A few weeks ago, Jordan started doing untethered pumping. I have to say, we both kind of love it. Most of the problems that he experienced with his insulin pump, and most of the problems he had with MDI, all disappeared when he started doing untethered. I know what you’re thinking… what the heck is untethered pumping?!? Let’s talk about it!
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What is Untethered Pumping?
Untethered is a mixture of MDI and using an insulin pump. You wear the pump for bolusing, and use injections for your long-acting insulin (commonly called basal insulin).
But… WHY?
As Jordan’s pediatrician so eloquently put it when I told her that he was doing untethered pumping with Omnipod and Tresiba… “but why? Why? WHY?”
You can bolus while on MDI… and you can give basal insulin via an insulin pump. So, why bother doing a mixture of the two?
There are a few main reasons why people use the untethered pumping method.
1. Summertime! That’s right, untethered pumping actually became a thing because of summer fun.
Many people practically live at the beach or pool during the summer. When you wear a tubed insulin pump, that causes a bit of a dilemma.
You can’t bring the pump into the water with you, so you unhook it.
But, the pump is delivering basal insulin continuously throughout the day. If you unhook your pump for a couple of hours or more, you’re missing that basal insulin.
Some people combat this problem by hooking it back up every couple of hours and bolusing the missed amount of basal. If it’s only once in a while, this is a completely reasonable solution.
But what if, day after day, for weeks or even months, you’re needing to hook up to give yourself basal insulin? Why not just inject long-acting insulin once a day and then only hook up the pump when you need to bolus?
That’s how untethered pumping became a thing years ago. Since this method has your insulin pump unhooked most of the time, they were “untethered” from their insulin pump.
2. TDD (total daily dose) is too high for a pump.
Sure, some people use untethered because they spend all day every day at the beach and use a tubed pump. But what if you don’t hang out in the water? What if you don’t have a tubed pump? Omnipod isn’t tubed, but people still use it to go “untethered”.
Pump reservoirs only hold so much insulin. Most pumps hold a maximum of 200 or 300U of insulin. The pump site is supposed to last for 3 days.
If you don’t have a high TDD, that works fine. But what if your basal is quite high? What if your carb ratio and sensitivity factors require a lot of insulin? What if you go through more than 200 or 300U in 3 days?
Untethered can help in this situation!
Taking basal insulin via injection means you can stretch the pod/ pump site life farther. Instead of having to change your pump every 2 days, it can last the full 3 days as intended.
3. Anxiety about pump failures.
The number one concern that most people have when switching from MDI to pumping is that there is no long-acting insulin.
Long-acting is like a safety net for lots of people.
If the pump fails for any reason (I’d like to point out that this is rare, but does happen), the basal AND bolus insulin are stopped. The body is getting no insulin and that increases the chance of DKA.
What if, instead of the possibility of no insulin in the system, you knew there was always at least long-acting working in the background? Would that ease your anxiety about insulin pumps? It does for a lot of people.
Related: Basal Testing: The Beginner’s Guide
To be honest, Jordan doesn’t fall into any of those categories
It was more accidental than anything.
He’d been doing MDI for about 4 months. He was fine with it, we had his long-acting set pretty well, he had no problem with multiple injections a day.
Then, we had a snafu with the pharmacy. We ordered pen tips and the pharmacy said they “didn’t have our order on file” when we went to pick them up.
He was pretty short on pen tips at that point, so I suggested putting on a pod (we still had some from before he switched). We could bolus through the pod and that way we didn’t have to worry about how many pen tips he had.
But, he’s using Tresiba. That’s a really long-acting insulin. It lasts 36+ hours. There was still long-acting insulin in his system from the previous night. So, we set the basal rate to the lowest setting possible on the pod and kept giving the Tresiba. We were planning on only using one pod until we got more pen tips after all.
It didn’t take long for us to realize that there were several benefits to untethered pumping. We had stumbled onto something kind of great.
How do you set up untethered pumping?
Ok, I’ve talked about how it all started (both in general and with us personally), and different reasons why people use the untethered method, but how do you actually do it?
We didn’t bring the basal on the pod right down to zero. In fact, it won’t let us on the Eros. I hear the Dash allows a 0 for a basal rate, but that’s not the case with the version Jordan currently has. His basal is the lowest it can be at 0.05U/hr.
I’ve heard that you don’t want to set up a zero basal rate in the Omnipod anyway. Rumor has it that it can cause occlusions in the pod. I don’t know if that’s true, but I’d rather not find out through personal experience.
It’s that simple. Take long-acting insulin once a day (or split into 2 doses depending on the kind you’re using) and bolus with the insulin pump.
When it’s set up this way, you can’t really use temp basals to your advantage. I personally don’t use them much anyway, so that’s not a problem for us.
If you DO use temp basals a lot…
You can still do a version of untethered pumping!
Lots of people set it so that 30-50% of their basal is given through the pump and the rest is given via injection.
This can be helpful especially if you fall under the “high TDD” category but still want to manipulate your basal.
Benefits of untethered pumping:
- Fewer injections than MDI. He went from 8-10 injections a day to 1. While he didn’t mind the injections, he quickly remembered how much easier it is to bolus with a PDM than stabbing himself with a needle each time.
- Basal is always doing its job. There is no question about whether or not his basal is working. When we do a basal test, I don’t have to worry about a pump problem messing it up. DKA is also less likely, although, he’s never been in DKA (knock on wood).
- Pump sites can last longer. If you go through a lot of insulin, doing untethered pumping can reduce the number of reservoir or pod changes that you have to do.
- You don’t have to be attached to a pump 24/7. With the exception of Omnipod, of course, you can connect and disconnect your insulin pump whenever needed instead of trying to find somewhere to clip it or getting a spibelt to carry it in.
Untethered isn’t for everyone
In fact, it’s not very common at all. It’s an option that most diabetes teams either don’t know about or don’t make a habit of recommending. Not because it’s bad or they particularly dislike it, but because they don’t see the purpose of it.
Regardless of how popular it is, there are still many people with T1D who stumble upon it and see the benefits of doing an insulin pump/ MDI mashup.
Jordan and I are fans of this method… are you?
Happy Carb Counting!
~ Leah
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