Hi @mamamaegs . I’m so sorry about the frustrations you’ve had with pumps. This may not be anything new but there are “smart pens” available for dosing. As I understand it they work with a CGM to help calculate what to take.
Bigfoot is apparently the newest one - I’m not sure it’s available yet.
Thank you for that tip, Dorie. I have an InPen gathering dust in my closet, yet what I really need is smaller dosing increments. Half a unit of rapid is wayyyyyyyyyyyyyyy too much for me to use with corrections and many lower carb meals/snacks. I end up feeding my insulin, and even take carbohydrate with my correction dose to lower my glucose more safely. The “memory” on the smart pens would be helpful, though, as I often find myself in that panic of, “did I just do the right number of units?? How many did I actually fire into my skin?!” This panic seems to be more common with my “silent” pen that I do not hear “click,” even though I don’t ever count every audible click on my other pens. Usually, I remember if it was a lot or a little, though :). Sanofi may have a smart pen for their long-acting which would be more helpful than the rapid InPen. It’s like a white knuckle grip for 4 hours versus 24 hours should an error occur. Overall, it’s difficult enough to be going through a lot of my challenges with the best in precise tools and medications. Without them, it gets more desperate.
Thanks for that throw back, Dennis. Since the first one was taken off the market for safety reasons (lung tissue is very delicate and susceptible to cancer apparently), I haven’t looked into them a lot. The first version was also a fixed dose of insulin that at the time required a lot of carbohydrate 3 times a day to cover. I’m really insulin sensitive right now, and if back in the day it was 45-55 grams of carbs needed per meal, it’d likely be closer to 100 grams 3 times a day now. I am really needing very small dosing increments, sometimes just 8 TDD (basal and bolus). This likely means I need to figure out why my capillaries keep getting knicked with infusion sets and be allowed pump therapy. I’ll give a quick look at the dosing of the inhaled insulin again, though–thanks! And, I do love that it may get insulin into people sooner who are reluctant to do injections. Or, even for those of us that can have more pain associated with shots.
Bummer, Dennis. A quick google search led me to this: “It is important to know that each unit of injected insulin is equal to 1.5 units of Afrezza. That means that the smallest dose of Afrezza is equal to just over 2.5 units of injected insulin, which may be difficult for people on lower doses of insulin.” It looks like the inhaled insulin will be great for the more insulin resistant. I’ll keep looking to see if smaller dosing units become available, though. Keep the ideas sent my way–thanks!
I hope they soon come up with some that deliver “micro-doses” (I’ll call it that - don’t know if it’s the true term). I know what you mean about panicking over “Did I our didn’t I - and how much🤔?” was sometimes a big issue when I took shots. I trained myself to make a mental note - right after injecting I’d say “I took my insulin” and that helped. That was way before trackers which I use now but it’s still great to use a device that records so I can enter after the fact if need be.
Ya, the panic real…particularly when you’ve inverted a few rapid/basal doses in your life :). I’ll remind my endo that I am interested in the newer long-acting “smart” pen. I try to journal my dose right away, yet I get bombarded with “hosting thoughts,” and to put it mildly, it can be dangerously distracting. Micro dosing pens would be great. Fingers crossed, my underlying issue of excessive bleeding can be addressed.
Yep - I know those distractions well! Some people prefer handwritten journals but I’ve come to prefer apps (in no small reason because sometimes it’s hard to read my own writing!). Sugarmate is very popular.
Thanks–I’ll look into Sugarmate. I have Glooko downloaded, as well as my generic meter’s software, Carelink, and Clarity, yet I rely on the chicken scratch to quickly review my numbers as I am needing to be less than elegantly patient and titrate rapidly. It’s easier for me to flick through my food and BG journal than to upload my reports. My endo did mention than Sanofi was going to have some kind of smart pen attachment that would log doses, yet I am not sure if it is for Lantus. I think the discussion was dropped because like the InPen, it was only for rapid. With my mental distraction, and that I start injecting at 3:30 a.m., I really need that “history” safety net to make sure that I did it all correctly. Beyond a bit tuckered 
Messed up a dose timing today…and needed the grocery checkout buttons hit for me twice in one easy transaction, forgot about 3 turn offs while driving, said thank you when I meant no thank you, etc. today And, keep me posted on micro bolus advancements with pens and/or syringes!
Now, I’m feeling somewhat silly about my smart pen responses. I replied via my personal email and your attachments didn’t come through. Bigfoot does look like a nice option, yet I am uncertain about the Libre CGM. Doesn’t it only give readings when scanned? I need that bad boy waking me up in the middle of the night without a scan. I also don’t understand if I can purchase each component individually, or it if has to be purchased as a system. Maybe one system could be purchased and then the smart pen caps reused for a period of time. They still didn’t address my most urgent need of micro bolusing, though. I hate “feeding” insulin when I’m not choosing to eat. I feel too lousy at mildly elevated glucoses to not give a correction bolus, yet 0.5 units of rapid is usually too much insulin which makes me need to take it with carbohydrate even though my blood sugar is high. Obnoxious and not the best weight management plan. Same goes with the long-acting. On a nicer note, I just had xylitol, cinnamon, and ginger sprinkled on cucumber slices and that was some carb-free greatness
First of all, interesting snack you mentioned at the end. I recently bought some mini cukes and you reminded me to use them - I’ll check out your spices!
The Freestyle Libre2 does alert even without swiping, although you do have to swipe to see what your number is. As long as it’s within 20 feet you’re good. The initial Libre comes with a transmitter, receiver and sensors. You get refills of sensors only.
I wish I could say more about the caps but perhaps others on the forum could. I read briefly about Bigfoot a while back and I think it works/will work with both long- and rapid-acting insulins.
You’re super sensitive to insulin! Apologies if you said this before and no need to answer if you prefer not, but how far does 1 unit cause you to drop, and what do you consider a high reading?
What I’m about to say comes with a great deal of caution and you should definitely have a deep discussion with your doctor, but have you thought about some of the older formulations of insulin? It’s been so long since I took them I almost hesitate to bring them up but I started out with U40 then U80, then U100 of NPH (background) and Regular (for meals) As the “U” goes up the number of units needed goes down. I hear some people use U200, which takes half the dose of U100 for the same response (by way of example). The old form have different peaks and valleys than the ones typically used now and I’m not sure which are still available. But it might be worth a talk with your doctor, and I don’t know if they even come in pen form but you never know. @Dennis @joe any thoughts?
You’ll like the cucs! Someone shared with me that sprinkling sugar on cucumbers was supposed to make them taste like watermelon.
And, good to know about the Libre. My endo mentioned it while I was having issues getting Dexcom and the Guardian shipped to me, but it didn’t really go further. A distributor that I chatted with mentioned something about it not being as effective for T1’s, but I forget her point. Happy to know that it’s not about alarming without swipes for overnight protection. And, it looks like Bigfoot is up and selling, yet they are doing an odd shipment package scenario. I’ll ask about the caps, it’s minor in comparison to needing micro boluses, yet it will be helpful. If I have to buy the whole system once, so be it, I suppose. And, I am feeling like a fraud. I am sooooooooooooo insulin resistant since yesterday afternoon. I knew I shouldn’t, yet I really indulged in dairy. Even when it’s carb free, like cream cheese, it sky rockets my blood sugars for hours. I was still dealing with it at 5 a.m. today. Most other days, it ranges, yet for the last 3 years or so I have been more insulin sensitive than makes sense. When on my pump, I do a 1:80-115 ISF with TDD basals nearing 8-10 units and I:C being 1:30ish. I get all of the math tested, and then I fluctuate sensitivity and it becomes even less precise and I just eat the same every day and mildly exercise at the same day, etc. to counteract it all. I supplement with a ton of carbs, even at 8 units basal, yet I can’t seem to get it all dialed in without feeling poorly from hyperglycemia. Prior to these last years, I was fairly typical with an ISF of more like 1:45, I:C of 1:15-17, and TDD basals of 20-28 units, with the exception of the 3 days leading up to my period when I would be insulin sensitive and need about 30% less insulin. My cycles are now very irregular and I don’t have the same kind of prediction of when I will be extra sensitive, yet some of my extremes are reminiscent of those PMS kind of days. I oddly rise out of hypoglycemia slower now and need far fewer carbs to treat a low, too. I start with 8 grams, sometimes 4 grams and wait 30 minutes before treating again. There’s so much junk and back history, yet to yoru question, I also keep my goal range very tight (and unrealistic) of below 92 mg/dL. I had a severe, I don’t even know what to call it, stretch where my body inflamed everywhere if my blood sugars went higher than that or if I ate inflammatory foods (grains, dairy, legumes, nightshades, sugar alcohols, etc). My feet were so swollen I couldn’t lace my shoes, my wrists ached to the point that I couldn’t open my test strip vial, and I just felt on fire at my extremities. I am getting more confident with mild hyperglycemia as those extremes rarely re-emerge, yet the typical symptoms of fatigue, dehydration, polyuria, hunger, etc. seem very amplified to me as compared to years past when my blood sugar was 120 mg/dL, etc. It’s difficult, and likely very difficult to guide me clinically because my standards are dangerous, yet preventative of what I find so dangerous, pain and discomfort. I can’t believe I went through the worst without CGM. Now, I am trying to navigate it all on MDI and many spontaneous/I didn’t realize I suddenly fell asleep naps are happening when I hit the 100’s mg/dL. The naps are needed after waking up all night long to urinate excessively with a blood sugar of 107 mg/dL. Yet, if I am not doing that, then I am treating 55 mg/dL readings at 2 a.m. with this over and under MDI basal jazz. Fingers crossed, I can get at least a fighting chance back with a functional infusion set. Again, keep me posted on micro bolusing pen options or innovative new pump designs
@wadawabbit thanks for the tag,
@mamamaegs , Eli Lilly makes “Sterile Diluent” which is a fancy name for pH controlled sterile water. You make your own U10, U20, U50 insulin by, …well…, adding water. This makes an injected “1 unit of insulin” which by the way any old pen or syringe can do, contain only a fraction of a unit (e.g. 0.5 0.1, or 0.05 units of insulin or any fraction you need). Not sure if this is helpful, but it is something you could do right now. Heck, a good pharmacist should be able to formulate it right into a vial for you. cheers good luck
Oh, wow. I’ve never heard to that. It sounds infinitely more challenging and prone to error than an insulin pump, yet at least it could be an option until an infusion set solution is found.
Hi Megan @mamamaegs I can relate to your insulin sensitivity - kind-of, but I’m not as sensitive as you appear to be. The insulin dilution that @Joe described has been used for many years; if you go that route, be very careful with measurements and calculations. Have an expert pharmacy technician verify your work.
As a rule, I try not to base my insulin by comparing my doses with anyone else, BUT… My ISF are close to yours, ranging by time of day between 75 - 95, and my 30-day average basal pump history says my TDD = 5.3 units. The same Tandem pump history says I use less than 20 units per day that keeps my TIR at 92% while I eat a minimum of 225 grams of carb every day - that 30 day period had a couple of parties.
A question I always ask when people are having difficulty keeping glucose levels up, is “how recently have you validated your pump basal settings”. Pump basal rate settings should allow you to go an entire day without needing to eat; because I enjoy eating, I validate my basal rates in 18 hour segments. I noticed discussion in the 2021 Physicians diabetes guide that a major concern is “overbasalization” and cautioned physicians to monitor. Of course individual body composition can require differing amounts of insulin.
Thank you, Dennis. So far, I had limited luck at the pharmacy, yet my endo previously practiced as a PharmD and was aware of the diluting solution. It sounds like it was used for young children with pumps to keep the basal rates high enough to hold a prime, etc. He is going to check with the peds endos. And, I am not sure how much of the thread you have viewed, or even what exactly I am responding to from my personal email, yet I am recently forced to MDI. One idea is for me to have a separate diluted vial of rapid to use specifically for correction boluses. Although I am struggling with a food sensitivity to dairy induced insulin resistant day today, typically 0.5 units rapid via a pen is too large of correction dose for me these past several years. That’s hopefully where a diluted insulin could step in until I can get an infusion set to function properly for me with a pump. And, basal rate testing can of course happen with MDI, too, yet it’s more difficult for me to not eat for that long, even with a split dose. I am definitely on too much basal with MDI, yet I fear the exaggerated symptoms of hyperglycemia that I experience so I supplement the too high of basal with carbs as I can’t precisely place the insulin where I need it with long-acting injections. I end up frequently doing that with IPT, too, as my insulin sensitivity can fluctuate rapidly from day to day and I struggle to stay on top of all of the dosing changes. My basal can fluctuate from 16 to 8 units in a month and that could likely be adjusted further down to near your 5 units if I at got a handle on when my transitions were occurring and not relying on carbs to counteract the over basalizing. It’s all gnarly, intense, and with unrealistic glucose goals these past years. Thanks again for the heads up on the diluted insulin concern, and fingers crossed, there will be an infusion set that maintains insulin flow for me instead. I tried the Tandem T-Slim set and really struggled with it–excess bleeding and bruising at the sites with accompanied elevations in glucose. Likely, their other sets are similar to the ones I have tried with Medtronic and previously, Animas, with little consistent success with any of the sets. I think the count was 7 infusion sets on my 2 set change days this past week with glucoses that wouldn’t budge much below 190 mg/dL, despite many correction doses, and excessively bleeding and/or bruised sites. Tired from it all. Wish me luck.
Good morning. I was skimming through the thread again and a couple of thoughts cane to mind. I hope I’m not re-hashing things you’ve already covered.
You mentioned excessive bleeding. Have you been tested for bleeding disorders? Out of curiosity I did a search on “bleeding disorders and glucose” and found a few (very few) scientific articles - the most recent was from 2011: Blood sugar and a protein combine to increase bleeds - BBC News but you never know where you might find a hidden treasure.
I also searched for conditions that can cause excessive bleeding and found this article Bleeding Disorders: Causes, Types, and Diagnosis among others. Growing up I had heard about hemophilia, but there are various other conditions and even vitamin insufficiencies that can account for it. A hematologist may be able to shed some light.
You said you use Humalog because it’s the formulation your insurance covers - they may cover another one with special authorization by your doctor. I suspect insurances use the ones that give them the best price, ignoring the fact that it’s not “one size fits all” and making us do the work to get what we need. My insurance moved to an insulin that wasn’t approved for pumps😳 and we pumpers all had to get auths. Ridiculous.
Dorie - One correction to what you wrote. You don’t get special authorization from your doctor you apply for special authorization from the insurance company and your doctor supplies the supporting documentation for why you need the authorization.
Pam K.
Thank you for clarifying/correcting!