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December 7, 2003

Insulin Pumps

Question from Tampa, Florida, USA:

I would like to change from injections to a pump. Have you ever heard of people doing the pump and injections? Not at the same time, but if they don’t want to wear the pump to a special event, like prom or a wedding, can they switch?


You always need to be able to give just injections if you have a problem with the pump and are waiting for a replacement. It is best to work with your own doctor to figure out how to best replace the basal insulin you normally give with the pump with injections. Giving the insulin you need before meals with injections instead of the pump is usually straight forward (unless you are using a complicated extended bolus/square wave bolus with meals). In short, yes, you should be able to work out a plan to be able to disconnect from the pump for an extended period of time.

I do sometimes have patients give insulin both with the pump and injections at the same time although this not standard procedure. I often give half or more of the daily basal insulin requirements with a once a day injection of Lantus. If the person wants to disconnect the pump for more than an hour or two at a time, having the Lantus already working, makes this easier. If the person is very active, instead of lowering the basal on the pump, they may be able to disconnect the pump for a several hours if they are giving enough Lantus to cover their lower basal requirements with exercise. Since they are still giving part of the basal with the pump, they can still vary the basal at different times of the day by giving different amounts with the pump so they still have that advantage of the pump compared to giving all their basal as a once a day Lantus. Remember, even if you aren’t eating, you need some insulin working 24 hours a day (your basal insulin).

Whatever you do, it’s best to plan ahead with the doctor, nurse, or pump trainer who is going to be supervising your pump therapy so you can tailor your plan to your own needs.

Additional comments from Jeff Hitchcock, CWD Founder and Editor:

Two posters presented during the 2003 ADA Scientific Sessions indicated that pump users can take a “pump vacation” by using Lantus and NovoLog or Lantus and Humalog and maintain the same level of control:
Type 1 Diabetes Patients Can Temporarily Switch From Continuous Subcutaneous Insulin Infusion With Insulin Aspart to Basal Bolus Therapy With Insulin Aspart adn Insulin Glargine (view poster)

Switch to Multipel Daily Injections (MDI) With Insulin Glargine (Lantus®) and Insulin Lispro (Humalog®) From Continuous Subcutaneous Insulin Infusion (CSII) With Insulin Lispro–A Randomized, Open-Label Study Using Continuous Glucose Monitoring System (CGMS) (view poster)