one if that is the hand they are dealt at the moment. I would hate to think some people out there feel they don’t have good control over their diabetes because they can’t get a pump. This isn’t true but, they might be lead to believe it is. They need empowerment and those of us who feel strongly about using all that modern technology has to offer should think twice before speaking. Even my own doctor (I refer to him as my ex-doctor) laughed at me when I told him I wanted to get off of the pump. He said, “nobody goes backwards, people always want to seek to improve their blood sugars, not disturb them”. He disturbed me! What ignorance! (Its ok, he Continue reading >>

## Guidelines For Temporary Removal Of The Insulin Pump

correction factor (insulin sensitivity factor) is 4.0 the basal rate is 0.60 units/hr until noon correction bolus: 14.8 – 6.0/4.0 = 2.2 units Total dose: 2.4 + 2.7 + 2.2 = 7.3 units, rounded off to 7.0 2- Long term off pump (24 hrs or more): There are 3 options Give long-acting insulin (Lantus or Levemir) as basal, and rapid insulin for boluses Give intermediate-acting insulin (NPH or N) ** call the doctor on-call for this dose Give rapid-acting insulin every 4 hours including overnight, as per the “short term” example Calculate the total daily basal amount of insulin and give as a single dose of Lantus or Levemir. It can be given as soon as convenient. Then continue every 24 hours thereafter. These insulins cannot be mixed with other insulins in a syringe Take rapid insulin for meal, snack and correction boluses The carb ratio’s and correction factors remain the same as for the pump Children who are too young to give their own insulin may need to have a parent go to school to give the lunchtime dose. The basal rate is 0.50 units from midnight to 6:00 a.m., and 0.40 units for the rest of the day until midnight. The total basal is 10.2 units. The dose of Lantus or Levemir will be rounded off to 10.0 units, given once every 24 hours until the insulin pump is resumed. Since Lantus and Levemir are basal insulins, you cannot have a basal rate running when you restart the pump or severe hypoglycemia may result! Restart your basal approximately 18 hours after the last Levemir dose; 22 hours after the last Lantus dose.    If you want to re-start the pump earlier, set the basal rate at 0.00 units/hr until all the Lantus or Levemir has worn off. Extra blood sugar checks will be needed to see how your adjustments are working, especially after the first inj Continue reading >>

## Switching From Multiple Daily Injections To Csii Pump Therapy: Insulin Expenditures In Type 2 Diabetes.

Switching from multiple daily injections to CSII pump therapy: insulin expenditures in type 2 diabetes. CTI Clinical Trial and Consulting Service, 1775 Lexington Ave, Ste 200, Cincinnati, OH 45212. E-mail: [email protected] To identify variations in expenditures and utilization of insulin and other antidiabetes medications by comparing patients with type 2 diabetes mellitus using continuous subcutaneous insulin infusion (CSII) pump therapy versus multiple daily injection (MDI) therapy. Truven Health Analytics MarketScan Commercial Claims and Encounters Database and Medicare Supplemental Database for 2006 to 2010 were used in a difference-in-differences approach that took advantage of variation in the timing of the switch from MDI therapy to CSII pump therapy. Continuous users of MDI therapy throughout the study period were compared with those who switched to the CSII pump therapy during this period. Specifications included: coefficient estimates from cross-sectional ordinary least squares (OLS) regressions with: 1) no additional controls, 2) controls for patient demographics and comorbidities, and 3) patient fixed effects. Propensity score matching at baseline mitigated concerns regarding patient selection bias. While insulin expenditures rose during the study period, switching to CSII pump therapy led to sizable reductions in insulin expenditures. This reduction in insulin expenditures due to switching varied between \$657 (standard error [SE] \$126; P<.01) and \$1011 (SE \$250.60; P<.01) per year. This study demonstrated a significant reduction in insulin expenditures among MDI patients who switched to CSII pump therapy at various times throughout the study period. Continue reading >>