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Can My Pump Swim?

Looks good, right?It's game on for white-water rafting in July.  Chris's sister made the reservations and we're off and running for the weekend of July 7th. 

As I mentioned in a previous post, I'm ready to do this, but navigating insulin needs may prove trickier than making my way down the rapids.  As one of the most ungraceful people on the planet, it's certain that I will either be tossed out of the boat or I will simply fall out, rendering my pump useless if it ends up waterlogged.  You guys mentioned the AquaPac and things of that nature, but knowing my luck, the pump will somehow become disconnected and lost. 

Pumps aren't cheap.

So I'm disconnecting for the trip.

I've given some thought to grabbing a script for Lantus and bolusing throughout the day with a Humalog pen.  This way, I'm covered on the basal front and I can selectively bolus for meals and any corrections throughout the day. 

My brain is covered with questions, though.  

How much Lantus do I need to take?  I've been pumping for over three years now and I barely remember what my insulin needs were B.P (Before Pump).  And should I start this "pumpless" regimen a day or two before the trip so I can have things almost figured out before we hit the river?  Also, what about morning highs?  I had some serious dawn phenomenon business going on B.P., and I have a morning basal setting that's almost double what I take for the rest of the day.  Should I just suck it up and run a little higher for those three or four days?

I have a call in to Joslin and I'm waiting for their two cents.  But I know you guys have the other $0.98.  :0)  Any thoughts on this?  I appreciate any and all feedback!! 

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I wonder if your pump company can give you a loaner pump? After Noah's Florida fiasco, the nurse at the hospital told us that some comapies will do that if you're traveling so you have a spare.
Sounds like a fun trip! Something I've always wanted to do. Have a great time :)

Kerri,

Although I'm a newbie I wanted to offer some advice. Since you'll be doing some serious activity over those couple days there is a good chance your insulin needs will go down considerably.

I think going off the pump a day or two before the trip is a GREAT idea. One to get used to calculating with a pen again and two to see how your body will react. If you disconect the day of the trip your only option is to go pumpless. If you disconnect a day or two before and realize the shots just don't work anymore you still have the option of using the pump (fear of loosing and all).

Lasly, just go and have fun if you run somewhat high for a couple of days you're not going to wind up in a coma or have organ failure. Chances are with the amount of activity you'll be doing you won't be high at all.

Have a great time!

Ed

I recently had to go off the pump for six weeks and switch back to injections -- and the last time I did injections, it was with Ultralente, which apparently they don't even make anymore. Definitely confirm with your doctor, but two different endocrinologists told me the formula is a 1:1 ratio, so your daily dose of Lantus would be equal to the total 24-hour basal. However, I found that Lantus didn't actually work for 24 hours for me, so I divided it in half and did an injection every 12 hours. Also, just using the 1:1 ratio, my BG was in the high 300s constantly, and I ended up raising my Lantus by another 6 units (26 to 32). Since you don't want to be high or low on your trip, I'd suggest figuring out your Lantus doses at least a week ahead of time. In fact, if I were you, I might use a shorter-acting insulin like NPH every 8 hours so you at least don't have to wait 24 hours to make a change to your dosage.

A while back my pump decided to stop working so I had to go back to MDI until I could get another pump mailed out to me..it was a holiday weekend, go figure.
Well, I called the doc in a panic bc for some reason when I got the pump I forgot everything I knew about MDI.
He put me on NPH for basal with Novolog for the rest. I asked why we were using the NPH vs Lantus and he explained that Lantus takes time to build up in(and get out of) your system and work properly as opposed to the NPH that works at full power immediatly.
He did a few quick computations and came up with my NPH dosing which really ended up being almost identical to how much basal I took every day just split into 2 doses of the NPH.
And when I got Pumpy III ;p I switched right back without a problem bc NPH doesnt leave any nasty insulin aftertaste like Lantus would have.
Hope that helps ; )

I recommend that you try it before your trip. Many people find that Lantus doesn't last 24 hours, and find its more effective to split the dosage so you get full, 24-hour coverage. Also note that Allison Blass (lemonlemonade.com) discovered that Lantus peaked somewhat (as have many others) during her trial with her untethered trials, and its best to discover that beforehand. But you don't want that discovery to occur when your on vacation, so give it a trial for a few days and get the bugs worked out in advance of your vacation. Also, remember that while you may be more active on vacation that exercise tends to show up hours later with Lantus since you're not on a rapid-acting insulin, so its better to reduce your dosage slightly ahead of time, better to be slightly high than dealing with hypos for 12 or 24 hours!

Hello Kerri,

About 2 month ago before I was taking Lantus and I was taking 7 units at 7:00am and 7 units at 7:00pm and bolusing with a Novalog pen. Lantus does not work 24 hours and it usually peaks about 6 hours afterwards--this is according to my wonderful endocrinologist. If it were me I would probably call my endo because they can give you an approx number of units of Lantus based on your height and weight. That is what my endo did and she was pretty much right on. Go luck, have fun and I really like the photoshoping of the Minimed pump!!!

Hmmm ... never thought about NPH instead of Lantus. Excellent tip! I'm eager to do this as seamlessly as possible, so thank you so much for your feedback!

Hi Kerri,
I use the Animas 1250 and it's waterproof so that's not an issue for me. However, loosing the pump while riding the rapids would be a problem.

What if you use the Aquapac to protect your pump from the water and then place it into a fannypack secured around your waist and it should be fine. The buckles on most fannypacks are very tough.

Good luck and have a fun trip!

Shirley

all I have to offer is if you go with Lantus, you're probably better off with two doses, with the morning dose smaller than the evening. Greg found that out very quickly.

When O goes off her pump, we do her total daily basal rate with Levemir.

I also second starting this a few days before your trip, so you can work out any bugs and see if Lantus/Levemir lasts 24 hours in your body.

Hi, Kerri. Do try the Lantus a couple days in advance. I also found that I had to split my dosage in two, but I also needed more insulin than my normal basal rates. Good luck!

Hi Kerri,

Sorry for the long post but I just dealt with this issue when I disconnected to go ocean kyacking. I had all the same questions you do - and my endo was great helping me get it figured out. I did the lantus by vial and the humalog pen.

I went off the pump for two "trial" days prior to leaving - just to get the hang of doages and timing and I would highly recommend it.

Your entire daily Basel rate = your lantus bolus but because I was (& you will be) significantly more active we pulled back to between 60% to 70% of the total (better a bit high & adjust than too low).

As a precaution, I bought a "dry bag" at the local REI to house my meter, pump, pen, vials etc. It kept everything dry & ready to go.

And yes - I did get dumped into the ocean a bunch of times & my BS wasn't up to pump control but it was so much fun that it was definitely worth the hassle of figuring it all out.

Kerri,

Regarding the morning highs: You could try taking a Lantus dose that will roughly cover your lower 'daytime rate', then wear the pump to sleep set with a basal rate to top up to the 'dawn rate.' Whether that works will depend a bit on what hours your dawn rate covers and what time you guys are planning on hitting the rapids.

I would also experiment with Lantus for a couple of days ahead of time. It would be petty awful to discover that the dose you gave was going to leave you hypoglycaemic all day long. Remember with Lantus: once it is in, it is on until it's gone!

Good luck

Kerri,
I can't help with the pump questions but I can tell you chances of falling out are really good, but all in all you will love it. I went a few years back. They dragged me kicking and screaming. But I had a wonderful time. And would do it again. I didn't have the pump problems. Only problems with the little PLASTIC hat they made me wear to protect my head. Looked like a tonka truck hat. Anyway just have fun!!!!

"Untethered" regimen? Lantus? I call that a bad idea. First, get loaner pump to allay your concerns. Then, get an Aquapac, as others already suggested. Finally, be glad that you do not have to deal with Lantus (or Levemir) peaks, uneven absorption over the day, unpredictable lows when you are physically active, and tooth-grinding highs due to dawn phenomenon.

Cheers,
Felix.

For me, Lantus works way longer than 24 hours, and the overlap from the previous day makes a difference.

Personally, I think I'd just disconnect for the few hours and keep a fast-acting pen on hand - but I'm no pumper and wouldn't have a clue if that's a good idea or not :D Just sounds easier than working out the maths with new insulins and the risk of it going wrong if you only have a couple of days to work it out...
White water rafting sounds like heaps of fun! I'm a chicken so I'll stay safely on this side of the world with my feet on the ground ;)

Agree with above comments on Lantus...I was on it BP (before pump). I had lows when it peaked and highs in the a.m. because it didn't last. Ended up doing the split dose thing which worked so much better. I agree that going off at least a few days before will give you a better idea of what your need will be. Good luck and have a great trip.

Your MM pump is waterproof as long as the case is not cracked. I have gone into the water with mine many times and had no ill effects. MM took away their "waterproof" claim because too many people went swimming with cracks in their pump. If your pump is in good shape I wouldn't worry at all, but DO get a loaner from MM, I have done that every time I went on a long trip.

I went on a white-water rafting trip back in the days of my Minimed 508. I used the SportGuard waterproof case and had no trouble whatsoever. We even swam parts of the mild rapids, and I did not leave it in the boat. I secured it by putting it in a fanny pack (so cool!) with only the little cord poking through.

I think I would have to recommend staying on the pump and using some kind of guard if in fact your pump isn't waterproof..or even if it is just for more peace of mind. My reasons for this are that if you are doing something so unusually active, even if you go off your pump a few days earlier, your non pump insulin needs will suddenly change once you start up all the hard work on the raft. It's during active times that pumps are at their best. Every time I have gone hiking I have been unable to imagine doing it without a pump. My insulin needs have always changed so drastically with the extra activity. Hiking is not rafting however, but I still think the same applies. Pumps are at their best at times when you're doing unusual things. You can change on the fly, change your basal, bolus for any unexpected event. At any rate. Goodluck!!

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