3rd day highs on omnipod anyone?

Although my son is starting to deal with teenage hormones and rising blood sugars, there seems to be a pretty clear trend that he runs higher ( stuck in the 200's not 300's or god forbid 400 there is an occlusion type high) even with slightly more aggressive bolusing that third day seems to be a bugger and things get better when he eases into the new pod. Dose anyone else have this issues or any tips to help. He doesn't want to switch to another pump or go back to MDI, nor would he like changing his pod every other day, of course we would do this if things really got out of hand. It is frustrating thinking pump therapy is going to be so much better as the nonD population thinks it is like having your own pancreas! I hate that we try so hard and can just see his A1C rising. Maybe for the teen years you really need to change your expectations, but I clearly think his omnipod is a player in this. Any thoughts? Thanks! Amy

My son has 3rd day highs for two reasons - 1. we were using humalog and it wasn't lasting 3 days in the pump, so we switched to novolog and that helped a lot and 2. if i was reusing a site too much, or not letting it rest, i would get 3rd day highs, so i just alternate to a different site and that helps a lot too. I have a lot of factors controlling this in a two year old too - growth hormone is insane, and there's always some kind of cold or infection with a toddler - just always a constant challenge.

Is there a Diabetes Educator in your Doc's office? If so, get in touch with them. There are some tricks they know that might help. Be sure to be very very strict on keeping records, as that will help find the new norm for your teenager.

I had this same frustration for over three years until I read the fine print on the insulin info sheets. I was using Apidra and found that both it and Humalog state that their insulin should be replaced in a "reservoir" every 48 hours. Novolog, on the other hand states that it lasts 6 days in a reservoir. I switched to Novolog in January of 2012 and that has solved the 3d day rise for me as well as I find that I'm more sensitive to Novolog on the whole. A 24 reservoir life doesn't work well with the Omnipod 72 hour "lifespan". I actually have had the Novolog be effective for the full 80 hours that a pod will go before it shuts off. Hope this helps. You do work hard at this. My endo says he's never seen anybody work as hard as I do and have so many ups and downs but in my 46 years with diabetes this (and my DexCom CGM) are the best tools I've had. I wish you well!

thanks jla, we have used novolog from the get go, probably more of it is from growth but there does seem to be a connection to the 3rd day, we are seeing his endo in a month, i try to tweak myself in between but i might need to put a call in sooner. thanks for your support!

I can empathize with you. I'm struggling with female hormones leading to menopause. When my numbers get out of sync, it can really be frustrating trying to figure out if it's just part of the endless basal need changes or a site absorption issue or an insulin issue or just plain old gremlins.

My first reaction when I begin to run high on the 3rd day is to pull the pod early to see if it's hormones or site absorption. Most of the time, I'm still high even with the new pod so I basal test again and adjust.

I too have had the thought that maybe I just need to lower my expectations because I find myself getting so discouraged. I'm working so hard and not achieving the results that I used to be able to get with much less effort.

I also use Humalog and this discussion has prompted me to make a note to ask my endo about trying Novolog when I see him again in August to eliminate the insulin as a variable. So thank you for that.

We just trained on the Omnipod yesterday, so forgive me if this is a "duh" thing for anybody, but our trainer said he had a person who was popping off the needle cap before he filled the reservoir so when it primed the pod was unable to get all of the bubbles out because it needed that seal over the needle/cannula.

The person was having highs on the third day because he was hitting all of the air by the third day in the pod that he didn't get rid of during priming.

no duh thoughts here! we follow a pretty good "protocol" with filling so thats not it but thanks, hope this line of thought dosnt discourage you we are overall happy with omnipod no method is perfect. or we wouldnt have to work so hard on management, best of luck with your transition and ask away if you have questions!

HI %Amy,

My son and I are both on the Omnipod. Although I don't have this issue, my son (who is six), does. It is very frustrating. When I see this increase, I put a temp basal of 20% increase on. Then, I have to worry he is going to go low, but usually, he does not. Of course, this does not happen with every pod, but many! My little guy does not like to get his pod changed, so this is one way I have devised to get that third day. FYI, we are on Humalog. Interesting discussion about Humalog vs. Novolog. Again, for me, I don't have that 3rd day high, but my son is so much more sensitive.

Our doctor wrote our Omnipod prescription for 2 days instead of 3 because she said often kids don't absorb insulin as well on the third day since their bodies heal faster than adults' bodies, and the body sees the pump injection site as something that needs to be healed. We don't always change after 2 days but often see the highs start on the third day if we don't. We are on humalog as well though so I don't know if there would be a difference with a different insulin. Our endo didn't think so but we haven't experimented ourselves.

So does this mean that this also happens with "traditional" pumps?

good question, i know others have commented with highs when it is time for a change out with other pumps but i'm not sure what the statistics are, i guess it is just in generally way harder to manage kids than adults with type 1 so many more variables, just keep watching for trends i guess! i was just going to turn up jacobs basal a bit during the overnight and low and behold he woke up at 71! on a day when he needs a pod change so go figure!

I've spent many years on Minimed/Medtronic/Animas tubed pumps. Yes, I have often had a third day problem with absorption. Not with every site, but often enough. I had an allergic site reaction with Novolog, red and swollen "pump bumps." I switched to the O'pod last week in search of fresh virgin tissue! New sites on the arms work and absorb like a dream.

best of luck with omnipod, interestingly jacob has used arms the last two times and has had better luck, i think his belly sites needed a rest. ask if you have any question about your omnipod.

I'm an adult with type 1. I was diagnosed at the age of 16 so right off it was difficult to control my diabetes due to the teenage hormones. I'm now 28 and have been on the Omnipod since October 2011 two months after the birth of my son. I don't have the third day highs like everyone talks about and I am on Humalog. My prescription is written out for every 2 days because there are times where I go through more insulin and have to change it every two days. I think a lot of my issue is we are trying to conceive baby #2 and my hormones are out of control still. It sounds like there's a possibility that his third day highs has to do with hormones as I ran higher especially when I was a teenager.

Amy, how are things? Kennedy is in the same boat, she has gone from 25 inits a day to 35 a day within two weeks time!! we see a little third day trend with the apidra too, sometimes I run a temp basal + 10% for the last 12 hours and that does help, try to eat low gi for the meal before the pump change helps too, I mentally blame omnipod here and there as you can see from my former posts, but the last two weeks, we have NO KINKS, NO CLOUDED INSULIN, NOTHING to blame except just the diabetes... I was so scared to make a huge leap at once with her doses, but we just did it and have had an ok past 24 hours...
I pulled my pumping insulin and reread the chaper on gaining control, which really helped me a lot, pod sync with endo tomorrow, they will probably be horrified when they see this!! We have a two week average of 190!!

YES! don't pop the top till AFTER PRIMING, I did this once, but then I noticed all the insulin literally blowing out the cannula before and thought to myself " this cannot be right"

Hi natalie, things are slightly improved, i've upped his night time basal a bit and tend to overshoot a bit on most boluses, i also think he was overusing his belly sites and gets better results from his arms. i doubt your endo will be suprised by kennedy's numbers as this is expected in the teen years yeah another variable to consider! they will help you tweek. we are going in a few weeks, so we'll see, try not to think of that A1c as a report card grade, although i guess we all do, just another tool to help. and perfect numbers are not the norm for teens so we just have to do our best. good luck tomorrow, let me know how it goes if you are not to busy, hope you and your family are having a good summer. amy

My diabetic educator told me that arms and legs always do a bit better than abs due to the movements in muscles. That movement causes the insulin to absorb faster. This may seem good, but can also have bad effects. Anyway, it's worth noting just so you know that it's different and needs to be adjusted for where the pod is at. Add to that the activity changes for a teenager and you can have a heck of a time keeping up with the doses needed. Good luck!

that makes sense scott, i remember on needles he would go out after dinner after an injection and play basketball and have some pretty low lows, this week he had two after dinner same situation after bolusing with the pod on his arm really just fooling around with the football and playing with the dog, so many variables! thanks for your input! amy