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[IP] Diluting insulin--- (LONG!)

I have some thoughts on Carrie's question Friday about diluting Humalog for
her 5 year old.   Is dilution too much trouble?   Michael of IP responded
"yes". The real question is what works best?  I have found dilution both
easy and essentially no cost.

I am old to diabetes and new to diluting but for me it has been the way to
go since the first couple of days on the pump (end of Feb.) when the amount
of Humalog I needed for basals turned out to be .1-.2u/hr.  Some endos may
not even realize that Humalog can be diluted. My endo's  response to my
question about a diluted Humalog was that there would never be a market for
it because so very few people need tiny amounts  (Raise your hands out
there!).  Thanks to a wonderful person in this IP group, I found dilution!

My real concern, as for any of you on small amounts of Humalog, is that the
body and the pump work well together. As   MiniMed  phone reps  will advise
you, anything less than .3u per hour is not good.  Why?   One reason is that
when you try to reduce from .4u to .3u, you're cutting your amount by
25%--when you go from .3u to .2u, you're cutting by 33%, and when you go
from .2u to .1u you are cutting by 50%.   For a second reason, MiniMed says
you may run into clogging and/or NO DELIVERY with  amounts less than
.3u/hour.  For me, when I tried .1u and 0.0u, I had some NO DELs but I
wasn't sure why.  I have read in here that it "works" for some children, but
I don't feel confident that a pump will deliver less than .3u per hour
satisfactorily because of  the problem of "drop size" . I know Bob B. has a
piece on Disetronic pumps in the IP info. list, in which he says they can
deliver tiny amounts over an hour--ie., spread .2u over the hour.  Sorry, I
really don't believe it.  That .2u doesn't begin to get into your system
until it builds up to "drop size".  What is a "drop"?   When is it "big
enough" to drop off the end of the canula into your system? Good question!
I don't know the chemical description, but a drop of .5u Humalog primed on a
piece of wax paper will impress you that ".1u" is a mighty tiny thing if
it's supposed to be one-fifth of that. The tubing we all have is tiny but
not tiny enough  to "deliver" infinitestimally-sized drops.  Those "clicks"
you hear (with MiniMed) don't mean that the insulin is actually IN you with
each click, it is just building the drop size volume.   Increasing the total
volume of "liquid" going into you is going to help those "drops" move into
you---hence, diluting is a wonderful solution to what is really a volume
problem. Suddenly, I am able to dramatically increase the length of time I
can leave a site in and intermediary values like .25u are a wonderful thing
to achieve!
What took time for me was finding exactly  how to get the diluent.  Yes,
it's available from Eli Lilly, when ordered by your pharmacist, no
prescription needed, and FREE--- just call the number on the Humalog box.
But your pharmacist must order the diluent. It's sent to the pharmacist for

The bottles look just like Humalog ones, ie., same size--they can sit on a
shelf. I take one, remove the amount of diluent from it that I am going to
replace with Humalog and that becomes my "mixture" to use in the reservoirs
--make a new one when it runs out. Once humalog and diluent are mixed, that
mixture remains "usable" for about a month and is refrigerated.

You can make, for example, a 40% dilution (4ml out of the 10ml of diluent
are replaced with Humalog)---then you could change your pump insulin setting
from 100u to 40u  and the amounts of units would remain the same, ie., .1u
is really .1u, same effectiveness but the volume that would go into you
would be 2.5 times as great. A full 3 ml resevoir would then contain a total
of 120 units.

Dilution is really something you can do yourself.  It's not hard. I would be
happy to help if you have questions.
Cheers of the day!

Barbara (B.B.B.-yes, three of them)

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