Hi everyone,

I know I'm bringing this up again, so forgive me....But:

 

I am having issues with highs again after POD changes. I feel like for a while there, the issue was under control, but I guess what I didn't figure out is "why" it was under control. I'm wondering if time of POD change is an issue based on what I eat for dinner that evening? I mean, I've consistenly (since I started the POD) been changing in the evenings, and as I mentioned, it wasn't an issue for a while, and now it's back....Also I do bolus prior to a change, but am wondering if I'm being too conservative due to fears of going low overnight? I usually just bolus a unit or so. Any pointers would be most appreciated :)

 

Thanks!

 

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Replies to This Discussion

I have not really had this issue...but then I change in the mornings and I always plan it so that I can bolus right after the change. Guess I didn't want to go thru the night on a new pod either and and since the mornings seem to work for me I've just kept it that way. I have given a bolus before the change if my numbers were elevated and then bolus with the new pod and eat so that I make sure to get a bolus in as soon as I can after a new pod is on. It's been working for me and I've been lucky to never have had an occlusion yet so I'm keeping my fingers crossed. But you might want to try a morning or early afternoon before lunch and keep track. I definitely think that different times of the day will have different results and hopefully an improvement. That was a great tip to leave the old pod on after a bolus to give it more time for absorption...I have done that to a degree as I put unisolve on it and leave it one while I put the other one on so maybe that's why it seems to work as I have it one some time before taking it off. Good luck!
Great that you are having success. The thing that we found and heard from some other folks is that insulin resistance is higher in the morning so there is more of a chance of a high BG number. This is a great discussion--really helpful to compare what everyone is doing.
Hi Gina,

I have been on the Pod for 4 mos, but have had Type D1 for 48 years. I have had 4 pods that I believe to be defective that caused high bg....over 400!! It didn't matter what time of day it was. Here's a list of what I was doing:

1 Test blood BS between 80 - 120
2 Deactivate current pod
3 clean area of arm for pod placement with water only
4 work plunger so as to lubricate inside of syringe
5 made sure there were no air bubbles, filled pod 7 primed it
6 placed pod on arm, inserted cnula
7 activated new pod
8 waitied 15 mins....tested blood 300+ took bolus
9 waited 15 mins tested blood 350+ took another bolus
10 waited 15 mins tested blood 400+ DEACTIVATED POD
11 Activated a New Pod took another bolus ....waited 15 mins...tested blood 300
12waited another 15 min....test......250
13 waited another 15 mins tested,,,200
14 Used same vial of insulin on both Pods.

I never rec'd any type of alarm. Insulet sent me 4 replacement POD's and issued a RMA so their engineering can evaluate.
All Pods have now been sent back to Insulet and it will take them 8 weeks to give me the result of their eval. Sorry tobe so long winded, but maybe you have had some bad Pods? This same scenerio happened to me on 4 different occasions, but they were all from the same Lot with different Sequence #'s.
Thank you for outlining and ruling out other issues. Something is going on with the pod's hardware design that leads to occasional occlusions/high bg. The whole issue makes me wish for a tubeless pump that uses standard infusion sets such as the CellNovo concept. I am hoping the design of the upcoming Solo and Jewel will not be prone to this issue. Maybe the force used by the pod's automated insertion is sometimes insufficient to punch the cannula into the skin in a way that leaves the cannula in a proper, unkinked position. If Insulet is unwilling to acknowledge this phenomenon I at least hope they are working on a re-design.
For me, the problem only occurs when I wear pods on my inner thighs. Now I don't bother with that location, but I was able to alleviate it with mixed results though a combination of post-change bolus, post-change temp basal increase, bolusing early for my first meal after change, etc.
However, after learning more about basal during my last endo visit, I have one other suggestion: try a temp increase in basal a couple of hours BEFORE the pod change. My endo taught me that basal rate has a much bigger impact on BG than I used to think it did, and that it's affect is quite delayed in some people. Using that knowledge, I think an increased basal rate could be a more gentle way to giver your body the insulin boost it needs to get through the change; a bolus right before might be too drastic and "scary" as you suggested.
Good luck.
The scary thing is.... I am pretty sure that not all the pods are priming fully. THat means some shoot blanks in the beginning and some start off great. Omnipod denied that this could happen when I talked to them. They said it would alarm if it didn't fully prime... but someone on here had their physician test some pods off of the body... not all produced insulin the first dose.. and some did.
So.. what ever you do.... just do it carefully. YOU might be giving too much or too little depending on the start of that pod...if this is the case. So.. I feel it is a good practice to only change a pod in the daytime where you have time to figure things out and correct ....not in the evening when time is limited and you will be sleeping.
My son loves the pod... says he would go MDI before he went to a tubed pump...so just like you.... we continue to try to find what works the best. I really wish the POD itself wasn't one more piece in the puzzle of diabetes care for my son. Everyone gave great ideas... we keep trying and have yet to find what works best for him.
We were the ones that tried the experiment to activate the pod but not put it on the body...and see what insulin came out right away. I was shocked to see that when I tried it, nothing came out with the first .50 bolus...but the cannula did fill with insulin. So my guess was that this was not fully primed. My nurse tried it as well, but she got the pod to work perfectly right out of the gate. I think Gil on this forum used to work for Insulet and he said that some pods do not fully prime, so that insulin you think you are getting the first hour/hours after a new pod might just be filling the pod. In the past I have tried a bolus of anywhere from .5 to .75 with the new pod for my daughter just to "prime" it, then continued with the regular bolus for dinner (we used to change the pod right before dinner to see if it was working before bed).

The last few times we did that, it didn't go great. She was still high, but the pod did "kick in" later. So what I am doing now and actually causes me less stress is to change the pod AFTER dinner...so at least I know she gets her dinner bolus and doesn't spike to 300-400. I will do a higher temp basal after pod change to try to compensate for the priming issue. But I have found that by changing the pod after dinner, if she goes high it's only (usually) 200s because it's just the basal she might be missing for a while, and the insulin from dinner is still active for a couple hours as well.

We've had skin issues, PDM issues, pod failure issues that have all been resolved pretty much successfully. But this issue is by far the most problematic one of the Omnipod. It shouldn't have to be this hard!
So Jennifer do you just do a temp basal then, with no pod change bolus? And how long do you do the temp basal for? We have been doing a 2hr +30% basal but sometimes my daughter's numbers spike later. We were actually thinking of boosting the pre-change bolus. [we do a 0.5 bolus on the old pod, wait and then do the temp basal on the new pod--all just before dinner.
I do not do a pod change bolus when I change the pod after dinner. My daughter is four, and I feel it is just too risky to do it after she's eaten her big meal for the night and she's about to go to sleep. Of course I check her overnight but it's just too scary for me, and I absolutely HATE treating her in the middle of the night. I think it's such a violation of her precious sleep!


Also, the last few pod changes her BG at the time of change has been very good, like in the 80-110 range...so I'm too scared to give a bolus with that number!

I generally do a .35 basal (as opposed to her normal .25 basal after dinner) for two hours. There is no rhyme or reason for this number or time...I literally just plucked it out of thin air...like so much with D! I feel it's just a help to get the pod going. High basal rates definitely accumulate in her, so I'm hesitant to do too much...If she has gone high, it's usually only somewhere in the 200s (even high 200s) because she's only missed her basal (which is so low anyway overnight) and her BG is usually good coming into the pod change. If she goes high I just correct her. Sometimes the first correction works, sometimes I have to do it all night. Again, no rhyme or reason as to why some pods take longer than others. Usually by the third correction if it's THAT kind of night I add 10-20% to the correction and it seems to take care of it. Not much sleep for me that night though :)

There are just so many variables it's hard to say. I think location of the pod has a ton to do with it. When we put it on her back, it works fantastic (almost too good). When it is on her bum facing "in", she notoriously has high numbers.

If it were me with D, I would probably go for the extra bolus, stay up a little later and have a snack if necessary. But I just can't put my daughter at that kind of risk.

A lot of people seem to bolus with the old pod. That never used to make sense to me because it obviously doesn't help the new pod get working, but I see now that at least you have three or so hrs of active insulin while the new pod gets up to speed.

Sorry for the long reply but there are just no easy answers with this stuff!!! I have learned so much on this site, I don't think we would have been nearly as successful with the pod if not for everyone here. No matter how good drs and nurses are, it's us who are actually in the trenches who can figure things out the best!
After reading all these comments we changed our routine and have seen some good success.

We are still doing a change bolus of 0.5u and a temp basal of +30% but we do it all with the new pod (so after the change) and we do it right after dinner. Done three changes this way with good BG afterward.

A caveat. A couple of days ago my daughter fell while running cross-country (cut her face up and chipped a tooth). Her pod was on her stomach but looked ok. That night her numbers climbed into the 300s. Pod looked ok and when we did a correction. Morning numbers were high but not extraordinary. Then at 9:30a she called from the school with BG of 455. We gave an injection and changed the pod. Did the +30% temp basal but no extra bolus. She ran for cross-country and did her normal routine. Later she went low. Then around 9:30p her pod started falling off. We had to do a second pod change. This time we only did a +20% temp basal and no bolus. At 12:00a she was 56. The cross country running has a lot do with the low number but from now on we will only do the 0.5u bolus plus +30% 2hr temp basal if the pod is changed at dinner. Otherwise a new plan is required.
We also had highs with our 3 year old. We found that leaving the old pod on for a few hours with a 50% increase in basal for the first 2 hours has eliminated the highs.
I've been having problems with this on and off. At the moment, I decide whether or not to take an extra bolus depending on my blood sugar when I do the pod change. If I'm lowish, no bolus. If I'm normal or high, I do about 1.25 u, then I program a temporary basal +30% for 3-4 hours on the new pod. This seems to be working for my in-between-meals blood sugar.

My problem is that I seem to always spike really badly with the very first bigger meal that I eat on a new pod. I just can't seem to wait long enough or take enough insulin.... My blood sugar still goes up over 300 most times, but only with that first meal, even if it is the next day (after a good, controlled overnight). Does anyone else have trouble with this?

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