I’ve had pretty good luck with Omnipod over the past year (last A1C 5.1) but maybe I got a bad lot or something because last week I woke up at 3AM and noticed I was at 379. I immediately knew the pod failed and got up and changed it. The weird thing is at 1AM I was riding a steady 115. No alarm from Omnipod at all. So I changed it and spent all morning getting it down then two days later (yesterday) it was time to change my Dexcom. I was at 85 when I changed it. After the two hour warmup when it came back online the first reading was 350, I’m like no way. So I did I finger prick and sure enough it said 322. Obviously that pump failed too, again no alarm no nothing. I haven’t been over 300 in years and usually never go above 200. Is it normal for it to rise that quickly? And anyone else experienced a bad lot of Omnipods? Got 3 left in the box and no way am I going to use them. Even worse it couldn’t have happened at a worst time. Both times no food on board to cause it.
I had a bad batch a couple of years ago but did not have problems as severe as yours!! What did Insulet say when you talked to them about the pod failures?
I once had something similar happen during a warm-up and since then do intermittent fingersticks during the warm-up period to keep an eye on my BGs.
It has me baffled because my basal rate is only at .7 units per hour, so after 2 hours I would’ve only missed out on 1.4 units of insulin. I can’t see how 1.4 units would have made that much difference, especially since my correction rate is 25/mg for 1 unit. I must be missing something.
Insulet didn’t have much to say other than they would replace the entire box.
The entire box! Great
The “rule of 1800” is that as a rough starting point, your insulin sensitivity (how much a single unit of insulin will lower your bg) is 1800 divided by your total daily dose.
If you use the 1800 a different way, this rule says that if you don’t take any insulin for 24 hours, your bg will go up by 1800.
Your 2 hours, is 1/12th of day, and 1/12th of 1800 is 150.
So yes, as a rough rule of thumb, your bg can go up several hundred in just two hours without insulin. Yours went up 230, not 150, but it’s the same ballpark, and there are some nonlinearities involved.
This is definitely true for me too my sugar shoots up with no insulin. As resistance starts immediately.
It takes 3 to 4 times the insulin to drop from 300 to 200 than it does to go 200 to 100.
That being said, you won’t go up to 1800 likely because your kidneys start removing it at 180 and you can get up to the 400s you would likely be feeling pretty sick by then.
I take a low dose of Lantus every day and it prevents spikes like that and lowers the possibility of DKA.
That 1.4 units of basal insulin is highly effective because of its great timing. The old adage, a stitch in time saves nine, definitely applies to insulin delivery.
The basal delivery metabolizes the glucose released by the liver. Stopping this well timed insulin delivery has a non-linear effect on blood glucose.
This is a great explanation by @Tim12 , but he overlooked one little piece of conventional wisdom. When you’re making basal adjustments, the advice is to look at and adjust the basal 1-2 hours prior to the problem spot you’re trying to address, because it takes time for that insulin to accumulate and work and for the evidence of that work (or lack thereof) to show in your BG data. Which means your pod could have failed 1-2 hours before that 115 and 85 you reported. There’s no possible way to know when, since it didn’t alert, but you could have already been on the rise from lack of insulin and not known it. Do that same math @Tim12 proposed, but accounting for up to 4 hours of missed insulin instead of 2, and it explains the discrepancy and how you could easily hit 300s without insulin for those hours.
And another note, your correction factor/ISF you report of 25 isn’t the best measure to judge how a jump like this is possible. Since we become more insulin resistant when we’re high and needing those corrections, that setting is inherently lower and more aggressive than it might apply to basal needs. You just can’t make a 1-to-1 comparison between the two.
I have had several “bad lots”. In my case I think it’s a me and certain lot numbers. I can go through one lot as I am now, with almost no failures and hit another lot and get continuous problems. My problem is usually on the second day having to give a ton of extra insulin and staying high. But it is linked to certain lots only, and sometimes only to certain boxes. But it is a definite me issue with only certain lots.
With my Dexcom alerts now, I usually have caught my BG levels before I go up way high, I was reminded of the old days, when I could hit 200-350, 90-180 minutes after a pod failure.