Happy Saturday! Welcome to another edition of our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois, where our goal is to always "tell it like it is" — no matter what! We're glad you're here!

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Megan from Nevada, type 1, asks: Can you tell me how this whole "giving yourself a small dose of Lantus so you can disconnect your pump for a few hours" works? How would you calculate the right amount of Lantus when you haven't been on long-acting insulin for a long time?

Wil@Ask D'Mine answers: You bet I can! It won't work at all. Now, moving on... What? Oh. Sorry. Amy says I need to give you a little more detail than that.

News nuggets from around the diabetes community

NEWSFLASH: FDA Clears Dexcom Share Direct
Dexcom gets regulatory approval of its 'on-the-go' mobile apps for CGM data-sharing.
State of the Union: It's Time to Cure Diabetes
President launching new precision medicine initiative to better treat, cure diseases like diabetes.
'Robotic Pancreas' Appears On American Idol
Carlos Santana's nephew Adam Lasher shows off Dexcom G4 during live performance.

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OK, so here's the deal, Megan. You can use Lantus to help you take a pump vacation—for days, weeks, or months — I guess even for years, if you wanted to. But Lantus is ill-suited for taking just a few hours off. Here's why: Lantus is a 24- hour time-release insulin. Well, technically it's insulin that's been manufactured to be more acidic than the body. When you inject it into your pH-neutral body, it "microprecipitates," basically forming little lumps of insulin, like friendly gallstones. The stones then dissolve a little at a time over a day or so, slowly releasing the insulin into your blood.

The bottom line here is that you can't un-inject a Lantus shot, and any shot you take will last 24 hours. So you can't realistically use Lantus to cover for your pump for just a few hours because you'd overdose on insulin once you hooked back up (the Lantus would keep dissolving away, and the pump would be feeding fresh fast-acting insulin in on top of it). I guess you could un-hook, take Lantus, hook back up, and then suspend your pump for the rest of the day... but it hardly seems worth it.

If you just want to be off your pump for a few hours for some hot tub action or whatever, the better choice is to probably (depending on your blood sugar level), look at your basal rates over the time you want to unhook, add up the insulin you will miss, take some of it before, and then add the rest of it back in when you hook up again.

But if you want to take more than just a few hours off, I can help you out with that, too. You've probably forgotten by now, but the initial settings for your basal rate were calculated by your pump trainer by taking 80% of your total daily basal insulin dose, dividing by 24, and plugging that number in as a units-per-hour drip. Of course, since then, you've modified your basal a great deal, adding steps up and steps down to fine-tune the basal delivery to your body's needs. But you can still reverse-engineer the original math to convert from pump back to Lantus.

Start by finding the total daily dose of basal insulin on your pump. For instance, on a Medtronic pump, go to Main Menu > Basal > Basal Review > and right at the top of the screen you will see your 24-hour total. Mine happens to be 22.05 units a day. So if I wanted to metaphorically chuck my pump in the trash, I'd take 22.05 x 1.2 (increasing by 20% to reverse-engineer the original reduction of 80%) = 26.46. I'd round down in this case, as a half-unit of basal insulin is meaningless, and take 26 units of Lantus. If you're more insulin resistant and need more than 40u of basal at a time, the current thinking is to take half of it in the morning and half in the evening so the body doesn't have quite so many "insulin stones" in one place at one time.

(FYI: on the OmniPod, go to Home > My Records > Insulin Delivery, and then use the down arrow to look at the last full day to get your total daily basal—accurate so long as you didn't use any temporary basal rates that day.)

By the way, the onset of action of your first Lantus shot is around five hours. Everyone likes to think of it as "peakless," and that's more or less true, but only after the second shot. The first one takes some time to get to work. After that, the next shot's spool-up time is overlapped by the previous shot's tail. If you take Lantus at the same time every day, you end up with an effectively peakless day-to-day basal insulin coverage. In terms of switching from pump to Lantus, the last drip of basal from the suspended pump will last four hours, so it's dying off as the Lantus spools up. You might see a small bump in your blood sugar level during the switch-over, but it won't be anything dramatic.

 

Joel from Vermont, type 2, writes: I turned 59 at the end of December, and was admitted to the hospital for an infection in my right index finger. There I found out I am diabetic (644 blood sugar level). Could there be any connection between the two?

Wil@Ask D'Mine answers: No causative connection. In other words, there's no way in hell your finger infection caused your diabetes, and there's no way in hell the diabetes caused the finger infection.

But there might be a more subtle connection between the two.

I'd wager a box of doughnuts that you've had diabetes quite a bit longer than you think you have. It would be a safe wager for me, 'cause type 2 is a sneaky bastard that lurks around in the shadows for a long time before it's discovered. People who have diabetes but don't know it yet, tend to have higher blood sugars. And people who have higher blood sugars tend to heal badly.

Ah-ha!

So... a finger infection sent you to the hospital? It must have been one nasty infection. One that didn't want to heal. One that was gorging itself on all that spare sugar in your blood. One that didn't have to worry too much about your white blood cells (essential for healing) because there were stuck in a traffic jam trying to get to the site of the injury (high blood sugar retards both the action and distribution of white blood cells).

So the only connection is that your already-growing diabetes made it hard for your injured finger to heal. Which led you to the hospital. Which lead you to your diagnosis. Which was a very good thing indeed, and I think you should thank your lucky stars that you injured your finger in the first place. That infected finger lead to the most important day of your life: Diagnosis Day.

Hey, the diabetes was there. It would have been discovered... eventually. But the longer it went undetected, the more havoc it would have had a chance to wreak in on your body.

When it comes to diabetes, an early diagnosis is an early blessing. Now you can focus on learning what you need to keep it in check.

Oh, and the next time you injure your finger — by when you'll surely have your blood sugar levels in a more healthy range — odds are it'll heal just fine.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.