I was on a T/Slim IQ Control for about 3-4 months in early 2021. It was both great and terrible. When it worked, my blood sugars were really smooth and slightly better than shots with Dexcom G6 (went from A1C of high sixes to low sixes). Unfortunately, I could not figure out how to stop having injection site and tube issues, even though both my Diabetic Educator and Tandem nurse were offering multiple suggestions. I gave up and went back to shots. I have a lot of scaring on my abdomen from using it as my main area for shots for 25 years, so tried to rotate injection sites to my legs, and the Tandem pump just didn’t work for my legs, even though shots are fine there. I am wondering if switching to the OmniPod would help, especially now that the OmniPod 5 is out. Anyone have better luck with the OmniPod rather than using a pump with tubes?
So I was MDI for 28 years before starting on the T:slim X2. After 5.5 years with the X2, I just started on Omnipod Dash pods about a week ago. Jury is still out on them. There are things I love and things I hate.
I don’t think you’ve given enough information to get the answer to your question, though. There are MANY possible points of failure the equal “absorption issues”. You haven’t actually said what help you were offered and what you’ve tried and if you’ve actually figured out WHY you’re not absorbing insulin.
Is your absorption issue constant or sporadic? Do you think it’s definitely scar tissue in your abdomen that’s the problem? That would be indicated by your pump/insulin regime works perfectly when you get your infusion site in the right spot, but other spots are just a no-go from the moment of insertion, AND there’s no noticable damage to the cannula when you remove it (we’re eliminating kinked cannulas from the equation here). What infusion sets have you tried? Have you tried actually switching insulin? (Humalog causes inflammation in me, whereas I’m much more tolerant of Novolog. That inflammation results in variable insulin resistance, which could be perceived as an absorption issue.)
Whether Omnipod is different depends on what you’ve already done…
Absorption issues come with ALL insulin delivery methods, yes, even Omnipod. The problem of scar tissue at the sites still exists, plus there’s always the possibility of pod failures or “tunneling” at the site, basically where the hole around the cannula gets stretched out or just can’t absorb and the insulin gets pushed back out the skin instead of going in.
Omnipod does have some advantages, though. Have you tried Varisoft (soft cannula that you insert yourself with no automatic inserter, and then withdraw the insertion needle) or the Autosoft 30 infusion sets (similar to Autosoft:90 or Autosoft XC, but with a different inserter device that puts them in at a shallower angle)? Omnipod is a soft, angled cannula, so it would be more similar to one of those two than the most common 90-degree infusion sets. It might allow you to find unscarred tissue because it’s reaching new places. The shallow insertion angle might also work better on your thighs. If you’ve tried Varisoft or Autosoft 30 with good results, then yes, Omnipod will probably work well. If you haven’t yet, trying one of those infusion sets might be a good preliminary test.
The other big advantage is the fact that you don’t ever have to touch your Omnipod site, since it’s self-inserting. You can put it anywhere you can reach, without the need to squeeze triggers or manipulate the disconnect point. The nature of how hands-on typical pump infusion sets are really limits their placement real estate. But since Omnipod is hands-free, It means you can put them on your backside: butt, arms, love handles, back, etc… Lots of fresh flesh with no scar tissue back there!
Unfortunately, I’m on my third pod right now, and 1 out of those 3 failed with a MAJOR absorption issue and had to be changed at 3 am of the second day without any alerts or failure notifications, just crazy high BG that wouldn’t respond to the insulin I was injecting via the pod. I think I was just too inexperienced, with too many new things happening at once to recognize the problem. I started Pods and DIY Looping for the first time on the same day, as well as giving up my beloved Control-IQ automation since DIY Looping forces you to learn the system in baby steps without any automation at first. Too many new things and opportunities for failure hid the pod problem.
There’s a protective tab that you have to snap off of the pod before applying it. My second pod did this weird bungee, snapping rubber band thing when I removed the tab. Only being my second time, I didn’t know this was odd. In retrospect, I think the cannula was actually sticking to the tab, and that’s REALLY not right. You’re supposed to inspect the pod after removing the tab, to make sure nothing is sticking out already, and there wasn’t. It had snapped back in. But with a little more experience, I probably would have elected to not apply that pod in the first place. It seemed to work well, though, so I didn’t give it another thought until things were going haywire on the second day.
Likely you are allergic to the adhesive and when it runs down the cannula it’s gets inflamed and stops absorbing.
Likely the pod will be similar… I use barrier tape under my infusion sets and it helps quite a lot.
@Robyn_H Is choke full of information. There are more more things you can try with a tubed pump to try to make it work. The major advantage of a pod is the ability to put it whereever you can reach, the calf of the leg, the thigh, the arm and not likely to already have scar tissue there.
Bit you can have problems with pods too, I do. I haven’t ever used other pumps. I have been having more pod failures the last 1-2 years. I say pod failures, but it’s probably more of a pod site failure. In my case I’m also convinced it’s certain lots, maybe they don’t insert the same depth or angle, but I trend with several bad in a row and it doesn’t matter whether I have picked new territory. Right now I am on a streak of about 2 months with not one issue. But I am also using Afrezza to ease the load on my pod so I’m not sure if that is what is helping me.
So pods don’t necessarily clear up a problem. But you do get new territory. So it really does depend on what caused your issue with a pump before whether the ability to have new sites might help. If legs work for you, legs are great for a pod…I just knock them off easier. You can use something like Skin Tac to help secure it.
thanks for the responses so far. To your point, Robyn, I should have specified that I think I used three different types of infusion sets, including the Autosoft 90 and even tried a self-injecting metal set, recommended by Tandem. No go. It did not seem related to the kind of infusion set, but rather, to the location. On my stomach, off to the side, where there was no scar tissue, no issues, but the “real estate” was very small there. On my legs, it worked about 70% of the time, but 30% failure rate was too much hassle, fears, and really high blood sugars for me.
Since diabetes is a lifelong science experiment, you should probably try out Omnipod since Tandem wasn’t a good fit for you.
After 15 years of tubed pumps, I tried out Looping and Omnipod a couple years ago. I am a senior and my skin and tissue couldn’t handle the weight and stiff cannula of Omnipod. I had pain, bruising, adhesive problems, and severely inconsistent insulin absorption. But I loved being tubeless. I was so happy to return to the relatively gentle infusion sets of my Tandem pump.
But lots of people love Omnipod.
There are not as many choices in pumping as there were 8-10 years ago. But at least there is still some choice. There are both physical and mental adjustments to each method of insulin delivery. You didn’t do well with Tandem. Maybe you will with Omnipod. I say “Give it a try!”
[post content deleted by author]
I appreciate everyone’s input. What you are saying makes sense. I just wish I could come up with a better solution. I know you all know this, but I get to the point of feeling like giving up–as in, I really want to stop trying. Nothing I am doing is working very well, or should I say, not working very well for very long. I had such high hopes with the closed loop pump system. And, at first, it was a game changer for me. I was able to overlook all the warnings about injection site failures as user error. However, after a few months, with the issues continuing despite different options and plenty of help (and I am not actually stupid), I realized that pumps, and tubes, and cannulas, and all of that just didn’t work for me or my body. I was so disappointed. So, here I am back with injections, and running into the same problem I have had for years: early morning high blood sugars that come about hours before I wake, and last for several hours after I get up. I even try waking up at 4 am, taking an extra shot of short acting, going back to bed, and it doesn’t seem to do anything. It doesn’t seem to matter if I eat nothing for 6 hours before I go to bed, or eat a low-carb high protein snack (e.g. almonds or a protein bar) and then take a little extra short acting insulin. It doesn’t seem to matter whether I lower my Triseba or take extra each day. it just makes no sense… I don’t want to sound too dramatic, and I do realize others have had T1D longer than I have, but after nearly three decades of frustrations, I have lately started to think, “I am nearly 60, so the good news is all of this struggle is coming to an end soon.”
Sending you a big hug…and hoping you’ll find a solution.
I have a suggestion for you. I know the frustration. But what you need to do is just keep trying the possible solutions until something works enough?
I have been having more issues with pods. For me there is definitely some kind of link with certain lots. But a big part is obviously some kind of me issue and pods. But I love my pods. So in my case my insurance covers Afrezza the same as any other insulin. I know that less insulin through a pump can help prevent tunneling or other issues with pods. So first I experimented with just using Afrezza some, and decided I loved it. So now my pump is used for my basal settings, it’s the regular Omnipod, not a loop. I also use the pump for small corrections or small dosing. I have DP or FOTF too so a pump is invaluable to deal with it, It seems to be working as I have been having a good streak of the pods working.
The other solution is just try it and see if maybe placing it on the legs or arms works, some have even used shoulders etc? With no scar tissue there maybe it will work? At least for a while until another possible solution comes along? I would also try to make sure it’s very secure with some extra adhesive used as it was explained that the more the pod can move the more you can cause tunneling.
You really are not stuck with it for 3 days. My Omnipod script is written generously for every two days, so I have no problems with supply. Plus you can call in failures and they will send you replacements. My insulin is written generously too. So in my case I pay $40 for a 3 month supply, no matter how much insulin or pods I need. So if the pod fails or is just not working optimally you can just call it in. They have always reimbursed me up to $25 each year with no issue for the insulin wasted. If you go past the $25 they ask for proof you pay for it. I have collected each year since starting to use it for the insulin wasted as I used to pay $180 every 3 months for my insulin. But they only pay so many cents per unit, if you want more than that per unit it could be an issue. I still collect the $25 because while I pay less for insulin, I waste a lot more because of having issues with more pods.
I have also pulled insulin back out of a pod that failed, especially the first day, you can withdraw about 2/3 of the insulin back out of the pod, I used to do that as I didn’t like to waste it. They don’t recommend it, but for me it worked. I know others that do so, that’s where I originally learned about it. I just don’t usually bother anymore. I have just resigned myself to it being wasted.
When do you inject Tresiba MichaelJohn63? I take Tresiba too and I don’t have problems with rising bloodsugar in the morning. I give my 9 or 10 units of Tresiba around 7:00 in the morning. My glucose level is almost always about 70 to 90 in the morning. It doesn’t rise until I eat breakfast, which is usually within 20 minutes of getting up. I eat my oat groats and fruit and and am back down under 100 about an hour later if I ride my exercise bike. Lately I haven’t been exercising after breakfast, and I still don’t stay high very long. My bolus insulin is Novolog.
This is a normal day for me, I still have days when nothing goes right.
You can absolutely try out the OM5 but you may still have absorption issues since you had problems on your legs with other kinds of sites.
If I was on MDI and I was consistently getting DP or FOTF then some of the changes I would make are getting some exercise before bed. This will have a positive impact on your metabolism for anywhere from 12 to 24 hours.
Do not eat protein/fat at night. This will slowly turn into glucose over the course of many hours thereby raising BG while you are asleep and unable to deal with it.
I concur with @Marie20 Afrezza can work miracles with a fast rising or stubborn high BG if you can get your insurance to cover it. If not then I believe Eagle Pharmacy works with Mannkind to provide Afrezza at about $100 a box, which if you are only using it for corrections will last you awhile.
Marilyn, I take Triseba in the morning, between 7 and 8. I normally take between 18 units, although I am trying to vary it to see if it helps. If I take less than 18 (14 or 16 units) the DP is worse. If I take more than 18, I go low in the night, then have to eat glucose tablets, and my sugars rebound high.
Firenza, I will look into Afreeza (never heard of it). I do exercise pretty regularly. Yesterday, I went for a 10 mile bike ride, a 2 mile hike, and then cleaned my house for two hours from top to bottom (vacuuming, sweeping, mopping) before going to bed last night. I did have a low later, normalized with juice, went to bed with a BG of 96, and was steady-ish until early morning, and yet, at 5 am creeped up to 120, and by 7 am, was at 135. The reason the pump worked so well (when it worked) was the “miracle” of being able to increase my basal rate to specifically target the early morning highs, so I was regularly waking up (when I wasn’t having infusion site issues) in 95-110 range for several weeks in a row, which was a first for me in the nearly 30 years I’ve had T1 diabetes.
[the content of this post has been deleted by the author]
Quick update. Things are better, with my blood sugar and somewhat with my mood. For the past three days, I upped my Triseba from 18 Units to 22 Units, and then only ate snacks during the day to counteract the Triseba. I also made sure not to eat anything less than five hours before bedtime (except a couple of glucose tablets and a bit of juice to counteract after dinner lows). Staying away from fat and protein in the evening along with increased Triseba has helped quite a bit for the past 36 hours. My blood sugar this morning was 84, which is about perfect. Took a little humulog to counteract morning rise, and it is now 98 after 2 hours. I also did quite a bit of exercise, which clearly helps me with absorption. I think I will still plan to explore the Omnipod 5 closed loop system, since I am allready using the Dexcom G6, and if it doesn’t work, come back to shots. Thanks for all your suggestions and support. It really helped me get through a tough physical and mental spot in my struggle/journey with this disease.
I would think that going back to any sort of pump would result in less tissue damage than working with MDI since a pump will only cause one skin penetration every few days. I personally have never used anything BUT the OmniPod, and I love it. I, too, have some tissue damage from over 40 years of MDI, so the OmniPod was wonderful when it came out. The “use almost anywhere” feature should be great for you, allowing you lots of new “territory” to use without having to hassle with any tubes. I just started the OmniPod 5, so the only site restrictions are having it within “sight lines” of wherever I have the Dexcom sensor located. I have found the OmniPod VERY reliable with almost no Pod failures, so I suggest that it may be a viable option for you. Since it is a closed loop system, though, you DO have to have some patience and give it at least a month to learn your unique diabetic make-up. Give it a try. If you do not like it, you always can revert to MDI.
Thanks for the reply SherryAnn. I have set things in motion to see if my insurance company will cover the OmniPod 5, so we will see. yes, I have thought about the scar tissue and other absorption issues I am creating with multiple daily injections versus once every three days. I have used a closed loop system (the Tandem Control IQ with Dexcom) so am familiar with the current technology and after a few weeks found it very effective (except for the frequent issues I had with failed cannulas and injection site and injection set issues). I think there are just too many points of “error” in a pump system for me, perhaps including user error, but after nearly four months on the pump, I did finally give up. Hopefully, the OmniPod will be better.
Michael,
You are in good company. We all experience bouts of negativity, frustration, etc. Good thing is…everything changes! My endo once told me that T1D is impossible to control; all the time. We must remind ourselves that we are doing best we can and sometimes, it stinks…and for reasons we cannot always observe. I can watch my arrow go up as soon as i get angry.
That said, I will agree with Marilynn that FATS in evening are often the culprit in
AM and nighttime highs. I like Marilyn try to limit fats t/o the day but especially at night! MDI works well with this routine. Was on pump 25 years and too many absorption issues for comfort.
Hope you are doing well today!
Thanks Lisa. I sometimes forget that I am not alone. I don’t know anyone in my personal life with Type 1, so I often think of this as a disease only I understand, even though I have a team at my endo clinic. There is only so much they can do or understand, and with my absorption/site problems with the pump that they were unable to solve, I had basically given up asking them for help, which is why I came back here.
I have been following the advice offered here and am doing much better, overall, with my nighttime and morning highs. Basic rules I am following: eat as little as possible after dinner (unless needed to counteract a low), and then only have small carbs, no high fat/protein after dinner. Exercise every night after dinner for at least 20-30 minutes on my stationary or real bicycle.
Here are a couple of screenshots I just took from my Dexcom and Dexcom Clarity apps.
If I can maintain these numbers or something close, 6 out of 7 days a week, I’d be very satisfied.
M,
This looks great! My endo actually told me to “get off the pump” when I was desperately frustrated. I like MDI because I can inject anywhere and KNOW I am getting insulin! Remember, everything IS FOR NOW! We may shift the flow at a later date, but life is too short to make long term decisions. I often have low alarm toward AM and eat 1-2 Glucose tabs and if I change Tresiba, I will have high alarm so we all ride these waves.
He also suggests looking at the big picture. If you can get most days looking like this graph, my professional opinion is YOU are doing great!