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RE: [IPk] Pump v's Lantus MDI - the 3rd way?


 Maybe I can persuade Sasha's consultant to let us try this regimen as he wont
hear of her having a pump.

 I have heard other people commenting on the fact that Lantus can sting when you

> 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 
> regimes.
> 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 
> hypo.
> Drawbacks:
> - 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 
> users.
> 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 
> control........
> 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 
> hugely.
> 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 
> cheaper.........
> 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.....
> Louis
> ***********************
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