Josephine's Pumping Adventure: Inquiry Regarding Insulin Pump Transition - Insights and Experiences

[Bluemarinejosephine]

Dear friends,

I trust this message finds you well.

I would like to inquire about your experiences when transitioning from insulin pens to an insulin pump. Did you observe a significant decrease in your insulin requirements? Personally, I have recently embarked on a journey with an insulin pump, and over the course of the past four days, I have encountered a series of hypoglycaemic episodes.

Prior to transitioning to the pump, my daily basal insulin regimen consisted of 18 units of Levemir when using insulin pens. In preparation for my transition to the Omnipod Dash, my diabetes nurse recommended a 30% reduction in my dosage, resulting in an initial dose of 12.35 units of Novorapid for the Omnipod Dash.

After four days of continuous basal testing – during which I abstained from consuming any food or beverages, including coffee and tea – my current insulin requirement has been reduced to a total of 10.5 units. As I am writing this, I am treating yet another afternoon hypoglycaemic episode.

I am interested to know if any of you experienced a reduction in your basal insulin requirements when transitioning from long-acting insulin to short-acting insulin for the pump.

I appreciate your insights and responses.

Thank you

Josephine

 

[In Response]

When I transitioned from MDI to pump, my DSN explained that we would need significantly less insulin on a pump due to the way it is administered.
Both my total daily basal and my insulin to carb rations were reduced.

I am surprised you were not told this when you had pump training and given assistance setting up your basal profiles.

 

[Bluemarinejosephine]

When I transitioned from MDI to pump, my DSN explained that we would need significantly less insulin on a pump due to the way it is administered.
Both my total daily basal and my insulin to carb rations were reduced.

I am surprised you were not told this when you had pump training and given assistance setting up your basal profiles.

Dear In Response,

Thank you for your quick reply. I was unaware. I was not told this.
Also, what kind of assistance did you receive in setting your basal profiles? I have one ‘starting profile’ so far which I am adjusting with the help of my diabetes nurse via email correspondence.

May I ask you please, how long did it take you to establish your correct dosage for your basal and for your bolus rates? It is my 4th day, I am sleepless, famished, very tired, and was hoping that I would have seen the light at the end of the tunnel by now, but I fear I have hardly started…

 

[ElenaP]

Dear In Response,

Thank you for your quick reply. I was unaware. I was not told this.
Also, what kind of assistance did you receive in setting your basal profiles? I have one ‘starting profile’ so far which I am adjusting with the help of my diabetes nurse via email correspondence.

May I ask you please, how long did it take you to establish your correct dosage for your basal and for your bolus rates? It is my 4th day, I am sleepless, famished, very tired, and was hoping that I would have seen the light at the end of the tunnel by now, but I fear I have hardly started…

Prior to my starting with my first pump (over five years ago) and prior to changing to my current pump 15 months ago, the DSNs asked me to do 24hr fasting in six hour sections. I then wrote down hourly readings. From these readings the DSNs worked out my hourly-basal rates which they input to the pump. That has worked well for me. I remember that when I started on my first pump, the total amount of insulin in a 24-hours went down from the volume that I had used with insulin pens.

 

[In Response]

Dear In Response,

Thank you for your quick reply. I was unaware. I was not told this.
Also, what kind of assistance did you receive in setting your basal profiles? I have one ‘starting profile’ so far which I am adjusting with the help of my diabetes nurse via email correspondence.

May I ask you please, how long did it take you to establish your correct dosage for your basal and for your bolus rates? It is my 4th day, I am sleepless, famished, very tired, and was hoping that I would have seen the light at the end of the tunnel by now, but I fear I have hardly started…

I think I was lucky as I had CGM readings for the basis and it took about 2 weeks to get a “reasonable” standard profile. From there I was able to adapt it for exercise days (I need to reduce my basal for about 36 hours after exercise and my pump has a maximum of 24 hours for temp basal), period week, sickness, summer and winter profiles. However, I continue to tweak my basal patterns and still adjust it 8 hours later.

However, that is my experience. Others take shorter or longer and most people have less profiles and do less tweaking,

 

[Bluemarinejosephine]

Prior to my starting with my first pump (over five years ago) and prior to changing to my current pump 15 months ago, the DSNs asked me to do 24hr fasting in six hour sections. I then wrote down hourly readings. From these readings the DSNs worked out my hourly-basal rates which they input to the pump. That has worked well for me. I remember that when I started on my first pump, the total amount of insulin in a 24-hours went down from the volume that I had used with insulin pens.

Dear ElenaP,

Thank you for your response.

I must admit, I had hoped for a smoother transition experience myself.

In my specific case, my diabetes nurse calculated my total basal insulin, which amounts to 18 units of Levemir. Subsequently, she deducted 30%, resulting in an initial Novorapid dosage of 12.6 units as I embarked on my journey with the Omnipod Dash. She was adamant that it wouldn’t be enough.

Having lived with type 1 diabetes for the past 15 years, albeit using pens, I am well aware of how unpredictable fluctuations in glucose levels can be. Thus, I took it upon myself to initiate a basal test on the morning I commenced using the Omnipod Dash. This basal test has spanned the last four days, during which I am only treating hypoglycemic events adhering to the DAFNE guidelines.

Through email correspondence, I have been diligently reporting my hourly glucose levels both during the day and overnight for this duration to my diabetes nurse. She has been making adjustments based on this data. However, we find ourselves still in the process of determining my precise basal rate.

I must admit that this uncertainty is disheartening.

Thank you once again for your ongoing support and guidance.

 

[Bluemarinejosephine]

I think I was lucky as I had CGM readings for the basis and it took about 2 weeks to get a “reasonable” standard profile. From there I was able to adapt it for exercise days (I need to reduce my basal for about 36 hours after exercise and my pump has a maximum of 24 hours for temp basal), period week, sickness, summer and winter profiles. However, I continue to tweak my basal patterns and still adjust it 8 hours later.

However, that is my experience. Others take shorter or longer and most people have less profiles and do less tweaking,

Dear In Response,
Thank you for this.
I have the same prolonged effect from exercise (albeit using pens).
This is a very helpful guideline.