# Can you take a long acting, whilst on a pump?



## BillyBear (Sep 29, 2020)

_I've been told my community diabetes nurse that i would be unable to have the pump because of the risk of going into DKA,which happens quite often on both long acting and short acting insulin. I have found that whilst i am in the hospital being treated for DKA, while on a varible rate infusion of fast acting, the doctors continued to give me my long acting at the same time. Now my question is: If i wanted to go on a pump would it be possible to have a long acting at the same time to cover any problems should the pump fail for any reason? considering that when i am on a varible rate with long acting in the hospital my control is perfect._
_Any advice would be very welcome_
_Nikki_​


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## Kaylz (Sep 29, 2020)

Hi and welcome to the forum

I'm not a pump user but I know that no you'd only be using a fast acting insulin, you ask about if your pump fails, you are still supplied with pens to have as back up should your pump fail so you will still have a basal insulin to hand should such an incident occur

I'll tag some pump peeps for you @everydayupsanddowns @SB2015 @trophywench @Pumper_Sue they are pretty much like a group of pump experts lol and I'm sure they'll tell you more xx


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## nonethewiser (Sep 29, 2020)

BillyBear said:


> If Iwanted to go on a pump would it be possible to have a long acting at the same time to cover any problems should the pump fail for any reason? consid



Pens are always needed as back up, they stay on repeat prescription in case of pump failure. Mine kept in fridge replaced when expiry date is due.


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## BillyBear (Sep 29, 2020)

The problem I have is I can go DKA in a matter of 2 hours and was wondering whether anyone does use a long acting as well as the pump, or is it even possible?


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## Inka (Sep 29, 2020)

Yes, you can. It’s a kind of combo routine of pump and long acting.

I’ll see if I can find a link in a moment.


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## nonethewiser (Sep 29, 2020)

BillyBear said:


> The problem I have is I can go DKA in a matter of 2 hours and was wondering whether anyone does use a long acting as well as the pump, or is it even possible?



Pump delivers basal& bolus, dont need to inject long acting. The basal rate is adjusted during 24 hour period, so multiple rates are option, been on pump 6 years not been in dka.


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## Inka (Sep 29, 2020)

Here we are:

https://childrenwithdiabetes.com/un-tethered-regimen/

You split the basal need between the pump (fast-acting insulin as basal) and a long-acting injected basal insulin.

Obviously you’d have to take advice to see if that was suitable for you. I don’t use that regime but know others do.

As @nonethewiser said, with a pump you should always have back-up pens anyway.


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## BillyBear (Sep 29, 2020)

Inka said:


> Yes, you can. It’s a kind of combo routine of pump and long acting.
> 
> I’ll see if I can find a link in a moment.


Thank you, i would really appreciate this as I don't where to start x


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## Inka (Sep 29, 2020)

BillyBear said:


> Thank you, i would really appreciate this as I don't where to start x



Link above   You’d need medical input to help you work out how to split the basal. The idea would be that having a little long-acting on board reduces the risk of DKA. It would, I presume, allow you to take your pump off for longer too.


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## helli (Sep 29, 2020)

As a pumper, I can confirm that I always have pens as backup in case my pump fails.
The point about DKA with pump failure is you instantly have no basal insulin when the pump fails. (With long acting basal insulin, you have the basal in your body until your next basal injection is due.) As a result your BG can rise very quickly and you go into DKA within a very short period of time.
The main advantage of having a pump is, by using continuously pumped fast acting as your basal, you have the ability to change your basal rate throughout the day. For example, if you experience DP every morning, you can automatically increase your basal before you get up or if you hypo when you exercise, you can turn off your basal at that time. Therefore, the valueyou gain by having a pump is significantly reduced if you injecting long acting basal whilst on a pump.


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## Inka (Sep 29, 2020)

Also used by some exercise enthusiasts:

https://www.sciencedirect.com/science/article/abs/pii/S2213858720301145

(Sorry for spread out replies - doing 10 things at once)


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## MrDaibetes (Sep 29, 2020)

Some people that I have heard of  will use a pump for bolus and use then use a long active insulin for basal.


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## Pumper_Sue (Sep 29, 2020)

Yes some do use long acting injection and just bolus with the pump. Which seems pointless to me but each to their own as they say.

You really need to work out why you are having such problems. If for instance it's a lack of testing on your part then a pump would not be an option.

Have you done any basal testing so you can see exactly what your basal pattern is? One issue could be that your basal insulin does not match your needs. I know for a fact there is no basal insulin on the market that matches mine.

Have you been offered a CGM as this would help a lot?
You would also be better off talking to a pump DSN or a consultant with an interest in pumps rather than a community nurse as their knowledge is fairly limited.


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## trophywench (Sep 30, 2020)

I can't add anything to what's already been said, except to ask what area of the UK you live in, as personally I've never heard of a community diabetes nurse.


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## JJay (Sep 30, 2020)

trophywench said:


> I can't add anything to what's already been said, except to ask what area of the UK you live in, as personally I've never heard of a community diabetes nurse.


There are Community Diabetes Nurses not too far away from you, Jenny, over the border here in Northamptonshire! https://www.nhft.nhs.uk/diabetes


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## trophywench (Sep 30, 2020)

Yes but never having resided there I'm entirely unaware of how they or any other county arrange their healthcare - in fact clueless about the subtle nuances of the NHS in Bedworth or Nuneaton, since our GP surgery is still firmly situated in Coventry so an entirely different CCG.  When I got my first pump 10 years ago as my DSN knew my address she instructed Roche to direct their invoices to Warwickshire CCG and it was about 12 months before Roche mentioned it to the D clinic - so they checked where my GP was - 10 minutes later it was all sorted out!  (don't know anyone that works at Cov & Rugby CCG - bet they were pleased to get the outstanding 12 months bills for pump and consumables .....)


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## martindt1606 (Sep 30, 2020)

I moved on to a pump because i couldn't find a long acting insulin and injection regime that worked.  Now that i have moved on to control IQ on the tslim pump i don't  think it would be an option to use long acting (at the same time as the pump) due to the magical algorithms that are keeping my BS in target with bolus and basal adjustments.


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## SB2015 (Sep 30, 2020)

Hi @JJay 

I switched to apump as I was finding it very difficult to get my basal to match my needs, and with The variability in each of my days I wanted to be able to make regular adjustments.  I too have pens as my back up but have rarely needed them.  

The fine tuning of the pump to suit your needs can help to reduce hypos, and also gives you the flexibility to make a change to basal insulin by temporarily turning it up or down.  I do this for sports, turning my basal rate down an hour before I start and then stopping it when I finish.  I also run my pump at just 50% basal and Bolus when I am out walking for a full day.  So flexible.  BUT it does require constant monitoring which does not suit everyone.  

I have had two occasions when my pump went wrong in eight years.  I soon noticed because my levels rose quickly, as others have said would happen, but I felt rough so tested, spotted the issue and used pens to give a correction whilst I sorted it out. Neither of these led to a DKA, although I did develop some ketones, but because of the monitoring I found out and sorted it.  The levels started to drop within an hour and I just checked that they continued in the right direction.  

 I  take my pens with me if I am going to be more  than hour from home (if nearer I can get back to them if needed), but I very rarely need them, and although it was scary when I first went onto the pump I soon became confident in the tech, and my own monitoring.


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## helli (Sep 30, 2020)

SB2015 said:


> I take my pens with me if I am going to be more than hour from home (if nearer I can get back to them if needed), but I very rarely need them, and although it was scary when I first went onto the pump I soon became confident in the tech, and my own monitoring.


I only take pens with me if I am going to be away overnight. To manage shorter periods, I just take a syringe to manage pump failure. It takes up much less space and I don't waste unused insulin.


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## everydayupsanddowns (Oct 1, 2020)

Welcome to the forum @BillyBear

An intriguing question! And I agree that the answer is technically “yes”... but also that it is a regimen that solves one problem by creating another - and which reduces some of the potential benefits of insulin pump therapy... ie having a flexible accurately tailored basal profile.

If you are currently experiencing repeated DKA while on long-acting background, I am also not entirely sure whether a pump+long acting combination would offer you much protection? In fact, as others have said, insulin pumps do carry a slight increased risk of DKA, so it may not be an appropriate therapy for you?

Are you able to understand why and how your episodes of DKA are happening? Is it missed/forgotten doses? Injections into scar tissue? Errors with carb counting? Missed BG checks?

Rapid production of ketones must be very scary and difficult for you 

I think if you can try to work out what is triggering the ketones and risking DKA it will really help you plan a positive way forward.


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## JJay (Oct 1, 2020)

SB2015 said:


> Hi @JJay
> 
> I switched to apump as I was finding it very difficult to get my basal to match my needs, and with The variability in each of my days I wanted to be able to make regular adjustments.  I too have pens as my back up but have rarely needed them.
> 
> ...


I think your reply may have been intended for @BillyBear but useful info if I ever get a pump, thanks!


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## SB2015 (Oct 1, 2020)

JJay said:


> I think your reply may have been intended for @BillyBear but useful info if I ever get a pump, thanks!


Oops.  Sorry @BillyBear i should have checked more carefully.
I hope it is useful.


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