Can You Help with Pod Insertion? :) Need the scoop on Pushing Up/Pinching Up/Pushing On Nose

What is the best technique for insertion? Are you pushing up skin, pulling up skin or pushing down on the cannula with success?

We’ve been on the Pod for about 3 weeks now. We have had some early failures. I’m a little confused by the different instructions out there. I almost think I need another hand or two for insertions, so I must be doing something wrong.

Our trainer taught us to Push Up the skin on arm and leg insertions. Is this just around the cannula or around the whole pod?

If doing an insertion in an area where you can’t smoosh up the skin, like the stomach or but, or back - our trainer adheres the pod and then pulls up on the pod itself and then the adhesive kind of pulls the skin up with it a bit. Does this sound right? It seems like the cannula might not get inserted as deeply.

Ok, then I’ve watched some videos and I see parents like Lorraine (great blog by the way) who don’t seem to be doing any pushing up or pulling up of skin – but they are just pushing down on the nose during cannula insertion. The Omnipod book says the leaner you are, the MORE you have to push up the skin, which seems to contradict Lorraine’s excellent results (small child with little body fat). Pushing on the nose makes sense to me because the cannula would go in a bit deeper and be less susceptible to getting pulled out maybe.

Color me confused?

My DD is 13, and has normal curves you’d expect at this age and is a normal body weight.

What is your best technique for insertion? All tips are welcome.

Thanks so much!

I’m certainly NO child but I kept having issues resulting in occlusions when I “pinched up”. I watched some videos on line and started pushing down on the “nose” end. Not a single occlusion since then!!!

Thank you for sharing that – very interesting.

From your profile it looks like you had previously pumped, right? And I assume maybe some shots for a time before that? When you went to give your daughter shots, did you pinch up at all to give her the shot? Or alternatively did she pinch up the skin to give herself the shot? I use the same technique for that (as far as pinching up) that I do with my pods.
The purpose of pinching up (especially in a leaner area of your body) is to separate the epidermis/dermis from the muscular tissue below (canulas in the muscles are no bueno, which I’m sure you probably knew). So if you pinch up “too much” by grabbing a really large section on either side of the pod, you’re not separating that tissue–you’re pulling the muscle up w/ the tissue.
Keep in mind that the canula goes in a at 45* angle but vertically (from the surface of the skin, downward) it needs 6 mm of subcutaneous tissue/fat to successfully insert.

I pinch up in every location that I put the pod… I just make sure I have stuck the pod really well before I start the priming process, so I do not apply any additional pressure to the top of the pod. I can see possible benefits to that given certain situations such as how the pod is laying on the skin and the area of the body on which the pod is placed, but it has not been successful for me in the past, so at this point I do not do it.

I hope you are able to find some success with trying different techniques!

Thank you. That does make sense (separating muscle from dermis layer). So you are just pinching up a bit right around the nose where the cannula goes in (vs. all around the pod). I thought our trainer said something about pinching up equally all around the pod - this may be some of my confusion and why I use 2 hands for the insertion.



If you are inserting your stomach or back do you pull up on the pod itself?

Here is Lorraine’s Pod Insertion Video in case it helps someone else. Her son is maybe 5? and she inserts it on his back, pressing against the pod.

http://www.tudiabetes.org/video/pod-change-omnipod

Yes I try not to use my stomach too much b/c I did shot therapy and pumping there for 13ish years so I’m trying to give it a break.

When I use my back, it’s actually more of my flanks (areas over the kidneys, more towards the lateral–outer–edges of my back). So in the video of Caleb you posted below, I use a similar spot except almost a little more to the outside edge of that, w/ the canula facing outward (the same direction as how he put his on).

Yes, I do pinch up around the canula end when I’m inserting on my back (and in the rare case when I use my stomach, I also pinch up there too…and I also pinch up when I use my arms as well. So yes, I pinch up every time lol). I will try to work on getting a picture of that sometime in the future (I’ll see what I can do about convincing my roommate to help me :slight_smile:

Gotcha – You are still pinching up the skin on back and stomach and not pulling up/back on the pod.

Haha! So funny to see and hear little Caleb. He was around 5 in that video. He’s now 8. But we’re still pressing in, just like in the video. :slight_smile:

We were trained that way by an Insulet rep. We tried pinching up once (I’m sure I did it wrong) and it was a gusher. Since pressing just a little works, we haven’t tried to pinch up again, but it’s always in the back of my mind. I probably know of as many people who pinch as who don’t. I think you just kindof figure out what works for you and the placement on your body.

But be warned - if you ever need to call in an errored Pod, they WILL ask you if you pinch up and if you don’t why you don’t. Insulet - if you are listening, it would bring me great joy if you could please modify your CS process to have that little tidbit permanently noted in our file so I don’t feel like I’m being judged each and every time I call. “Are you still pinching up”, would be much more pleasant than “Are you pinching up? Why not??”

Good luck!

We pinch up along the sides of the cannula. I used to also press down, but after several occlusions, the folks at Insulet suggested we not press down. I stopped pressing down and we have not experienced such occlusions since. Like everything with T1D my guess is the ‘right’ approach differs a bit from person to person.

Thanks Lorraine. Your Caleb is a cutie. I have a little boy close to that age too.

Judging by the posts here, it does look like it’s a very individual thing. I kind of wish it was more cut and dried than that so we get it figured out sooner, you know? Oh well. She loves being tubeless (we were using the Revel) so we will keep moving forward.

Thanks for the warning on the Pinching Up Script, ha ha. At this point I better tell them Yes since I’m not prepared to defend any other answer. I know what you mean…I’ve dealt with Minimed’s Sensor Script for 3 years. It feels like the CSR has a flowchart where every possible customer problem leads to a big red box that says “User Error”. I’m exaggerating a bit (just a bit).

But be warned - if you ever need to call in an errored Pod, they WILL ask you if you pinch up and if you don't why you don't. Insulet - if you are listening, it would bring me great joy if you could please modify your CS process to have that little tidbit permanently noted in our file so I don't feel like I'm being judged each and every time I call. "Are you still pinching up", would be much more pleasant than "Are you pinching up? Why not??"

I am also no child, but I just slap the pod on and gently hold the whole pod still while it inserts. I find that this way the pod doesn’t “kick back” when It inserts the cannula…it’s the “kick back” from the spring loaded needle that seems to give me a sloppy insertion.
Just my personal experience!!!

Believe it or not ,I have been on the Pod for 3 years and have only applied the Pod on my upper arms. I just rotate arms every other day. Also I do NOTHING with my skin when inserting cannula. I just stick it on and hit start, I have not had any problems doing this for 3 years. Matt

Matt - you change your Pod every other day as opposed to every three? I’m wondering if I need to start doing that for Caleb.

My 16 yr. old son just leaves it be and does nothing…works fine for him…Did the pinching thing in the beginning and it seemed to cause more problems and hurt more.

You know…that’s a really good point. There is some kick back when it inserts and it would make sense to counteract that with a little pressure.

I’ve played with a dead pod and wow…that needle insertion has some force behind it.

We mostly push down on the nose of the pod - but since she is 4 there is a lot of squirming when inserting - so that may be why it works for us…

She wears it mostly on the arm.

This is what I do also. I pinch up the skin on both sides (kinda hard just to pinch at canula end, don’t know how that’s done) and slightly press down with my free finger and hold the pdm close while it inserts.

I pinch up around the area where the cannula inserts with my thumb and middle finger, and push down slightly on the nose with my index finger. I don’t have much fat anywhere so I’m always a little nervous about inserting too deeply.

Matt…I did 19 years of MDI in my stomach and would love to give the area a break.

I’ve been using the Pod just over a month now and have been afraid to try the arms because I feel like I will bump them off. Where exactly do you place it on the upper arm? Cannula window facing up or down? Any tips you can share would be very helpful… do you cover with an armband when working out, etc?

Thanks!

P.S. Lorraine, I also do every 2 days like Matt and it’s because I use about 75-85 units of Novolog daily