Does anyone use the "Untethered Regimen"(devised by Steve Edelman,MD) to prevent DKA in patients with Type 1 Diabetes on an insulin pump? This is especially useful for children on an insulin pump as their sports, play, etc may cause the subcutaneous canula to dislodge.

I always teach this in my course for nurses and advise patients of this regimen to discuss with their doctors. I think it is a brilliant idea. This is how it works:
Basal insulinis given as follows: 75% total daily dose is given by a once daily subcutaneous injection of Lantus
                                                             25% total daily basal dose given by insulin pump
Bolus insulin is given entirely via the insulin pump

We have used the untethered regime for years. My son was dx'd w/ T1 in 2000 @ age 8 and we quickly found Dr. Edelman’s untethered information on the childrenwithdiabetes.com website. We used it to accommodate his soccer schedule when he was younger. He now is extensively involved in karate and continues to use it. He often plans for a canula change to coincide with practice nights and chooses to remove the infusion site completely before starting, since it is often dislodged anyway in the course of practice.

Thanks for your contribution regarding the usefulness of this regimen for your son.  It solves many potentially problematic situations for adults as well as children with Type 1 Diabetes.

Hi Pat, I need your advise. I have a 45 yr old patient  who is a tennis pro and works constantly. We have been addressing his frequent lows during the afternoons and he is now adjusting much better. How often would you allow him to disconnect his pump on a regular basis. Remember he does this for a living and daily. Does this remove the usefulness of wearing a pump? I appreciate your help.

Hi Ginger
I assume that your patient has Type 1 Diabetes and is not using the "Untethered Regimen" yet.   Whether or not he is using the "Untethered Regimen", I think that the best way to assess his glycemic response would be to use an interstitial glucose sensor for awhile until it is clear what his glycemic response is to his tennis playing.

It is really his decision regarding whether or not his pump is useful.  It is worth trying if he wants to do it.  Keep us posted, Ginger regarding was he decides.

Hi Pat, I did not give you the whole case study. He has type 1 and has been on the pump for years and out of  control. His lows are getting much worse and I finally got him to make an appointment with an endocrinologist in Miami that he has not seen for a year. He will not do continuous glucose monitoring, not available in this area, but hope the Endocrinologist in Miami will arrange it. The best thing we got to do was to get him to eat more food and lower his basal insulin units. I have not tried the untethered regimen before. We have very few pump patients down here. Thanks for your help.

Your patient is lucky he has you as an advocate, Ginger.  He couldn't be in better hands.  Keep us posted