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[IPk] Pump v's Lantus MDI - the 3rd way?
About six weeks ago I started experiencing very high BG's for no apparent
reason, while on my new D-Tron Plus (Humalog). I was having problems with
the sites becoming red and swollen, though not full infections, and so I
started to change my Tender sets every 48 hours. This did not bring the
high BG's down, and they remained in the teens.
After a week of endless set changing, scrutinising for mechanical problems
(on my new and seemingly good D-Tron Plus), and extra careful carb
counting/testing, I raised my basal rate from 16u to 19u, spread evenly over
24hrs. This had little effect on my blood readings, and I began to worry
about my control on the pump.
After careful deliberation, I decided to go to the hospital and ask to try
Lantus - why not? what was there to lose?
The nurses and doctors agreed that the BG's were high without obvious
explanation, though a urine test had revealed some white blood cells
indicating a possible urinary tract infection.
Nevertheless, with my sugars running high (not below 11mmol unless I
injected Humalog instead of delivering via pump), problems with site
infections, and a judgement that the Humalog itself was causing large BG
swings prior to the problems.....
I TOOK OFF my pump, and started on a Lantus(Glargine) and Novorapid MDI
regime. The nurse worked out an initial dose of 24u Lantus to be taken at
10pm each evening, based on a total daily dose of 40u Humalog on the pump.
Armed with precise carbohydrate counting, and adjustment of insulin dose for
exercise/food types and volume, learnt from my time on the pump, I can
honestly say that it has been a complete success so far, over the past
month. I have had regualr BG's throughout the day of between 5 - 9mmol,
unheard of on the pump or previously under Insulatard(evil)/Novoapid
The move from Humalog to Novorapid is also significant. The Novorapid
action curve is less sleep than Humalog. I find this beneficial, as although
my BG can rise intially after a meal - after three hours it GRADUALLY
returns to between 6 - 8mmol, as opposed to with Humalog, where the BG
returns to normal more rapidly, and the rapid drop in BG can *seem* like a
- I have to inject again, and have therefore had to be careful to rotate
sites on my stomach/side/bum as I have very little fat, though this is a
minor inconvenience in comparison with set changes/wearing a pump
- I have also had to adjust my Lantus dose if I have taken heavy exercise -
I am still perfecting this, and snacks are needed during exercise due to the
background unsulin flowing around.
- The Lantus is also quite painful to inject - this has been noted by many
My improved control on Lantus is also surprising given that I do not have a
*flat* basal rate. On the pump, my hourly basal rate - settled over an 8
month period, varied from 0.5u at midnight to 1.3u in the early morning,
indicating a dawn phenomenon and therefore uneven insulin requirement. My
fasting morning BG using Lantus have been between 3.8 and 9mmol (WOW! - for
me this ia great surprise) and I have felt energised on waking and during
exercise. I await my HbA1c in two months for a complete picture of my
I moved from MDI (Insulatard/Novorapid) to pump therapy in February 2002,
due to very high morning BG's and likely night time hypos. I should add
that I tried using Humalog three years ago, pre-carb counting, and I found
it made my sugar swing too quickly, giving false hypo warnings. I have been
a huge fan of my Disetronic pump and it improved my BG and quality of life
My move from the pump onto Lantus, which some may see as backward - to me it
seems sideways and upwards, has further improved my control, althougn quite
marginal in terms of readings, and I hope that this may continue. If I am
able to achieve similar/better control using Lantus/Novorapid MDI, I would
much rather be taking injections than using a pump. Oh, and its
At the risk of jutting my head out over the parapet - for those like me, who
have moved straight from Insulatard regimes onto a pump (Lantus came out
after my therapy switch), and who never used carb counting under MDI, Lantus
may just be worth a shot.....
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