I recently switched from a tandem pump to omnipod 5 and am noticing a pattern of high bg on the second day around the time when my site should be changed. I’m just assuming the pods aren’t lasting a full 3 days for me and was curious if this has happened to anyone else. I never had an issue going 3 days between site changes with my tandem pump. Its obviously not the end of the world, but id love for them to last longer if anyone has any suggestions.
I have eros Omnipod though.
I have been having more of an issue with my pods over the last couple of years. For me it still seems to be related to certain lot numbers, with some lot numbers I never had an issue with. But it’s been occurring more. I am assuming it’s a me thing combined with certain lots? But the ones I do, that’s the pattern that I start having, higher numbers the second day. Either I notice I am giving more insulin than normal and my numbers are still trending higher or my BG level starts to go up higher than it should have.
I’ve gotten pretty good now about noticing that if something is off the second day I just switch it out. Lately I have started using Afrezza more because of the issues I kept having with pods. I’ve not had a bad pod for a bit now …but sigh …I don’t know if it’s a good lot number for me or if it’s because it’s mostly basal insulin with a small amount of bolus through the pods.
Do you use humalog or novolog?
I use Fiasp in my pods and have been getting a full 3 days (and sometimes the extra 8 hours) for about 3/4 of my pods. I’ve had some that I gave up on at Day 2 just like you describe, but with Dash pods it seemed to happen more often. I started limiting my bolus to roughly 5 units at a time. If I need to exceed 5 units (say a big meal with 8 or 9 units) I use extended bolus and set it so about 5 goes in as a pre bolus and the rest goes in over a half hour as an extended bolus. Seems to help the pod sites last longer.
@Eric2 I use Humalog and I got some Novolog to try instead. And I had two pods fail in a row. In fairness that’s when I had started using Afrezza a lot and it was causing some weird fluctuations… Bigger DP spikes for one. So I’m not sure that the second pod in retrospect was a pod failure so much as a big DP spike. So I really need to try it again to see if using it made a difference. The good news is all the weird stuff that was happening the first two times using Afrezza a lot, hasn’t happened the third time around.
Did it fail with Humalog or Novolog?
And actually, to be more clear, when people say the “pod failed”, it can mean that the pod stopped working, or the infusion site deteriorated, or the insulin deteriorated. Like the pod is still pushing out insulin, but the insulin is just not working.
So in the case of the original poster, I asked which insulin she used because there are a lot of people who have reported that Humalog did not last as well for 3 days as Novolog. I am one of them who found this to be true! And there are a lot of research studies that showed that Humalog deteriorates faster.
So in cases where people say the pod “stops working” after 2 days, for a lot of those people, what they might really mean is that the insulin stops working well after 2 days. The pod is still pushing the insulin out.
Sometimes it’s hard to interpret exactly what is meant in these posts. But for anyone who uses Humalog and says their pod is not working well after 2 days, my first advice would be to at least try Novolog and see if it is better. If Novolog does not work after 2 days, then it could be a site issue.
And in any case, for any suspected pod failures, I would advise someone to remove their pod and do a bolus and at least see if insulin comes out of the cannula. That can tell them at least the pod is still doing it’s job. That can narrow it down too.
I’ve been on Omnipod 5 since May and I have always made it 3 days. Did you start the Omnipod 5 in the last month? I know it took me over a month to get the highs down. Now it knows me and my settings so I’m only get highs if I forgot to meal bolus or I’m feeling unwell. You should call Omnipod and they will send you a new pod and confirm with you that they should last 3 days. If you change every 2 days you may run out if doctor wrote script to change every 3 days. I think I get 45 pods for 3 months bc my doctor wrote that I change ever 2 days so I never run out.
I use Fiasp too in the Omnipod 5 with no issues
@Eric2 I had 3 pods with Humalog fail in a row, The second one caused pain so I switched it out, hence trying the third one. But then I tried the next two with Novolog and both “failed”. But the second one might not have, but on the other hand that box/lot I already had issues with. I have to try it again. But it sort of looks like Novolog didn’t make a difference. I haven’t figured it out. It seems to be a obvious me thing, but with certain lots? But it seems to usually occur the second day with trending higher. A shot always works and Afrezza always works.
When you say the pod failed, can you clarify that? Did you get a pod error code? Or did your BG just go higher?
It’s helpful to get on the same page here. To define what is meant by a “pod failure”.
Which of these is it?
- Site failure
- Insulin issue
- Pod mechanical issue
If you take the pod off, and you do a bolus and it still “clicks” and insulin is still coming out of the cannula, then let’s call it either an insulin issue or a site failure.
That helps to better troubleshoot the problem!
@Eric2 I rarely get an actual alert from a pod. Even when it something obvious. I call them pod failures because you never can always tell why and since the pod is the insertion and infusion set too, it’s all a pod failure to me. I just don’t check to see if they still click and release insulin because I am assuming it is still feeding me some insulin because if it was a total failure I can go up to over 300 in a few hours. Honestly unless there is a specific reason, me going over 160 is rare enough, I start paying attention to what is going on. Even staying over 140, did I dose right, was my timing off etc, but if there isn’t a reason I will try one correction dose and if it doesn’t work now I try to catch it early and move on and change it.
But for the most part, it’s an increase in having to give extra insulin because I am trending higher than I should be. There has been a few times that it’s the realization I just gave a bunch of units over the last several hours without eating to bring down my levels and it’s not dropping. So the extra is just helping me maintain the same level and not bringing my level down.
So when I change it, I give a shot or now I use Afrezza and everything works with the new pod as it should. Sometimes I drop too much as some of the insulin I was taking before I changed it does work, but it’s hard to ever know how much. Tunneling is a possibility, Omnipod suggested trying to secure it well to see if that helped as I guess the cannula getting moved about can cause a tunneling issue more, but that didn’t seem to make a difference except to be a bear to remove it lol. I tried completely new territory in different areas of my legs and that didn’t seem to make a difference either. I tried smaller dosing and that might have helped some, but I still ended up with some failures. It’s possible with a different pump people change the infusion sets, different material, different depth, but the pod is it, but I have a feeling that is what I need. I have all sorts of allergies so that might play a part. It’s not the Humalog itself because a shot always works. The ocean swimming doesn’t matter either because I have pods that work fine after swimming with them, so that’s not it either. I am on a lot number that is not causing any issues right now. I have started to use Afrezza a lot more, but even the days I rely on the pods they seem to be fine. So who knows.
I love my pods, but I am hoping Tandem comes out with their patch pump that you can change the infusion set so I can try that.
But I am assuming it’s site failure…but with certain lots only.
I use Omnipod Dash loaded with Fiasp with AndroidAPS, which is pretty much the same as the O5.
The closed loop gives much more information about how well the pod is working, but it’s not easy to figure out. My best guess ATM is that I have no problems if I avoid scar tissue.
I suspect the issue is Fiasp - it has an activator (nicotinamide) that stimulates the skin to rapidly adsorp the insulin. I saw problems before I moved to a closed loop and swapped back to regular insulin as a result. I swapped back to Fiasp when I started AndroidAPS but was also careful about the scar tissue. It works just fine - 80 hours out of every pod (I’m an environmentalist, at least according to the local politicians
So what I’m suggesting is that Fiasp is very site sensitive; I don’t know if you use Fiasp, but Insulet are the only pump supporting it so far as I know.
Ya, I was just trying to be specific because that helps find a solution.
Like an infusion/absorption issue would have a different solution than if it was insulin degradation or if the pod just totally stopped working.
For infusion/absorption problems it could just be a matter of finding better real estate on your body. Or it could be a matter of doing the larger boluses with a syringe or pen, and just using the pod for basal management and small boluses (that would help preserve the site longer).
It’s not the same though. Humalog deteriorates in a pump faster than Novolog. It can work fine with an injection, but that is not the same as after it has been sitting in a pump for a few days.
Read this post I did a while back. A lot of reference links in it.
@Eric2 Well, I am using Afrezza a lot now. My pods are lasting 3 days, but they lasted 3 days a lot before. The confusing part is I can go months with no issues and then I hit a box and I will have 2 plus not work. I have switched the Humalog out and that doesn’t seem to matter either. I tried the Novolog and do need to give it another chance to be fair. So why is it deteriorating in a pump faster? The Pubmed articles are very technical lol, of something I am completely unfamiliar with it seems. Am I getting it’s the container it’s in in the pump changing the chemical structure and causing deterioration?
This is interesting to hear because I did not have this issue with the starter kit pods-they all seemed to last 3 days no problem. I think I have one from that lot at work so maybe I will have to do a little experiment and see if it makes a difference!
I use Novolog. From reading other replies im realizing I didn’t have this problem with my first order of pods and now im wondering if the pods could really be part of the problem.
Yes they are technical!
The idea is that motion of a person’s body, and heat from a person’s body, and the material that contains the insulin inside the pump reservoir can cause breakdown.
A lot of people don’t know this, but motion can cause eventual breakdown of insulin. (Not just a little motion, but a lot of motion, and it is a gradual breakdown.) So if you are doing a round-the-world sailboat adventure, you would need to restock your insulin in the various ports. If you tried to keep it with you the entire trip, it would not work after a while. The constant motion of the waves would kill your insulin supply!
Plastics too! Insulin always comes inside glass. Even in pens, the cartridge may have a plastic outer cover, but the inside part of a pen where the insulin is kept is glass!
So those studies just compared the various insulin’s, and they said that NovoLog was the most durable.
Even if that does not fix your issue, it’s still interesting stuff.
Would be helpful for you to make a list of the locations you are wearing them when they do not work well. That might help you further troubleshoot. And maybe at least rule out the location issue.
Like maybe you can figure something out like - “…no, not all arm locations are failures, but every time it fails it does happen to be on my arm…”
Or maybe the failures are more likely to happen on certain days of the month, depending on where you are with all of that. (Sorry, don’t know and not trying to get into your business. ) But monthly cycles are also a big factor on insulin resistance. And if you are using more insulin, the infusion site may fail more.
Or maybe something like - “…every failure happened when my total daily amount was over X units for 2 days…”
Anyway, things like that can be a huge discovery.
@Eric2 It’s not location per see, I have locations I like better, but the best spots and completely new spots were failing too. I am retired and well past menopause. My hormones can flare up off and on if I don’t pay attention to my thyroid, but resistance wouldn’t explain why a shot or Afrezza work at the right amounts. I have a tendency to have resistance in the mornings.
It’s possible it’s related to the size of dosing or overall amount, and that still can play a part. But I tested making sure I dosed under 2 units and gave shots for the rest and I still had it happen. I really want the pods to work at least for my basal and small correction or small snack doses.
But I am using a lot of Afrezza right now and having no issues with my pods, but this could be a better lot for me. I just can’t help but wonder is the insertion not as strong on some, maybe slightly shorter or even more adhesive on some as I have allergies to many things. Maybe I react to the cannula itself even. When I take my pods off I have a raised lump that goes away after. But there seems to be a connection with certain lots and a me factor in there somewhere. And I have to say, I was using a good lot and accidentally pulled one from a bad lot number for me and had a failure. I realized I had done that when I reached for another replacement. I have since removed those lots to another location lol.
I tried the Novolog in the pod and it didn’t work either, but in fairness I need to try it again. I can pull out a box of a lot number I don’t like lol. I knew switching to Novolog worked for some people, but not why.
I have my script written to be able to change them every two days so I have a lot of wiggle room to not use some. Plus I do call most of the failures in for replacements. When things are going smoothly they do last three days fine.
From reading all of this it sounds like you have really considered everything! I should have known, you are super smart!
That’s great, that’s the best any of us can do, just analyze everything,
I was trying to piece together all the possible reasons, just to help with a general understanding. For me, the term “pod failure” was super vague!
So here is what I have come up with. Please let me know what else can be added to this list.
a known pod problem (pod alarm or occlusion)
a unknown pod problem, a mechanical pod problem (the pod is not pushing out insulin properly)
air in the pod’s insulin reservoir (a bolus is part air and only part insulin)
a shallow infusion site
a cannula that has come out of the skin or wiggled loose
poor absorption at the infusion site
over-saturation of the infusion site from a lot of insulin
a generally bad infusion location
weak or bad insulin
degraded insulin (starts to go bad after the first 2 days)
insulin resistance unrelated to the pod, but from other issues (sickness or hormones)
more overall insulin needs that are not known and therefore not supplied by the user
- a person having a misunderstanding of what their actual insulin needs are
I am not sure what else can be added to that list. But to me, analyzing it from that perspective can be helpful in trying to fix the problem.
It sounds like you have already gone through all of that!
I am not sure what else can be added to the list. Let me know what I missed!
Even if this does not help you, let’s finish the list and it may help someone else troubleshoot their issue.
One to add,
The ability of the pod to wiggle or move and then the cannula creating a bigger space and more likely to cause a tunneling or pooling effect.
Securing it better is supposed to help stop that, but that didn’t make any difference for me. Even if I’ve tried small doses and it didn’t help, with my allergies and reactions to so many things, this could be one of my issues still.
PS The other thing I have been wondering about is where I live and the particular area I am in. We have our high humidity and constant rain all year long. I’ve already had 3 replacement PDM’s sent to me and 2 Dexcom reader replacements in 4 years. Things rust here really really fast.