Here is a real head scratcher. The past 3 pods I’ve worn on my thigh (outside quad area) have followed this same formula-mealtime boluses work at 50%. Ex: morning coffee (tbs half and half and sugar free syrup) normally raises bs 50ish points. I’ve found bolusing .45-.55 covers this rise. With the leg sites even bolusing .75 still returns a 212-250 bs 3 hrs after when an arm, back, tummy site would yield a 70-120 3 hrs later with a .45 bolus. Now, if this was standard of all leg sites I would institute a separate basal rate/temp basal to offset this slow response. But-here is the kicker-my overnight fasting bs is perfect (100 this morning). What is the deal? What could be causing my basal to work properly but not my bolus? Both are small increments (overnight basal 9 pm-3 am at .6 which is similar to the small .45-.55 morning bolus). Has anyone experienced this? I don’t want to change out the site when I know the basal works. Would you double your mealtime boluses? Cover boluses with injections? Seriously, what gives?
I'm wondering if the front quad area should be better? From looking at the example on Insulet's web site, it looks like they recommend the front and not the side. Just a guess though. From what I understand, we all have good and bad areas, you may have found one of your bad areas.
I would call your Endo as this is a serious question. Doubling Bolus could be dangerous - I would never double anything - small increments and see the results each time - MAYBE - but not double. My daughter reads different when on her legs - she seems to run higher so we compensate a little and it seems to work. Good luck - I know it is frustrating.
I would chalk it up to a bad area if my basal wasn’t working either- but maybe trying my front is a good idea-thanks Scott!
Thanks jms-I wish I could call my endo but all I have is a PCP-grrrr small town medical practice!!! Like your daughter I often run a little high on my legs. I’ll figure it out-thanks for your help!!!
When I tried my quads and my calf a few times (after seeing someone post a photo here of that location), I experienced the same thing. Basal rates were fine...but I couldn't catch a meal with any sort of bolus to save my life. It didn't matter if I doubled the amount, or if I gave it plenty of head start (finishing the bolus a solid 20 minutes before eating the meal), or even trying to eat lower carb meals--it all ended with me having BGs outside my target range.
Like others have mentioned, you could try moving the location slightly, but that too might not help. For me, I steer clear of those sites because of the added variability and lack of success that I experienced. I wish you better luck than what I had!
Rate of adsorption is critical for boluses and doesn't matter at all for the basal. If the rate the insulin gets into your blood stream is twice as great at one site than at another the peak of the blood sugar rise after eating will be half at the faster site. For basals it doesn't matter because the injection of insulin is continuous... well, ok, it matters on pod change because if you go from a fast site to a slow site there will be a temporary BS rise.
The obvious way round this is to bolus later, relative to the time of eating, on the fast sites. If you double the bolus you will find you end up with lower blood sugars after all the food and all the insulin has been processed, but you may not notice this if you normally do correction boluses some time after eating.
The key problem is that it is very difficult to control rate of adsorption of *food* and impossible to control rate of adsorption of insulin. Since the two rates hardly ever match we all see temporary BS rises or (more rarely) falls after eating. Shifting the time of the bolus to earlier allows for a BS drop before eating which counters the rise after.
John Bowler
So I’m not alone! I feel relief knowing I’m not the only one, but I sure do wish you had found a solution! Just kidding Bradford-looks like I’ll have to follow your advice of avoiding that area. Thanks!
Let me get out my magic wand and do a little hocus pocus to 'fix ya' ;)
Ha! I, too, am sorry that I couldn't get it figured out. I mean, I figured out I needed more insulin in those spots and that I couldn't ever really cover meals well. But I never really found that "ideal amount" or that ideal timing, etc. So for me, it was just easier to cut my losses and move on, than to try and keep beating myself up about it, ya know?
YDMM (and hopefully for the better!!) ;)
I agree. I think it's related to absorbtion of insulin and the dynamics of basal versus bolus .
Rather than say that the rate of absorbtion doesn't matter for basal, however, I think that the smaller doses, relative steady state of insulin dosing, and absence of a large glucose load makes the affect of basal absorption less transparent than for bolus doses.
I get a pod change high every time my pod expires, regardless of site chosen. For me, something is going on at a new site that changes the dynamics of absorption temporarily. I can't explain it away with lack of basal dosing when a pod change takes 5 minutes and I'll see less of an effect if I have to, for some reason, suspend basal for the same amount of time.
I have the luxury of many sites to choose from and I think, over the years, I've pretty much settled on sites where the apparent absorption rates are a lot more predictable and similar to each other. I used to have any number of different basal programs just for those stubborn sites that just seemed to require more bolus an basal. I largely avoid those sites now.
i just started my new pod today, and we used my arm...in your opinion, where are the best sites. i'm new to a pump so i don't have absorption issues (yet) and don't have a lot of fat, but I use a CGM which is on my stomach. Is the arm a good spot...guess this is gonnna be all trial and error. THANKS!
Yeah, lot's of trial and error, and a few lost pods in the process. I imagine the best spots are probably different for everybody. My most consistent spots are on the sides of my abs and around my waist. I don't have a lot of fat either, but those are the spots where I have the most subcutaneous tissue to work with. I use my arms too, just under the shoulder back near where the triceps originate, but those spots are less consistent. They range from the fastest absorbing sites where I'll use way less insulin than other sites, to some of the most slow absorbing where I can get some pretty crappy averages over the three days a pod is on there.
It sounds like you previously had been pumping at a different place (abdomen, arm?). This raises a question for me -- why rotate so broadly? I have switched from right arm to left arm and back for years now, only rarely going elsewhere. (At social events I find people often grab your arm/shoulder, so I switch to belly before those...)
Am I alone in finding a good spot and sticking to it? Have others found that after relying on one area for a period they become less effective and have to move elsewhere.
Simply: is rotation really important?
I bolus 1 unit expressed (for me) as 12g of carbohydrate on pod change. My assumption has been that this effectively primes the new site, so that insulin in that site gets into my bloodstream more rapidly than it otherwise would.
My statement about the basal was based on an assumption of a steady state under my skin. The pod injects insulin under my skin, but the insulin has to be available in every part of my body to work, so it has to get to my arterial blood supply. To get there it has to get into the capillaries that feed my veins, into my heart and out again. That takes time on a new site, but once it starts happening it just keeps on happening - so long as the basal is constant it doesn't matter how long the insulin takes to get from the pod to my heart.
John Bowler
I do the same thing. Pod change, bolus 1 unit if my BG is already in normal range, 1 unit plus whatever correction is required if my BG is out of range. It's hit and miss. Some changes I'll be low and have to correct, some changes I'll still go high and have to correct, but never as much correction or difficulty bringing my BG back down to normal than if I didn't bolus at the change.
Some changes, I'm dead on correct and will not miss a beat. There has to be a song to write about this somewhere in there.
I've always assumed it's because of basal rate absorption rate differences. Who knows, might just be gremlins.