Untethered at the Beach

Laddie_Head SquareMy summer beach vacation is approaching and I have already started a list of to-do’s, must-haves, and don’t-forgets.  Like most people with Type 1, I pack a double or triple supply of pump and CGM accessories, test strips, Novolog insulin, and all of the other paraphernalia needed to care for my diabetes.

I don’t normally keep long-acting insulin (Lantus or Levemir) at home as a back-up for my pump because I feel comfortable with an active and easily-filled prescription at a national chain pharmacy.  But when I go on vacation in a remote location or out of the country, I always take syringes and a vial of Lantus with me.  I could also take a vacation loaner pump from Animas, but for short trips I don’t bother.

Beach GraphicsAlthough my Animas Ping is technically waterproof, I don’t like to wear it in the ocean for fear a rogue wave might rip it off and send it down to Davy Jones’ locker.  Even in a pool, I don’t want to deal with the consequences of water intrusion while I’m away from home.   Because of the fear of theft, I would never leave my expensive medical device in a cooler on the beach or near the pool.  But at the same time, I don’t want to abandon the convenience and precision of my pump for mealtime and correction boluses.  And I cannot be without basal insulin for more than an hour without hard-to-correct blood glucose excursions.

My solution for beach and lake vacations is to use the untethered regimen for my insulin.  The untethered approach involves taking about 75% of my basal insulin by daily injections of Lantus (or Levemir) and using the pump for the rest of my basal and for most or all of my boluses.  The advantage of this is that it allows me to leave my pump safely in my hotel room or lake cabin for hours at a time because most of my basal requirements are being met by the Lantus injection.  The advantage of having my pump cover part of my basals is that I can program a bump in my basal rates during the pre-dawn hours.  Also, IMO it is better not to suspend the pump for hours on end so I have a pump pattern giving me a constant 25% of my basal needs to supplement my Lantus injection.  Some of this basal goes down the drain when I am not wearing the pump, but with my increased activity all day long, I actually don’t need it.

Lantus and PumpIf I am going to have a  daylong outing with required boluses of fast-acting insulin, I carry syringes and a vial of Novolog in a Frio case or even more conveniently, take along a Novolog pen.  But on this vacation I know that I will be close to the hotel all of the time and won’t need that option.

The best explanation of the untethered regimen can be found in a 2004 article by Steve Edelman.  Although I only use this regimen on vacation, there are others who use it every weekend or athletes who use it all of the time.

I was motivated to write this post after reading a 6/27/13 blogpost by Sarah Kaye Sugabetic.me  in which she describes how she juggles the use of her Ping pump along with her Omnipod.  She states that the Omnipod is great for POOL TIME and I agree that a Pod would be perfect for beach and lake vacations.  Unfortunately my insurance company is not going to pay for a second pump system just so that I can swim and snorkel tubeless a few days a year.  Sarah has also been spreading the idea of painting her Pods with nail polish and maybe my insurance will approve them because they are a fun fashion accessory in addition to being a life-saving device:)

In the past the untethered regimen has worked well for me on water vacations and I expect the same success this year.  It is also a reminder that there are creative ways to increase the flexibility of our diabetes tools by thinking outside the box.