I’ve been trying out the Omnipod 5 and there’s a lot I like.
The thing I have trouble with is the infusion sites. They mostly start out fine but many end up failing and I also worry about how much damage they cause if they last the full three days.
– Failures. I’ve used 6 pods so far and in 3 or 4 cases, the site has given out before the three days that the pod is supposed to stay on. When I pull off the pod, the area is often wet with insulin that leaked out. The only way I know that the site doesn’t work is my blood sugar doesn’t come down despite boluses.
I think I could cut down on the failures by replacing my sites every other day instead of every three days (if insurance would go along with that), but I don’t think it would solve the problem entirely.
Yesterday, I had a colonoscopy so I was fasting and using very little insulin. Nevertheless, after the procedure, when I started eating and bolusing again, the site was no longer any good. (It had worked fine until then and had done a great job keeping me in range before and during the procedure.) That pod had been in use for only about 42 hours (not even two full days) and had not had to do a lot of infusing (maybe 40 units over that time). Still, it stopped working and when I pulled it out, the area around the site was wet with insulin.
– Damage to sites. When I have had pods that went the distance and have been effective, the infusion site is sometimes raised and red. It’s not a big deal, doesn’t really hurt or anything, but I’m concerned that it’s exhausting the area as a potential infusion site more than my Tandem infusion sets do.
What I notice about Omnipod’s infusion system is that it is shallower than any tubed system I’ve used. This allows access to more sites. I wouldn’t want a deep infusion site on my arm for example. But I wonder if it’s also leading to the high rate of leakage and to the raised and irritated sites.
What I’m used to are mainly T-steel and occasional Tandem Autosoft infusion sets. Both go in deeper than the Omnipod and both can also be leaky or get irritated, but it seems to happen less. Plus, it’s easier with a tubed pump to see and feel what’s going on underneath. Pods, of course, cover the site entirely.
I wish Omnipod had two different depths – one shallower and the other slightly deeper for different areas and different body types rather than the one size fits all approach.
Anyway, I’d welcome any insights. Do other people experience a lot of failures? Do you switch out pods more frequently than the three days they’re supposed to last? Do you think that having sort of irritated sites leads to exhausted/resistant areas on the body or that it’s basically superficial and that the kind of damage that leads to unusable places for infusion sites is happening deeper in a more invisible way? Making areas of my body unusable for subcutaneous infusion because of scarring is one of my fears.
Apologies for the longish post.
What some “pod people” do (
) is use the pod for basal management only, and use injections for meals.
That reduces the amount of insulin you are putting into a sight, and it allows you to still have a “smart” basal, instead of just using a basal insulin like Lantus.
But I am not sure how that strategy would work with the O5, because I think it gives you the basal amount based on your total daily dose.
Maybe someone on the O5 who has tried this can comment.
Unfortunately, this is the downfall for a lot of people with Omnipod. You’re not alone. It’s a pretty common complaint. Tandem’s CEO had made quips about loving Omnipod because they’re a great gateway pump for MDI users. They get a lot of Omnipod conversions.
What you described is nearly exactly why I went back to tubed… That, and I have a lot more site placement options with tubed sets. I like being able to put a flat infusion set wherever I can reach and not having to worry about Bluetooth communication or not being able to sleep on them. I will say that trying Omnipod opened my eyes to places I wasn’t using before. Like it made me realize I can totally put tubed sites on my hips, too, which I wasn’t using before.
At first I used to really panic when my BG shot up to 300, because that NEVER happened with t:slim. And then day I noticed I wasn’t freaking out about it anymore. It had become normal when the site failed. Realizing my complacency about it is what made me go back, because that seriously shouldn’t be normal or okay. And I never knew when they were going to fail. It’s not like it happened on a schedule, so I couldn’t really plan for it.
The one trick that really helped me with pod failures was learning to never bolus more than 5 units at a time. That’s a little more difficult with O5, you either have to go manual or set an alarm for a second bolus… But that would at least eek me into the 2+ day range. Sometimes I could get a full 3 days that way.
I constantly have issues with the sites. My script is written for every 2 days and that’s never been a problem with my previous insurance and now with a Medicare Part D plan. I seem to have more of a problem with certain boxes or lots. I haven’t figured out why. It’s just I’ll have 2 or 3 go bad within 2 days and then I switch boxes and I’m fine.
In my case it doesn’t fail completely, but the insulin just isn’t absorbing as well sometime on day 2. For no reason I’ll have to take more insulin or my number is staying stubbornly high for me. I have good control, so if I am staying in the 140’s to 160’s with an extra shot, I just automatically switch it out and then I’m fine. A couple of times I hit the 200’s, but that’s been rare because I switch it out really easily. My “high’s” above 180 are less than 1%.
The other thing that I watch for is I have DP. I have higher settings for it, so sometimes I can go higher, but it’s usually still under 140 when I wake up. So if I wake up higher than that, I switch it out. Past experience has told me when I thought it might be me and I leave it on, invariably the rest of the day I am fighting higher numbers. If I have to guess, I’d say about 50% of the time they last 3 days.
I love my pods and really don’t want to mess with tubing. Plus while I am on hiatus right now from swimming, I swim a long time and like getting some insulin. My numbers like to start to climb after about an hour when I swim so after an hour I am on my full basal rate. But yea, pods are notorious for having site issues. One depth, one type cannula and you’re stuck with no choices except a wider range of placement. I’ve taken to giving most of my boluses by MDI or Afrezza. I won’t give myself over 2 units at a time in my pod unless it’s an extended bolus. My pods are mostly for basal now. I miss when everything was by my pod!
Thank you for all these insights! It’s really helpful knowing I’m not alone.
This is what I’m learning. With Dexcom, I’m strongly on the side of sticking it out. I think it’s been years since I gave up on a sensor. As bad as they can be in the first 24 hours, I find that if I stick it out, the next nine days are good. Omnipod is the opposite. Once that BG starts slowly climbing and staying there, that pod is never coming back. Yesterday, I pulled one after about 28 hours — a record for me.
I really like the O5 algorithm. I think it’s very good at holding you steady without driving you low. I’m pretty sure that injecting boluses would mess it up. It is based on TDD so I think from pod to pod it would continuously lower your basal until it was useless. I’m not certain, though, so I’d love to hear if someone has done the experiment. I don’t think I’ll risk it myself…or maybe when I’m feeling adventurous.
What I’ve been doing is entering the carbs for different parts of my meal separately. The boluses are spaced out, but probably not enough. It doesn’t seem to help.
So, I think I’m on the road back to my Tandem, but Omnipod has shown me that I can have lower basal rates than I thought. I kind of knew that I was feeding my basal before, but O5 has really demonstrated that for me.
I wish I could use the O5 algorithm on my Tandem pump. Hopefully as they develop their next algorithm, Tandem will steal from the other pump manufacturers. To me, Control-IQ is Basal-IQ Plus, rather than a rethinking.
I also think that subcutaneous infusion will never lead to an effective artificial pancreas. We need the implantable pump Medtronic killed when it bought MiniMed, but I digress…
Some people do not do well with angled sets. Some pods seem to be leaky. I was blaming pods and then foun dout my thyroid was overmedicated and that was causing me to need more insulin.
I think it’s trial and error. And scar tissue as well.
My CDE writes fro two day changes and Medicare is letting me do that, so if I have a real good site I just run the three days. Sometimes I toss early.
That said, I never found a 90 degree set that I liked so angled was always best for me.
Yeah, that’s bad. That’s the device not working for you.
QUESTION: How long have you been on the Omnipod 5? Is this just a difficult transition onto a new device or is Omnipod just not a good fit for your body?
QUESTION: Where are you placing it on your body? There are many places I can put an Omnipod where I know it will fail (my upper arms, for example), but only a few places where I know it wont. Some of this is simply dependent on your body type and how you wear your clothes. I’m hour glassy, so I wear it on my hip. It should work in your abdomen, if its gonna work, but that’s where my jeans are, so that results in a bunch pf trauma to the site.
Women with more slight body types sometimes find that there just isn’t enough meat to hold the device. It’s a large device. Its painful to put it into muscley tissue. Have you tried putting it on your butt, above where you wear your pants?
Today is my 21st day and my 9th Pod. So they’ve been lasting, on average, a little over two days. The problem is that that little over is usually accompanied by some pretty high BGs and it’s not predictable. Some last a day, others longer.
I’ve tried upper arms (most comfortable but not necessarily most effective), buttocks (several times, usually ends up being uncomfortable), abdomen (the area I’ve used pretty much exclusively for the decades I’ve been on a tubed pump so I was hoping to give it a rest), and, once, my upper outer thigh because the trainer suggested it (that was quite uncomfortable).
I’m a man and I’m not especially thin or muscular so there are plenty of potential areas with a layer of fat. Like I say, I don’t wear tight clothes but neither are they super baggy. Sweats might change the equation for me but I’m not a sweats guy. My pants sit too high for there to be any room above them without putting a pod on my back ( where I would lean on it) or into my side (which I haven’t tried but it seems uncomfortable.)
Anyway, my plan is to go back to my t:slim later today with a new profile based on what I’ve learned from Omnipod 5. I think tomorrow I might order another 10 pods (I just have one left of the free trial I did) and maybe work them into the mix from time to time. I’d like to make it work because I like the algorithm.
I’m thinking of trying Tegaderm underneath a Pod because someone on the interwebs said that could help with leakage. Anyone tried that?
This could be a sign of what’s known as tunneling, where the tissue doesn’t absorb the insulin fast enough and so it backs up along the cannula to the surface. Some people are very prone to it (like me), and others not at all.
On the previous pod versions there were two viable options. (1) Use the pod only for basal and inject boluses, or use the pod for basal and small boluses (in my case, no more than 2 or 3U), or (2) extend boluses so there’s not so much going in at one time. In my case I inject breakfast and lunch boluses and extend my dinner bolus 5 hours. I’ve never had tunneling since.
On the Omni5, option (1) risks making the algorithm think you are much more insulin sensitive than you really are, so it will under-correct for high trends. To partly get around that, you can switch to Auto mode when you’re injecting, until you come back into range. However, the algorithm still isn’t working with TDD “full disclosure.” This would require a degree of attentiveness not everyone is cut out for.
The success of option (2) will depend on your diet (ideally lower in fast-acting carbs) and/or how self-controlled you can be about what, for me, would be long prebolus times.
If it doesn’t stay that way, I suspect you’re fine. Your body has had a plastic tube stuck in it for three days, so you can expect it to show some reaction to that. My bumps are gone within a day or two. Anything longer than that, especially if itchy or burning, and you should be concerned.
I love the pod, I love no tubes and I love not being aware I have any kind of pump on or attached to me, but it doesn’t work for everyone. Let us know how it works out for you.
(BTW: Thank you for calling them “site failures” rather than “pod failures.” Can’t blame the pod for doing its job!)
For what it’s worth, I found the Omnipod 5 great for basal. It was just a coincidence that I had my colonoscopy while I was trying out the Omnipod, but it really worked out great. The algorithm held me in a good steady range the whole time which was a huge relief because you can’t eat or drink at all for four hours before the procedure.
I also loved how good the system was at keeping my BG in range without driving me low and forcing me to eat when I was active.
Boluses seem to be the system’s downfall which is especially a problem because the algorithm pushes you toward getting 50-60% of your insulin from boluses.
I might try switching to manual mode and doing extended boluses each time I eat when I give the pods another try, but I’ve kind of lost all confidence in the ability of Omnipod to infuse enough insulin effectively enough for my eating style which includes a fair amount of carbs with meals.
You could try putting tegaderm or opsite Flexifix tape under the pod, the canula inserts into the tape. This helps stabilize the cannula resulting in less site failures. I have found this technique has greatly reduced site issues.
I was on omnipod and switched to MDI for the reasons you state. Had so much trouble with any site I tried. Just got the tandem pump even though I swore I would never go back to a tubed pump. Really disliked my Medtronic. So bulky. So far I like the tandem. Use my iPhone almost exclusively. So much easier than digging out the pump. Today when I changed the cartridge the tubing would not fill and it said I only had 50 units on board. I changed the cartridge and tried using the same tubing but still didn’t work so changed everything. Is this something that happens frequently?
I’ve never had that happen but I fill the cartridge all the way and just keep using the cartridge until it’s empty. For me, changing sites and changing cartridges are independent events. I’m not trying to put in the amount of insulin I’ll use in two or three days because I’ll change sites multiple times while using the same cartridge.
Wow mind blown. Did not know I could do this. So when priming the tubing the pump doesn’t know it’s the same cartridge? I will definitely try. What infusion device do you use? I got the stainless needles because worked well with Medtronic. But would like to try the 30 degree soft cannula. Any thoughts ? I like to use my thighs which don’t have a lot of fat and the needles hurt a little and I don’t like that the tab sticks up. Have to be so careful. Thanks so much for responding. If you have any other tips I would love to hear them.
Jane
Jane Cerullo
Doesn’t know or care. You can prime whenever you want. Don’t do the whole load cartridge thing just fill tubing. Also, when you select Fill Tubing in the Load menu, there’s a prompt that highlights New Cartridge. Don’t choose that. Just choose Fill. If I’m using the same type of infusion set, I don’t bother to change the tubing either. I just change the part that goes in your body. (If I’m switching infusion set types, I change tubing because the connectors at the end are slightly different.)
I primarily use T-steel. I also use Autosoft 30 (a soft cannula angled set with a spring-loaded inserter.) Never tried the thigh. I’d be wary. The (angled) inserter needle seems longer than a t-steel. There’s also Varisoft where you insert it yourself (no spring loaded device) so you have more control. I don’t like doing it personally. There’s something about the length of it and withdrawing the needle part while leaving the cannula in there that I find uncomfortable even though I’m generally comfortable manually inserting the steel set. Could be more psychological than physical.
Thanks for your reply. From what I read the Autosoft 30 cannula is much longer 13 mm. I don’t have any problem inserting needles. Maybe because I am a nurse. I am excited to try the soft cannula and your tips about reusing the cartridge. I was so nervous about this cartridge. People on YouTube made it sound so complicated but it’s not that difficult to fill. Have a great day. Jane
Jane Cerullo