Replies to This Discussion

Permalink Reply by jms1313 on February 24, 2013 at 10:55pm

My understanding of IOB is based on the absorption time of the insulin - it does not remain in the pump. Wait 10 min and the insulin is injected and you should not have to compensate for pump change?
Please correct me if this isn't correct but this is how it was explained to us and we have had no problems with changes for over a year and a half.

Permalink Reply by HPNpilot on February 25, 2013 at 4:36am

The PDM remembers the IOB... this is simply the PDMs calculation of the remaining insulin still acting in your body. It has nothing to do with the pod.

By bolusing again with that amount you doubled the insulin in her body and that is why she went low. There is no need to do anything special with IOB when changing the pod. IOB is not insulin waiting to be delivered - it is insulin already in the body.

Now, if you have a temp basal active , that is cancelled during a pod change as is any extended bolus pending. THAT is insulin still in the pod being dleivered, not IOB.

Permalink Reply by Jacob's mom on February 25, 2013 at 5:29am

very clear explanation HPN pilot! to avoid highs after pod changes we still do a bolus have you tried something small like .5 U? my favorite time for jacob to change is pod is around 4 or 5 oclock. about 1-2 hours after his afternoon snack he does .5 before the pod change and 1.5-5 U after with no food depending on his bs, but he is 14, i think the pump needs to be primed a bit to get going. then he tests for dinner around 6 ish so we have a good feel for how things are going. i was always nervous to have him change his pod around bed time, he despises overnight checks, but he does sometimes now out of necessity of course. just a suggestion. hope things settle out. amy

Permalink Reply by Piki101 on February 25, 2013 at 5:33am

My daughter is always high after a pod change and for some reason it takes a long time for her blood glucose number to come down. We never make any adjustments during the change. Our pod changes are usually at night and I would rather have her high than low. But we do check her every 3 hrs (even during night - 12am, 3am, 6am) and make corrections as necessary.

Per the Omni Pod website:
Insulin on board (active insulin)
The amount of insulin that is still active in the body from a previous correction bolus dose. The amount of time insulin remains “on board” or active depends on each individual’s duration of insulin action. Talk with your healthcare provider to determine your duration of insulin action. The OmniPod System continually calculates the IOB to help prevent stacking of correction bolus doses, which is a major cause of hypoglycemia

Permalink Reply by Steve D on February 25, 2013 at 6:35am

Sounds logical for your case. What I have done is I have and 2nd basal rate that I call "change days" and it is about 50% higher than the normal basal. This seems to take care of me on change days, where my numbers go up for a full 24 hours. As for the IOB when I change, (which is what I believe you are actually asking about) I dont do anytthing. The insulin left in the reservoir of the expiring pod just gets tossed with the pod. (sorry if this is not an answer to your query...I am just babbling this morning). good luck and PEACE.

Permalink Reply by Scott Wilkins on February 25, 2013 at 7:51am

I do wish the IOB calculation still remained after a pod change, or at least it was more accurate. I've seen it remain on some pod changes, but not on all. Not sure why, and haven't bothered to examine it yet. But it is a problem that Insulet needs to look at.

Permalink Reply by Simon Carter on February 25, 2013 at 4:15pm

If you use an external IOB tracker like ManageBGL you should be able to avoid stacking insulin resulting from this, even if you only use it occasionally (ie just on pod changes) to give you the correct IOB.

Permalink Reply by aimeeh2oski on February 25, 2013 at 7:17pm

Thanks everyone! I guess I was having a brain fart last night. I think I was confusing IOB with extended bolus. I should have realized that if IOB was going to be interrupted by a pod change, the PDM would alert - like it does for extended bolus. Duh!

As for the highs after pod changes - it doesn't happen all the time, so I'm reluctant to give any extra boluses pre- or post-change for fear of her going low. That's on my list of questions for our new doctor when we see him in April. Although I DO like Steve D's idea for a "pod change basal rate." That might be nice to experiment with. Or start with an increased temp basal for 8 hours and go from there.

Permalink Reply by cbaj43 on February 25, 2013 at 7:19pm

So, when I was on minimed pump, had to do a bolus of at least 3.5 units when changing the infusion set. I had thought a benefit of using the omnipotent was to not need to do that. After reading posts here, I am tempted to try half of the bolus when changing. I often get highs after a pod change.