My question is with regards to the “Un-Tethered” system for using Lantus with the insulin pump. I wrote to you last month about my son and his episodes of mild DKA from the pump because of disconnecting for sports or because of tube clogging. You gave me the information about the un-tethered approach and, to me, it sounded great. My son’s doctor had never heard of it and seems reluctant to let him try. Has this approach been used widely and are there any drawbacks? To me, it seems like a safety net to use with my teenage son who is not always as diligent as he should be when he is in school about checking blood sugars. Are there any dangers? I am not too familiar with Lantus.

If your diabetologist is unfamiliar with and you and is unwilling to “learn” about un-tethered insulin on your child, then I would not pursue this.

Basically, “un-tethered” insulin pumping is a compromise hybrid of pumping and injections. I presume you already read about The Un-Tethered Regimen on this web site. In essence, you give injection of background, long-lasting, insulin in combination with the continuous infusion of rapid-acting insulin provided by the pump. The rates of the rapid-acting can be diminished, given the addition of insulin from the injection. The rationale is that if there were planned or unintentional disruption of insulin from the pump, serious consequences, such as DKA, could be reduced because there was still “background” insulin from the shot of the long-lasting insulin.

I prefer insulin glargine (Lantus) but one could also use Ultralente or even NPH or Lente, but with caution due to the “peaking effects” of those insulins. If you are not familiar with Lantus, then perhaps you do not even have a “back-up plan” in case of pump failure or problems.

I strongly suggest that you have some serious one-on-one sessions with your diabetologist and/or your Certified Diabetes Education team and review insulin options, pumping, etc. Again, based on your (very good) questions, I wonder if you and your son got promoted to pump therapy a bit prematurely. But, you can get better educated! Open up some good dialogue sessions with your various diabetes team members.

DS