More than once I have written about using injections of Lantus in combination with an insulin pump. Although I have good results following this regimen, I tend to abandon it after a few weeks because it adds complexity and expense to my already complex and expensive diabetes life.
For those of you not familiar with the idea of using injections of a long-acting insulin along with pump therapy, this strategy is called the Untethered Regimen. It is described in a 2004 article by Dr. Steve Edelman as a plan where the user takes a pre-determined amount of basal insulin by injections of Lantus (or other long-acting insulin) and uses the pump for the rest of the daily basal requirement and for most or all of the required boluses. This approach allows a pumper to disconnect from the pump for long periods of time without worrying about erratic blood sugars and even DKA. The user still benefits from the flexibility of the pump with the ability to precisely dose for meals and corrections and to use temporary basals as needed.
In my previous experiments using the untethered regimen, I had the following pros:
- Smoother basal action
- Better pre-breakfast blood sugars
- Fewer highs from changing infusion sets
- Less risk of DKA
- Ability to have pump-free time
Somehow the cons always won out and I went back to pumping 100% of my required insulin. The disadvantages I experienced were:
- Hassle of shots on schedule
- Not enough flexibility for temporary basals
- Loss of prime on my Animas pump
- Increased cost
- Insulin plan more complex
So why I am rehashing this topic now? As you can probably guess, I am back using Lantus along with my pump. I have been struggling with overnight BG numbers for months, most noticeably spikes in the middle of the night followed by early morning lows. I have tried multiple changes in basal rates with little success. Similarly reducing evening snacks, changing my dinner menu, and giving up alcohol didn’t reliably fix the problem. My guess is that I have been dealing with a hormonal “dawn phenomenon,” but the pattern has not been reliable enough to make huge and somewhat scary increases to my overnight insulin.
About 10 days ago I decided to add Lantus to the mix. Rather than using two injections for 75% of my basals as I did in the past, I am giving 50% of my basal in one injection of Lantus at about 8:00PM. So far this is working great and I am not experiencing the negatives that I did in my previous Lantus trials. I’ve had night after night with few or no Dexcom alerts. I don’t need a “get-out-of-bed” bolus as I have required for several years to prevent my blood sugar from rising before I eat breakfast. My daytime BG’s have been more stable with fewer corrections required.
Why is it working so well? Magic, maybe. Actually I think that Lantus is providing a more stable foundation than the fluctuating pump rates I was previously using. I wonder if I have been experiencing pooling of insulin while asleep and that is not happening with Lantus. I have definitely been having itchy pump sites and even a few infections in recent months so maybe my insulin absorption has not been good. I suspect that whatever peak Lantus may have is matching up with my need for increased insulin in the early morning. Maybe I am just paying more attention to my diabetes and making better decisions over the things that I can control.
The fact is that although I don’t completely understand why, the untethered approach is working for me right now. When I wrote about this regimen previously, I was either using it temporarily for a beach vacation or calling it an “experiment.” I have a different feeling this time and can see it being a permanent change. Rather than feeling burdened by the scheduled Lantus injection, I feel a weird sort of freedom as BG numbers have been more consistent and less of a bother.
After having had Type 1 diabetes for almost 40 years, you’d think that I would have long ago given up on improving my diabetes care. I guess I’m just hard-headed or stupidly optimistic. Or maybe I just need to try new things to escape the boredom of a relentless day-to-day chronic illness. Whatever. The untethered regimen is working for me right now and that’s my story.
If you’re interested in learning more about the untethered regimen, check out the posts listed below.
Disclaimer: Nothing I say here should be construed as medical advice and please do not change your insulin regimen without consulting your medical team. At the same time remember that diabetes is a life-long science experiment (Thank-you Ginger Viera!). When things aren’t going well, take time to investigate different ways of eating and alternative ways of dosing your insulin. And no matter what, keep testing your blood sugar and always carry glucose tabs:-)
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It would be nice to do the same thing and always get the same result. Kudos to you for remaining “stupidly” optimistic after 40 years. Bravo! Well done. That, in itself, is something to pat your back over. That your new regimen seems to be improving your numbers is just icing on the cake. 🙂 Have a great weekend.
Thanks for sharing your insights on this method! This really gave me the incentive to try this out one more time. I used to do the untethered regimen three years ago just after I got my pump. My reason: I had serious troubles to retain stable bloodsugar levels. Especially in connection with sports. My body reacts very sensitively on rapid acting insulin. For me insulin glargin was far more reliable. However, everybody including my diabetologist forced me let go off Lantus. “It”s all about the basal rate which isn’t perfect yet” they said. For three years I’ve been working on the perfect basal rate, but still I’ve been quite unsatisfied with my pump-therapy lately. Now I gave the untethered regimen another chance last week after reading your blog post. And so far it’s been working great! Blood sugar levels are far more stable and reliable!
Thanks for reading, Michael, and I am glad things are going well for you. I continue to have good results with this. I am especially grateful for a phone alarm reminding me to take the Lantus every evening:-)
I’d be interested if you are still on the untethered regimen. I’m still doing it and I can say it’s getting better every week. I’ve started to do a lot of running recently (Marathon in October) and I reduced my Lantus rate accordingly. I’m down to 5 units of Lantus every day now which are accompanied by about 4 units of Novo Rapid that are mainly scheduled for the night and afternoon/evening. From 8 am to 2 pm and from 7 pm to 10 pm I’m only on Lantus and it works!
I’m so happy I plucked up the courage to give this a try.
Yes, Michael, I am still taking Lantus every day. 5 units in the evening. Thanks for checking in to let me know you’re having success with this regimen. The science experiment that is our diabetes….