# U200 in Dash



## Fatterthantheshadow (Feb 20, 2022)

Could anybody here offer any experience of U200 insulin in DASH pods. My next pump exchange is hopefully DASH, the pump team want to carry out a 90 day suitability trial, my TDD may mean I use to many pods on U100.
I would like to offer a solution!
I think U200 is only available in pens??? Do you use the pen to fill the pod or draw it from the pen? 
Anything information much appreciated.
It's possibly off label??


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## nonethewiser (Feb 20, 2022)

Be lucky to find anyone using u200 never mind in Dash pump, pods come with syringe so could use that to draw up from pen cartridge.


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## Inka (Feb 20, 2022)

There’s a video on YouTube of someone using U200 insulin in a pump but it’s a T Slim. Not sure if that makes any difference.

How many units a day are you using?


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## helli (Feb 20, 2022)

nonethewiser said:


> Be lucky to find anyone using u200 never mind in Dash pump, pods come with syringe so could use that to draw up from pen cartridge.


I thought the advice was not to use a syringe with cartridges as they are under pressure or something along those lines.
Someone reminded me when I suggested pen cartridges could be used as a backup if you can’t get hold of vials for an insulin pump.


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## trophywench (Feb 20, 2022)

Well they quote it in units and the reservoir takes 200u - but of course thats 100u insulin, so it would therefore take the equivalent of 400u of 200u insulin.  So less than a pen cartridge, hence the next fill you'd start off part filling the reservoir cos you'd want to use what was left, first then finish filling it from the next cartridge.

OTOH discuss it with your team because they do manufacture things for use in hospitals which aren't available to all & sundry - like eg intravenous paracetamol - which they set up a drip for when 30+ yo daughter got meningitis.  And that was a 500ml vial.


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## Fatterthantheshadow (Feb 20, 2022)

Inka said:


> There’s a video on YouTube of someone using U200 insulin in a pump but it’s a T Slim. Not sure if that makes any difference.
> 
> How many units a day are you using?


Seen it, and although not the most professional youtube video it is quite informative. 
It's basically the same issue with Dash or t Slim, higher dose people burn through consumables too quickly, with NHS funded pods it could be a deal breaker. For me the perfect solution is to put double units in the same size pod. Getting this percribed could prove tricky.


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## Fatterthantheshadow (Feb 21, 2022)

Thanks for your input, group 
If you do speak to anyone doing this I would like to pick their brains.  I need  the Insulin percription. I can set my loop up to use U200 quite easy. Once the profile for a stronger insulin is locked in, it's quite safe. Even if  I were to use u100 by mistake the loop will try and correct the under dose, it wouldn't cause hypos.
Think the problem will be what's written on every type of pump stops the doctor writing the prescription


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## Fatterthantheshadow (Feb 21, 2022)

Inka said:


> There’s a video on YouTube of someone using U200 insulin in a pump but it’s a T Slim. Not sure if that makes any difference.
> 
> How many units a day are you using?


100 on a bad day


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## Inka (Feb 21, 2022)

Fatterthantheshadow said:


> 100 on a bad day



Probably a stupid question but will they not give you a 300 unit tubey pump and just let you change the cartridge every 3 days? Surely that wouldn’t be too expensive?

As for the label on the pump, that’s just to guard against idiots, right? If you could demonstrate you could use adjust and use the pump, and maybe put that in writing, would that not do? Maybe without your loop to start with, just to show that you yourself understand and are competent.


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## Inka (Feb 21, 2022)

I control my pump with my phone, but I’ve just taken it out to look at and it doesn’t have any message about 100 units on it at all. It just says it must be used under the guidance of a physician plus the usual kite marks and manufacturer stuff.

My pump is the Dana RS, developed with the help of #wearenotwaiting (loopers).


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## trophywench (Feb 21, 2022)

Ah, now, the photo is of the back of a Roche Insight I think - and the back of my Combo also says 'Insulin Pump U100' but perhaps that's just Roche !!


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## nonethewiser (Feb 21, 2022)

helli said:


> I thought the advice was not to use a syringe with cartridges as they are under pressure or something along those lines.
> Someone reminded me when I suggested pen cartridges could be used as a backup if you can’t get hold of vials for an insulin pump.



Not been told that before so thanks for heads up helli.


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## nonethewiser (Feb 21, 2022)

Fatterthantheshadow said:


> 100 on a bad day



During pump training with rep there was guy that changed his pod every 2 days due to his insulin usage.


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## trophywench (Feb 21, 2022)

... and I've already told you I have to change every 2 as well.  Been doing it for 11-ish years and no-one's ever suggested it's a problem from a cost POV.  It's the same as how much insulin a person needs, surely?  You need what you need.  None of us does it for ruddy fun!


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## Fatterthantheshadow (Jul 2, 2022)

trophywench said:


> ... and I've already told you I have to change every 2 as well.  Been doing it for 11-ish years and no-one's ever suggested it's a problem from a cost POV.  It's the same as how much insulin a person needs, surely?  You need what you need.  None of us does it for ruddy fun!


It doesn't matter with my Insight pump, I can order what I need, although rationed tube sets lately mean more frequent orders. 
At this early stage I'm being told if I use more pods than the contract allows the NHS pay much more for the extra ones, just like going over on mobile date.
For this reason only a 3 month trial to start with, it could go either way. 

Also since I first asked this question I've noticed some loopers are doing very well on u200 lyumjev. For an experienced looper it looks ideal, it's quick enough for UAM (in a good set up), because only half the volume is used there's less insulin resistance and irritation and the pods last longer.
I start my DASH 90 day trial mid August


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## helli (Jul 2, 2022)

nonethewiser said:


> During pump training with rep there was guy that changed his pod every 2 days due to his insulin usage.


My CCG are very money conscious. As each pod is effectively a separate pump, changing more often than recommended is costly. Changing a pod every 2 days instead of 3 will mean the pump is costing 50% more than usual.


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## Fatterthantheshadow (Jul 2, 2022)

helli said:


> My CCG are very money conscious. As each pod is effectively a separate pump, changing more often than recommended is costly. Changing a pod every 2 days instead of 3 will mean the pump is costing 50% more than usual.


I think even more than 50%. The extra ones being more expensive


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## Sally71 (Jul 2, 2022)

Surely the U100 label on the pump is telling you what the pump is calibrated for?  So if you put U200 in you’d have to set all the basal details and ratios to apparently be giving you only half as much as you need.  Which is possible of course but could be very confusing!


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## helli (Jul 2, 2022)

Sally71 said:


> Surely the U100 label on the pump is telling you what the pump is calibrated for?  So if you put U200 in you’d have to set all the basal details and ratios to apparently be giving you only half as much as you need.  Which is possible of course but could be very confusing!


My pumps have always come with no preset basals. I have had to add them from scratch.
I wonder if U200 has a different consistency - maybe thicker or sticky - that some pumps do not like.


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## Fatterthantheshadow (Jul 2, 2022)

Sally71 said:


> Surely the U100 label on the pump is telling you what the pump is calibrated for?  So if you put U200 in you’d have to set all the basal details and ratios to apparently be giving you only half as much as you need.  Which is possible of course but could be very confusing!


Yes and no. The pump is licenced for U100 so you need to treat off license. We do have the right to do this, treat with Cinnamon if you wish. It's your responsibility. Getting the percription may be tough.

With my loop the set up is key, after this it's quite safe(as any insulin). If I inadvertently used U100 in a u200 loop the risk is raised sugar, but the loop will try and correct.
In a nut shell basal rate needs to be halved, ICF doubled, I:C doubled (c doubled) manual corrections halved + some other settings like max possible bolus.


helli said:


> My pumps have always come with no preset basals. I have had to add them from scratch.
> I wonder if U200 has a different consistency - maybe thicker or sticky - that some pumps do not like.


I've not seen it close up but have read about it. Loopers report Lyumjev u200 being slightly slower than Lyumjev u100 and also DIA slightly longer


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## Sally71 (Jul 2, 2022)

helli said:


> My pumps have always come with no preset basals. I have had to add them from scratch.
> I wonder if U200 has a different consistency - maybe thicker or sticky - that some pumps do not like.


I know that, but aren’t we talking about how much actual liquid the pump will give you?  I.e. if you need a bolus of 1u it knows how much actual liquid/how far to move its piston based on U100.  So if you put U200 instead which is twice as strong, how does it know that it doesn’t need to give you as much unless you’ve set up all your basals and ratios etc differently.  Or do pumps these days come with a setting to change it to U200?  I didn’t think you could change it but perhaps that’s what I’m missing.


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## rebrascora (Jul 2, 2022)

Is u200 Lyumjev even available in the UK? I was of the understanding Lyumjev was relatively new to the market here and not widely available even in u100. I would imagine there is a pretty small market for u200 insulin in general but maybe that is just because we only have a very occasional enquiry about it here on the forum.


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## Fatterthantheshadow (Jul 2, 2022)

Sally71 said:


> I know that, but aren’t we talking about how much actual liquid the pump will give you?  I.e. if you need a bolus of 1u it knows how much actual liquid/how far to move its piston based on U100.  So if you put U200 instead which is twice as strong, how does it know that it doesn’t need to give you as much unless you’ve set up all your basals and ratios etc differently.  Or do pumps these days come with a setting to change it to U200?  I didn’t think you could change it but perhaps that’s what I’m missing.


I've not used a Tslim pump, there is a youtube about this very pump, he does address the units being doubled, basically double the units that are displayed. If you use a bolus wizard the I:c ratios and Basal profile, isf set up is the key


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## Fatterthantheshadow (Jul 2, 2022)

rebrascora said:


> Is u200 Lyumjev even available in the UK? I was of the understanding Lyumjev was relatively new to the market here and not widely available even in u100. I would imagine there is a pretty small market for u200 insulin in general but maybe that is just because we only have a very occasional enquiry about it here on the forum.


It comes in pens not vials. Whether it's available in the UK??? It's why I'm interested in others using it, maybe if you get lyumjev u100 first then step up to u200. 
For me, it hopefully would make pods viable + quick for a loop


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