So, now that we’re finishing up our SECOND successful pod (3rd day is up in 2 hours…woohoo!). We are ready to begin making some adjustments on our sons insulin regiment. First, we notice that he’s ALWAYS high during the day…between the hours of between 10AM - 7PM, so our first change was to create a new Basal program which we called “Daytime”, where we will be administering .10u/hr instead of the usual .05/hr that’s on our standard program. We’ll monitor it, but we’re sure it will help in the daytime highs we’re seeing.
The second thing that I want to do is SUSPEND his insulin all together during the nights because his BG’s get to a perfect level and they literally stay there all night (when we have suspended the basal insulin). I typically manually suspend the basal at nights, then start it back up the next morning when I see his BG’s starting to go back up.
So, now to my question. I can’t figure out a way to set the “suspend” action to occur automatically, like the basal programs requiring insulin delivery. Anyone on the Omnipod know if there is a way to do this? In the interim, I have set up a ‘Temp Basal Preset’ for, between the hours of 12AM - 7AM, where the insulin is turned off. This will be at least a few button clicks less, but I’d really like to set this up to occur AUTOMATICALLY, nightly.
So, if this is possible, I’d love if someone could help me figure it out. I’ve read the book that comes the the Omnipod and I don’t see anything on it.
Usually the “suspend” feature is meant for manual suspension of the pump. You may be able to program a 0.0 basal segment in the basal rates…but, did you run this by his doctors? I would be very careful suspending insulin for hours on end. Since the pump uses only fast-acting insulin, you can get into trouble very quickly if you’ve got no insulin in your system at all (I find I can’t suspent completely for more than about 30 minutes without starting to go high). Some pumps will not let you set a 0.0 basal rate because of this, but will let you set a very low basal rate like 0.025 units.
Also, I’m confused why you created a whole new basal program for the daytime period. Is it just to try out and see how things work? Usually, the basal programs are meant for different types of days, such as weekday/weekend. If you create one for the daytime, you’ll have to activate it every single morning, and in that case I’d just change the default basal program… Myabe I’m missing something, though.
We have observed repetitive nightly stable BG’s or otherwise we’d not be considering it. We also have “high” alarms set on the CGM so in the event the BG’s DID begin raising, and/or cross a pre-set threshold, we’d be woken up with an audible alarm. Nighttimes’ are easy sailing (150 - 180 all night long and VERY level) it seems and I wish out “daytime” BG’s mirrored our nighttime BG’s. As far as running things by our Endo…no, this is “taking control”. Our Endos repeatedly say “no action necessary at this time.” We have an appointment on 1 Nov with a NEW AND AMAZING medical facility (we had our son who had cancer treated here years ago and it was a great hospital (referring to Children’s National Medical Center in DC.). They’re ranked 13th in the nation for pediatric endocrinology so hopefully they’ll be able to “help” and guide us a bit more.
Good luck with the new doctor! I didn’t mean to imply that you run all decisions by your doctor, just the idea of setting a 0.0 basal rate for hours (or suspending the pump for hours). It sounds like your son may still be in the honeymoon period. Daytime is a lot harder, as there are so many more variables, but for many of us nights are difficult as well, so that’s great that you have at least 1/3rd of the 24-hour day under control! I’m sure daytimes will become a bit easier as you learn about bolusing for foods in ways that can help prevent huge spikes.
The Omnipod allows you to create custom Basal rates based on trends you’ve observed during the day because you observe low, or high BG’s during given time periods. The below is the one that I just created and enabled. Now if I can figure out how to just “suspend (automatically)” the nighttime basal rates so I don’t need to do it manually, I’d be set.
I can “decrease” my basal rate, manually, to 0.0, and set that for x number of hours…but it’s a manual process. I’m looking (and hoping) there’s a way to configure it as a preset as you can with the other basal hour configurations.
And I’ve shortened the steps of completing the above, by creating a custom basal program where it runs from X to Y and shuts off the basal…but again, even that “shortened” version, is a manual process…I have to turn it on daily.
Yeah, most pumps have three settings, basal profiles (the screenshot you have above), temporary basal rates (the one where you can program X amount of insulin for Y period of time), and suspend (where the pump turns off all delivery until ti’s turned on again). I’ve never used an OmniPod, but if your basal profiles don’t let you go lower than 0.05, then I’d be surprised if there’s some “trick” to getting it to work (on the two pumps I’ve used, both of them just let you decrease to 0.0 right in the basal profile). But hopefully some OmniPod users will chime in and prove me wrong!
The other disadvantage for turning the basal all the way to zero for a sustained period is that it might impair the kinetics of the site. Trial and error will tell you.
Yes. Even with MDI’s, he’d go low at nights sometimes. No basal during the nights results in a perfectly flat line…between 150 - 180. So I’m not going to question the numbers. As long as he’s level during the nights, I’ll continue celebrating the numbers and being glad they’re helping his A1C’s,…which right now get ruined during the day times.
Well, the good (or bad, depending on how you look at it) news is that this will likely not remain a problem for too terribly long, as you son will (perhaps sooner, perhaps later) begin requiring larger doses of insulin as he grows.
Terry4 makes a good point about the kinetics of the site when insulin is suspended for long periods of time. The cannula can become “clogged” with dried insulin. You may end up needing to send your son off to sleep higher than you’d like at night so that the 0.05 basal rate gradually takes him from being high at bedtime to not too low by the morning.
You cannot do this with the OmniPod. What you are asking for, is the ability to program a zero basal rate. OmniPod does not allow for it. The only way to achieve this is to set a temp basal to “off.” If you suspend insulin, it will not turn back on without manual intervention. A temp basal will stop, and your basal program will resume after the period you selected. The workaround you have come up with, is the only way to do this.
We had the same issue with Caleb and I did this for months. However, it was not for as long as you are doing it. I tend to agree about the risk mentioned here - turning it off for too long can mess with the Pod’s ability to delivery insulin.
Just curious - why did you set a new basal profile? Why not just change the one you have? Are you planning to go back and use the other one?
Yes, we wanted to test this for a couple days. If it didn’t go as planned, we’d just go back to the default basal configuration (which is basically 12AM - 12AM / .05u/hr.
I hate the idea of basically forcing Liam to “go high” at bedtime just so that he can make it through the night. Even before we set up this configuration, we were turning off his basal during the nights (and had no clogs) because, if we didn’t, he’d drop too low during the nights. I guess to work around this I could build into this basal regiment a single .05 dose between one of the hours in the middle of the timespan we’ve suspended the basal? So something like:
12AM - 3AM: Off
3AM - 4AM: .05/hr
4AM - 7AM: Off
I certainly don’t want to risk clogging the cannula, but I also don’t want to risk hypoglycemia by administering insulin when his body doesn’t need any.
We’ll run it by our doctors, but I don’t expect much in the way of “help” from them. Nov 1st will be the new chapter as far as Endo’s go.
As long as he’s level during the nights, I’ll continue celebrating the numbers and being glad they’re helping his A1C’s,…which right now get ruined during the day times.