Hi… I’ve been on MDI since diagnosis and 0.25 mg of ozempic (my endo’s theory is that it can extend honeymoon in newly diagnosed) and am very active active. All of this has me on very low insulin doses. 6-8 units basal and 1-2 units for bolus for correction. Pre bolus is hard, because the same food may take me up to only 180 in the am, but up to 300 in the evening or vice versa depending on activity and a unit can drop me down a lot. My IC ratio is like 1: 75. I was started on lantus and aspart by my PCP a year ago and the endo didn’t change because they said it shouldn’t matter and my A1C and TIR have been pretty good. After much argument i got them to switch me to Tresiba for basal and it has been great. Lantus was really not lasting a full 24 hours causing highs by dinner and the correction for it was causing lows all night. The lows were making my a1c look good, but i was exhausted.
Now i’m curious about my rapid acting too - The aspart takes like 45-60 minutes to act for me for either pre bolus or corrections. Any thoughts on other insulin I should bring up to my endo?
I’m also curious about omnipod/pump options, but i’m not sure if i’m taking enough insulin to warrant it. What are normal T1D doses like for adults like? Is there a minimum dosage to qualify for them?
Are there smaller pods for kids/ 1/2 unit pens that adults can get?
So there’s humalog and amdelog as well as aspart. But the action is similar for me… you could try them and perhaps one works better or faster for you.
Pods require 85 units to turn on. They die automatically at day 3 regardless of remaining insulin. Tandem Medtronic and iLet pumps are different in minimum cartridge load and I can only speak to tandem and Medtronic, but you could conceivably put 30-40 units in them and get about 3 days out of the infusion sets. No there is not really a minimum insulin threshold for pumps but Medicare (for example) may have a maximum c-peptide for you to qualify Good luck
Hi @pady87 . The effects of exercise can last a while - even several hours after you finish, although just how long varies from person to person. Have you tried adjusting your meal dosage based on your activity?
Activity mode available on most pumps helps manage lows during exercise although the user needs to figure out how far in advance to start it and what the duration should be - generally trial and error.
Omnipod comes in only one size and their minimum fill is more than you need while their 3-day “lifespan” is less. There have been a few times that I added more insulin than I needed, or when I had to remove one early, and pulled the excess out - and while it’s not difficult it is rather annoying and some people are hesitant to “recycle” insulin. Unless things have changed Omnipod is commitment free so if you don’t like it you can go back to injections or switch to another pump. They used to send a non-working sample to try on “for size”.
It’s been a while since I’ve used a tubed pump and I don’t recall minimum fill but those would give you more flexibility.
That said, don’t forget the saying “If it ain’t broke, don’t fix it.” Some people do require a pump, but if you’re new to using insulin it may be a matter of figuring out just what works best for you. It’s something if a matter of trial and error combined with record-keeping to help determine patterns.
I highly recommend you check out the book Think Like a Pancreas by Gary Scheiner. He has Type1 diabetes and works in the field so has a unique personal perspective that is particularly helpful and might give you some food for thought to discuss with your endo.
All the best to you.
@pady87, volume of insulin needed, number of units per day, to manage YOUR diabetes shouldn’t be compared to what other PwD might use - we are each unique. As background, looking back, I believe I went through “honeymoon” - a HORRIBLE period during the year before I was diagnosed with diabetes 68 years ago; I regularly eat 225+ grams of carb every day.
My 30 day average [I use a Tandem pump] basal has been 5.71 units and bolus 13,74 units; my 90 day TIR is 92% with only 1% low. My I:Cr breakfast 1:9, lunch 1:22, supper 1:15, late evening snack 1:22; I’m more active than most octogenarians. The only time I bolus before actually beginning a meal is if I well above my 110mg target - for supper I wait until I’m into the creative meal my wife has prepared - the carbs on my plate might carry anywhere between 55 and 120, so I make my guess after tasting. Remember when changing your I:Cr, that the larger your dominator “75”, the smaller your insulin dose.
Does your doctor have a “guess” as to why the Aspart takes so long to become effective - when I used Novolog with a pump I never noticed a delay like that - maybe you could experiment with the FIASP - the Ultra-Rapid version of Aspart.
@Joe pointed out how much insulin you would throwaway with each OmniPod [a reason I haven’t used them] so you may be better off with a Tandem or Minimed [Medtronic brand name] pump. With both my 3 MiniMed pumps and with my Tandem pumps I have changed my infusion cannula insert on a three day schedule and switched out the Reservoir/Cartridge only on every other set change - I don’t like throwing away insulin. On pens, yes there are half unit insulin pens [an age restrictions]; do research and buy what fits your needs.
Hey @pady87 good to hear from you again. Sorry to hear you are on a stretch of rough road. There’s so much in your post, any chance you’d be willing to talk on the phone? I’ve got a couple of answers for you but there’s a lot of stuff it’d be better to talk through.
Faster insulins than aspart: Fiasp, Lyumjev, Afrezza
A faster insulin might not help. Aspart is already faster than the insulin your pancreas produces. A healthy body regulates glucose levels with relatively slow insulin and faster acting glucagon to keep glucose level up.
The requirements for insulin pumps vary by insurance plan. Generally Omnipod pumps require nothing more than a prescription. Some plans require a prior authorization for pods, I haven’t seen a requirements document for that yet. For pumps like Tandem and Medtronic that are usually covered as DME here’s the document that applies to my plan as an example. CG-DME-51 External Insulin Pumps You’d have no problem getting a pump on my plan.
There are pens than can deliver .5 unit doses. Note they all have a minimum dose greater than one unit. For aspart your endo would switch you from pens to penfills and prescribe either a NovoPen Echo or Medtronic InPen. For Humalog or Lispro Lily makes a “Junior Kwikpen”.
Of all the things you asked about I’d say a half unit pen is the best thing to bring up with your endo until they talk to you about a pump. You are a super complicated patient and while your endo can estimate some things that are going on in your body there’s a lot more they have no visibility into. You’re both doing your best.
Curious, non-medical-professional brainstorming here:
No one wants the honeymoon to be over and their pancreas to finally deliver its own final drop of insulin, but that period does make things even more unpredictable than they might be otherwise. So while making your own is preferable I wonder if eliminating that particular variable when the time comes - rather than prolonging it - might make your body’s responses more predictable?
I did a quick (very quick) Google search and found Ozempic can increase the risk of hypoglycemia: so if your body is still producing some of its own insulin - and unpredictably at that; and you are injecting; and your body needs very little added insulin right now, I wonder if Ozrmpic might be adding to the complexity of your treatment?
Regarding Lantus, I have read that some people split their dosage into two shots, morning and evening to get the coverage they don’t quite get with one larger injection.
Sharing some thought to discuss with your doctor if you haven’t already.
My endo and educator who have a lot of experience with cases similar to mine and advised me ozempic would prevent hypos - which it did. Even the minimal dose of ozempic seems to regulate my numbers pretty well - I notice a change at the end of 7 days or if i miss a dose. So i’m inclined to continue with it,
On lantus, i did resort to splitting doses towards the end as well as varying my dose from 4 - 10 units a day based on activity and monthly cycle day. Tresiba lasts a good 24 hours and i’ve only had to vary it between 6 and 7 units. The lows are almost gone at night.
One thing I learnt at last appt was that aspart is only good for 28 days once you open it even if not refrigerated - so they thought maybe it was just not potent enough… Mine was over 6 months old since i use only abt 10 units a month. So i’ve started throwing away most of my fast acting which is why i wanted to see smaller dose options. But even with a new pen, it takes about 30-45 mins to kick in. I will ask about the Fiasp. Thanks!!
So, i prebolus if i’m at >110 at mealtime and decide on 1 or 2 units based on type of meal. If i’m < 110 at mealtime, i bolus if i’m 250 and going up 1 hour after a meal - 1 unit for 250 and 2 units if over 325.
hi @pady87 all insulin, any formulation, is typically “good for 28 days once opened or used for the first time”. I recommend asking the doctor prescribe a 3mL vial/pen, which are typically available.
That is super helpful - Thanks! I did get the book the first time you recommended it to me - finished reading it and is on my coffee table for reference.
Yes - i do adjust meal and insulin doses with activity, but insulin adjustment is tricky at low levels - hence the 1/2 unit question.
I am using the 3 ml pens. So, some insulin - like tresiba says its good for 56 days - i use it up in less than 30 days so it hasn’t mattered, my educator did say its not been important to look up or mention bc most T1s on insulin use it up before that.
