Mammograms and the pod

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Permalink Reply by Bradford on October 22, 2009 at 10:00am

I went to school for radiologic technology, and I'm now a professor for an RT program (xray, CT, MRI, interventional procedures, etc).
As long as the pod is not going to be in the primary beam, the newer machines (with their proper shielding and collimation abilities) should be fine. Mammography machines and their callibration techniques are mandated by the FDA (unlike most of the other radiologic technology modalities) so the facility at which you're getting it done should be in good standing and have proper equipment if they're open for business).

If you're worried about it and you happen to have your pod on your arm, you could ask the technologist if they have any lead shielding that you could wrap around your pod. If it's on your backside anywhere, your body will absorb nearly all of the scatter radiation before it would reach your pump, so shielding shouldn't really be an issue.

If you were going to have a CT done and the pod would pass through the primary beam, it would be best to remove it (so you'd need to take a spare pod with you to put on after you're done). If you're having an MRI, the pod is contraindicated because it contains metal (any insulin pump is contraindicated for MRI). If the MRI is planned, you might switch back over to MDI with a basal insulin (like lantus) for that time period. If you are unable to do this, try to get some specifics about the time you will be in the room from the MRI technologist. If it is 1 to 1 1/2 hours, your glucose my rise some but you should not be in horrible shape. If you're imaging lots of body parts and you plan on being more than 2 hours, your glucose may rise some (maybe talk to your endo or CDE about the best approach if possible).

So long story long, I would not worry about the pod too much, other than letting the technologist know that you are wearing a pump (but that you're unable to remove it). Also, bringing your PDM into the changing room (wherever they have you leave your purse, valuables, etc) is fine. Just don't expose the PDM to the primary beam either (which wouldn't happen because the beam will be directed to your breast only), and you'll be golden.

Good luck with your imaging procedure and I hope you get good results!

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Permalink Reply by BWashington on October 22, 2009 at 10:11am

Wow! Great, detailed answer! Thanks a lot.

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Permalink Reply by Dee on October 22, 2009 at 11:26am

Thanks Bradford. I am going for a Mamo in a few weeks as well. I never thought about the pod. I wear it on my stomach, I don't think it will be affected judging from what you say.

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Permalink Reply by Mayumi on October 23, 2009 at 6:35am

Two days ago I had a PICC line inserted in my arm and my pod was on my stomach. I noticed my bg were especially high afterwards so I changed out my pod the next morning. During the PICC line insertion I think they must have x-rayed my chest area (no one told me what was going on at all!!), so I'm wondering if those beams damaged the pod's effectiveness??

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Permalink Reply by Eric Rizzo on October 22, 2009 at 11:29am

I just wanted to add that, if you did want to remove the pod, I doubt many people would see a significant rise in BG from the loss of basal insulin for an hour and a half. Unless your basal rate is unusually high, the residual insulin would probably be enough to maintain BG level for that long; even if not, don't forget that a short, low, temporary spike in BG is not likely to have any effect, unless it was really high.
Think about before you were on a pump and used long-acting insulin (Lantus, Levemir, etc); the chemistry that makes it long-acting was never accurate enough to guarantee that you were getting a consistent basal over the 24 hour period anyway; your body didn't freak out because of that, and it won't go crazy if you are pod-less for an hour, either.

Finally, my CDE told me that whenever I have to be pod-less for more than a half-hour, just correct when I put on the new pod: multiply the number of hours times my normal basal rate and take that much insulin as a bolus. For example, if your basal rate is .5 units/hour and you're pod-less for 1.5 hours, take a .75 unit bolus when you get the new pod on.

My point is, I don't think anyone should really worry about being pod-less for an hour or two; I just can't imagine someone's BG going way up in such a short period of time. But then again, I'm no doctor...

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Permalink Reply by BWashington on October 22, 2009 at 11:37am

Thanks. What you say makes a lot of sense. I guess I'm spoiled now that I have the pod (my first pump). :-)

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Permalink Reply by Andy Mayshar on October 22, 2009 at 11:50am

Just remember people who wear old fashion pumps (all others) remove there's for a hour or two on a regular basis. That being said I would not remove my OmniPod for a mammogram.

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Permalink Reply by Bradford on October 22, 2009 at 11:53am

I agree. For races when I was on a minimed, I would be disconnected from my pump for the swim portion. As long as I was not disconnected for more than 1 hr, I was fine.

And I like your CDEs method of accounting for that 'missed' insulin. Thanks for sharing that tidbit!

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Permalink Reply by MelissaBL on October 22, 2009 at 11:54am

The general rule of thumb with those who used tubed pumps is to expect a rise in BG of approximately 1 mg/dL per minute of disconnected basal. Depending on where your BG is at the start, this could pose a problem. Tubed pump companies do not advocate disconnects of longer than 30 minutes. When I first began pumping in 2000, I made the mistake of thinking I could operate without the basal rate for 2-3 hours (my reservoir was empty) and got very sick and collapsed from a high with ketones while performing. In my mind, a couple hours couldn't hurt. The reality is that your body needs basal insulin from the pod or from a long-acting injection at all times.

Also know that the rise in blood sugar could often occur as much as 3-4 hours after the disconnect, when that basal would have its peak effect. I missed 2 hours of basal on a pod with a slipped-out cannula a few weeks ago and saw ketones 6-8 hours after the fact, for instance. The important thing to do is to watch how long you are podless (should you choose to go podless) and to possibly compensate with increased temp basals before/after, additional bolusing, and/or additional testing.

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Permalink Reply by Lisa on October 22, 2009 at 2:11pm

I had a mammogram with my pod and I didn't have any problems and it was on my stomach. You shouldn't have any issues. I asked the technologist if it was going to be an issue and she told me no and everything went well.

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Permalink Reply by Sherry Ann on November 1, 2009 at 6:52pm

I agree with Lisa. I had a mammogram a couple of weeks ago, and I had no problems whatsoever. My Pod was on my abdomen, and the technologist said that it was not a problem at all. I did not take it off, and I had no side effects from the procedure. My Pod worked fine, and the mammogram came back good. I would wear it somewhere on the lower part of your body or back, and you should have no problems at all.

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Permalink Reply by BWashington on November 3, 2009 at 11:07am

Update, in case some readers are still wondering. I had the mammogram today. I was wearing the pod on the left side of my abdomen. Everything went well. I checked my BG when I got home and the pod was working fine.
By the way, the technologist was diabetic. She had never seen a Pod. :-)
Thanks to all of you for your replies.

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