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 :)
I have the same issue, where I’ll be high for about 4 hours after a pod change. It doesn’t happen all of the time though, so it can be frustrating. I always try to give myself a little bolus before the change (about 1/2 hour’s worth) and will also adjust my next bolus for a meal up by 20% if my reading is high before the next meal. I usually change between breakfast and lunch and am stable again by dinner time.
I’ve had this problem too. I solved it by giving a bolus AFTER the pod change. Whenever I remove a pod, there is always a little droplet of insulin where the catheter was removed, which means I’m losing some of my most recent bolus and/or basal. Depending on when I make the pod change, relative to meals, I’ll usually bolus 1-2 units right after a pod change. That is usually sufficient to fight off the post-pod change highs.
Another option would be to do your pod changes in the morning. Then you could aggressively treat those highs without the worry of overnight lows.
We usually do pod changes about 4 pm. Most times I give 1 unit before changing. We treat highs more aggressively at dinnertime after a pump change with a higher correction rate. We do another check at 8pm or so before her bedtime so that we can see if she is going high, if she needs a correction, and if we need to skip bedtime snack.
She’s 6 so we may be doing things a little differently.
For my 13yr old daughter, we are doing a 0.5unit pre-change bolus, then a temp basal on the new pod of +30% for 2hrs. We do the change just before dinner. Works sometimes and not others depending on what and when we have dinner. Would like to tweak this routine and thinking about a higher bolus with a longer smaller temp basal.
Would love to do a poll of this group to learn more about 1) pod change times (time of day, pre or post meal), 2) On which pod to do the pre-change bolus (old or new), 3) typical bolus dose, 4) typical temp basal amount and time.
Thanks Leighann. I’m totally willing to give it the 6 year old try as it sounds like you guys have it under control–which I’m striving for Thanks again!
Thanks AML for the info. Would love to see results of that poll too! Well for me: 1)change time is after dinner prior to bed usually around 9pm (though I’m trying to move it earlier, but ALWAYS forget!) 2) I was doing the bolus prior to change, but will now try after, 3)typical bolus: 1 to 1.20 units, and 4) I haven’t really done a temp basal in this scenario, but should probabably try it. Thanks again!
Gina,
The other tip people gave us is to leave the old pod on for a short time after the change bolus (we wait at least 15min after bolus before deactivating) and after deactivating (at least 5min). That way it addressess the residual “drip” that you and others refer to…or so we hope. Best of luck to you.
I wonder if Insulet acknowledges this issue. I can only guess it takes a few hours of insulin flow to dislodge bits of tissue that sometimes block the cannula after insertion? Maybe the cannula sometimes fails to go in straight after insertion and the curvature of the cannula gradually straightens as insulin flows through it?
Great point. Makes sense to me, though I’d lean towards the idea that they don’t acknowledge this? Or it probably depends which person you get on the other end of the line when you call in
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.
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!
