Highs after Pod change?

My son Spencer, has been on the Omni-Pod since November. He has four sites, arms, stomach that we use, so in reality, they come back to the sites every 12 days. For the last couple of Pod changes he has been going high (300-350) I tried adding 0.50 units, yet it seems to still go high. Any suggestions would be greatly appreciated. Thanks all!!!

The sites might be getting used to much. I've noticed this and its why I'm looking at trying placement on my legs. It seems the only spots that seem to work for me is my upper butt and arms. My stomach area is worn out from MDIs for so many years. Its will be 12 years in October. I started the OmniPod October 2011.

Any possible way that your son would be willing to try like the upper butt area or possibly the thigh area? It might help and give the other areas a longer break.

From your message you are suspecting that overuse of the same site might be causing the effects, but I think not. This happens to me (I've been on Omnipod since 10/2011, so about the same time), I also use the same number of sites as your son. I think it just happens; 6 months usage is enough to make me, or you, realize that those highs happen, sometimes, on a pod change, but that is all.

He has revisited the same area *approximately* 12 times, but the canula is minute and if there is damage (I had some last time) it is obvious. (I had a bruise about 5mm in diameter and bleeding; I'd presumably punctured a capilliary blood vessel.)

I believe (i.e. this is religion, not science - I don't have enough data for science) that there is some chance that the canula gets inserted into an area that delays absorption, so there is a hiatus while the insulin creeps through. This can only happen on pod change; after the hiatus everything happens consistently, but the delay is enough to raise my blood sugar. It settles out after maybe 8 hours. I just bolus in response.

Of course, the jury is out: what I just said is a hypothesis (back to science ;-). Insulet probably knowns but probably won't tell us, however we can work it out ourselves.

John Bowler jbowler @ acm.org

I experience the same problem. I think it is a plumbing problem - the pod primes, but when inserted it needs to build up a positive pressure to deliver insulin into the site. I don't know if other pumps show this behavior. I usually increase the basal rate by 50% for 1 h and give a 0.5 unit bolus after changing the pod.

I noticed that other Omnipod users seem to do this too. I haven't done it because most of the time it's fine. It may be that I don't notice, because I always change in the evening, but I think I would if it happened consistently.

I do always do a blood test and correction immediately before the pod change.

John Bowler jbowler @ acm.org

My endo who uses an OmniPod is the one that told me its from the over use of sites. It also has to do with the build of scar tissue from the 10+ years of MDIs.

Maybe, but I see the same symptoms from using sites that I *never* used for MDI.

I trust William of Occam more than any doctor (ok, Bill was a religious fanatic, but the correctness of his observations survives the idiocy of his up-bringing, may I enjoy the same fate.)

I think there might be a real issue with MDI scar tissue, but I think endos and medical corporations use it sanctimoniously as a defence against older diabetics who are more inclined to argue because, let's face it, we've heard all this before (PZI {"protamine zinc insulin"} anyone?)

Mike777 is correct of course, there is a real issue here. It might be reuse of sites, but if it is we can say goodbye to Omnipod, and possibly Insulet Corporation as an investment as well, because if reuse of the same site no more than 12 times causes it to fail then... Well, how many sites are there on your body? Divide by 10. That is the number of *YEARS* you have before the Omnipod ceases to work.


John Bowler jbowler @ acm.org

Change doctors.

We've also had a LOT of problems with the POD on our 2 year old. After going to see the doctor to talk about the issues we've been having she's suggesting that we look into the Medtronics unit. We were originally nervous about having the tubes on her, but she assures us that she will get used to it.

We've been on the shots (Lantus + Humalog) for the last 2 weeks or so, and did another pod tonight. Since we put it on, we've given her about 7U of insulin (though the pump) in the timeframe of about 4 hours trying to get her below 390+. She's just NOW down to 245, 45 minutes after her last Bolus. We'll have to check her again in an hour and a half, but at least she's below the 300's, FINALLY. For reference she usually gets about 4.5U of Lantus, and about 10U of Humalog total for the day, so the insulin must be going somewhere else!

I'm really tired of the Omnipod and never knowing WHAT you are going to get. SOMETIMES, it "just works", but most of the time, it seems to take forever to actually get going.

Oh, our doctor also said that the new pod might be better, we'll see.

I've noticed that for the first 6-8 hours my new pod doesn't seem to be pumping just right. I also try to combat it w/ raising my basal and taking a bolus w/ the old pod before I change. But after that initial 'break-in' period, the pod works fine. Which leads me to agree w/ John - I think it's a priming issue and not the sites themselves. Been on the Omnipod since Feb 2011 and a diabetic for 46 years (diagnosed at the age of 2).

I gather that the BG's go high after the pod change and not before. I used to have highs 8-10 hours before I changed and then it would take me a while to get them back down after a change. Two things I've done seem to help. Like others, I "prime" immediately with 1 unit as soon as I've activated a pod. I do a BG check one hour after and correct for the high. Usually that gets me back in range. Recently, I've also started a temporary basal of +15% for 1 to 2 hours when I've been high right before I change the pod. I am having many fewer highs in the last 12 hours of a pod life since I switched to Novolog from Apidra. Apidra and Humalog both indicate that they should be left in a "reservoir" a max of 48 hours before the insulin should be replaced. As you can figure out, that doesn't work very well with the Omnipod. Novolog indicates a reservoir life of up to 6 days. The change has made a huge improvement for me. Also, I have 14 sites on my back, buttocks, and hip area that I use and systematically rotate through those sites. That way, I only use the sites at least theoretically every 42 days. I've been on the pod since October of 2008. Sometimes the cannula gets bent or plugged with fatty tissue when you insert it and the insulin flow is impeded in which case you just have to change pods again. In this case, when I have to abandon a nearly new pod, I pull what insulin I can out of the one I take off using the "new" filling syringe and wiping the fill port with alcohol to maintain some degree of sterility.

I have one of the top doctors in the US. Everything he has said has proven to be true by science not religion.

I've been using the pod for 3 years now, and I'm certain it's a priming issue. I eat my last snack of the night, bolus for it, then change my pod. That way by morning I'm good. If I do change and eat a meal afterwards i'm almost certain to go high. i'm guessing it's the air in the cannula????

It is definitely an air issue. I am overly cautious about not getting air in the pod and then I hold the pod just right when priming so that it pushes the air out first. Since I started holding the pod a certain way while priming I haven't had very many highs after changes.

we have found that if kennedy does one unit bolus with pod change, she hits around 200 at lunch, without the unit she's 300... next pod change we are going to try 1.5 units extra and she how she does, her rise occurs around 4 to 6 hours after the pod change ( with apidra) with humalog it took longer, 6 to 8 hours.

Best of luck and let us know what you find out with trial and error.

Hi mike, we had major frustration with this issue, but have finally fixed it, we bolus .5 pre pod change and 1.5 to 4 units post depending on jacobs blood sugar we tried temp basal increases with mixed results, i dont thing your sites are "tired" it seems like the pump needs to be primed so to speaks, this has made a major change in our overall happiness with omnipod and our quality of life! i'm sure you can related to that comment. one other thing i try to not have him eat at least an hour after a change, he changes it consistedly around 4 430 pm do the extra bolus and he has been great at dinner. this works for us. wishing you the best! amy

How are you holding the pod while it primes?? I just leave it laying in the tray next to my PDM while it primes.

That seems a very reasonable expectation, like Mark asked - how do you hold it? Like Mark I leave it supine while it primes. I notice that sometimes it ends up squirting out more liquid than others. I'm very careful not to inject air, but there must be something in there before the insulin - I'm guessing it's either saline or air.

John Bowler jbowler @ acm.org

I leave the pod in its tray to inject the insulin into the pod then sit the pod in its tray on top of the PDM while it goes through the priming process. While it does that I cleanse the area and apply IV prep and Mastisol on the intended site before I ever take the pod out of its "cradle". I then remove the plastic end cap, peel the paper, and apply the pod. Do you "pinch up" with the thumb and middle finger while pressing down with the forefinger on the cannula end of the pod during the "start" procedure. One of the techs told me to do that. I then bolus 1.0 units, wait an hour and correct. Sometime I do a 10% temporary basal for an hour too.

I hold it at an angle with the outlet corner pointing up so that what little bit of air is there gets forced out first during priming!