Justin Delgado is husband to Kacie Doyle-Delgado, diagnosed at age 11. After more than a decade together, he considers himself to be an expert carb counter and Dexcom inserter. He graduated with his Master of Science in Finance from the University of Utah in 2013 and has been working in commercial banking since then. He attended his first Friends for Life conference in 2015 and is looking forward to volunteering with the teens.
March 6, 2005
Blood Tests and Insulin Injections, Insulin Pumps
Question from Charleston, South Carolina, USA:
Last summer was my daughter's first time on a pump while she was on the swim team. Her practice generally runs two hours, six days a week. She been type 1 for a year and a half. We had a terrible time with the sites and disconnecting and she'd shoot up like crazy, then later be low. We worked very hard to control this, but the summer was very hard. Her A1c went from 6.9 to 8.1. This summer, we would like to do Lantus and NovoLog so we don't have all the problems of last year, not to mention the cost of all the infusion sets, having to change everyday. How long would it take to regulate her back to this regimen? Would it be worth it if to only go back to the pump in September? The pump has been a godsend, but she does get irritated being connected 24/7. Any thoughts?
Here are a couple of thoughts:
First of all, switching back to a basal-bolus plan using multiple daily injections (MDI) with Lantus and NovoLog is easy and should be relatively simple switch. Will it be “as precise” as the pump? No, but you already knew that. Could it be as effective as the pump? Maybe. In fact, I think all pumpers should have Lantus as their “back-up” plan in case of pump mishap so they can continue their basal-bolus insulin regimen but use Lantus as the basal (instead of the continuous infusion of NovoLog/Humalog via the pump). You would still give NovoLog (by injection) based on carbohydrate counting.
Certainly, you can choose to disconnect during swimming, but keep the insertion site there. You certainly do risk losing the site as the adhesive gets wet. There is a newer adhesive that is supposed to be super bonding. Your pump trainers might be able to help.
Another idea is one that is gaining popularity. I have only had a couple of patients try this. It is sometimes called “untethered pumping.” In essence, it is a combination of pumping PLUS Lantus. Instead of giving all the basal insulin via the pump, a good portion of the basal (maybe up to 50%), is given as Lantus. Thus, when you disconnect from the pump, you still have some basal insulin, Lantus, on board.
I think the easiest change is just to switch to shots during the swim season and then go back to pumping when swimming is done. But, untethered pumping is a keen idea, perhaps.
Please do not make any changes without consulting your child’s diabetes physician.
[Editor’s comment: Whatever regimen you end up using, keep in mind that some of post-race high blood sugars might be adrenaline-related and may require a smaller correction since they may come down some on their own. Also, post-exercise lows that occur six or eight hours (or more) later can sometimes be avoided by providing a higher fat meal or snack after the exercise occurs.