I know this topic had been discussed here in the past but my search did not turn up many matches. Please forgive my post if it's overly redundant!
I started on the O'pod system last July. I've had recurring post pod change hyperglycemia almost every pod change. It's characterized on my CGM by a long slow (about 8 hours) march from normal BGs up to about 180-200. Corrective insulin doses via the new pod seem to have a somewhat muted effect. In other words they seem to help but not very quickly and they often need to be followed up with another correction.
Once the pod settles in, at about 12 hours, things seem to settle down with meal and correction dosing acting normal again. So I reasoned that I'm getting a gap in delivered insulin and/or absorption.
I decided to start adding insulin with a separate syringe at each pod change. I started with adding three units and have found that I need 7 units at pod changes to pre-empt the post pod change hyperglycemia. I don't take a lot of insulin; my total daily dose ranges from 30-35 units.
I feel like this is a lot of insulin to add but I can't argue with success. I like the O'pod system otherwise and would like to remain with it. For a while I was starting to think that I'd have to drop the Omnipod and return to a tubed pump. Having an 8-12 hour high BG excursion every third day seemed like too much to me. I have enough user-caused hyperglycemia and don't need more caused by the pump itself!
Does anyone else have this problem? What have you done to work around it?
I asked my Doc last week about this, as I did finally experience one of these events. He had a quick answer, and it appeared he'd known about it. He said it was due to how well the pump was filled. He suggested making sure there were no bubbles at all, and that it was filled carefully. I do recall being in a hurry with that pump that I had the high BG readings. So, I did fill the pod quickly and I'm sure there were bubbles in the mix. Normally, I'm quite anal about getting zero bubbles, and usually fill the pod slowly. Slowly in that the beep usually occurs about 1/2 way through pushing the plunger down on filling the pod. Play with that idea in mind and let us know what your outcome is.
Scott - Thanks for your slow-fill idea. I'll try it. If that's all it takes to fix this, it will be better than my bolus tactic to fill the gap. I'm tempted to waste one pod and one insulin load to examine what bubbles, if any, start out in a newly filled reservoir.
I went back and reread your post from before, and I see you had already told me his name was "Norm". I'm sorry I missed that! My dogs name is Brady.(and yes, we are EXTREME New England Patriots fans! Do you have a picture of Norm anywhere in Cyberspace?
Looking into the "bubble hypothesis" regarding the reason for my post pod change hyperglycemia, I've now examined three pods out of my used pods collection. I took apart one pod that I was forced to abandon after filling. As you can see in the picture there is a very large air bubble in the pod reservoir.
Sorry for the rotated photo. The bubble is actually at the top of its reservoir!
I fished two more used pods out of the used heap and observed the same large air bubble in both! I thought my insulin filling technique was done per protocol. I had one on one training last July and the trainer watched me fill my first pod.
For those of you so inclined, it would be interesting if you found (or do not find) the same large air bubble in your used pod.
I intend to try the slow fill technique suggested by Scott and see if that doesn't eliminate the bubble.
Alison - If you are interested in applying for a low BG alert dog, you might look into Early Alert Canines. They are a not for profit agency that trains dogs in Concord, CA in the SF Bay Area.
I love living with my dog. He's obedient, warm, and completely conforms to my schedule. It's great to get low BG alerts, especially when I am not aware that I'm low.
I've seen the same on opening pods I removed that still had some insulin remaining. What I am wondering is if the bubbles were introduced post-shutdown/removal of the pod or whether they were there all along. It's possible that when the pod is shut down and the motor driving the plunger is turned off, air can come in via the cannula when you pull it off. Or, if the old pod has been sitting for awhile before taking it apart, fluid could evaporate and air could come in.
I wish the cover were clear so we could see it during filling and operation.
One of the three pods that I opened today was one that never went into service. For some reason, just after the filling step was done, the PDM told me that the pod was terminated and I had to begin again with a new pod. That would argue against the bubble being introduced during shutdown and physical removal from the site.
I'm not sure what to think about this. I can't imagine that these bubble's are intended or "will do no harm."
I think I'll give Insulet a call tomorrow and see if I can learn anything more. I may need to go back to a tubed pump. At least I could always visually verify the absence of bubbles in the entire insulin storage and delivery pathway.
Here is another 'bubble' discussion: Bubble Discussion Link
nevada - That was interesting. The thread occurred back in 2010 and a few comments mentioned post pod change highs. The pictures of the opened pod provided incredible detail. I learned that some people don't even try to get rid of all the bubbles in the fill syringe through the needle. Instead they turn the needle downward and tap the side to get all the bubbles up against the plunger o-ring and then stop short when filling the pod. The bubble depicted in this thread's photos is very small compared to the ones I've observed. Thanks for the link!