Hi, all! This is my first post. I’m (long-distance) caregiver to my 83 y.o. mom who developed Type 1 in her late 60s. She has had an Omnipod pump for several years, and a Dexcom G5 for 18 mos.
We’ve had an ongoing problem with the Omnipod apparently not delivering boluses. The meter record indicates that it was dispensed, but her BG does not respond until we finally repeat the dose with a pen.
A year and a half ago, her BG got so high that she went into a coma and wound up in the ICU for a week. Omnipod replaced the pump, but we continue to have this problem with at least 1/4 of the pods (maybe more).
We/I have not been able to discern any pattern with insertion site, pod batch, storage or anything else. Mom’s endo professes to know nothing about this, and Omnipod has provided zero help. But googling, I’ve seen stray references to others having this problem (and even suing).
Although Omnipod always replaces the defective pods, we still waste a lot of insulin, to say nothing of the health effect of wild BG swings.
Does this problem sound familiar to anyone? Any thoughts on how to resolve it?
One suggestion might be to use an injection for basal, such as tresiba. Then use omnipod for meal/correction bolus, and possibly pen injection when meal bolus seems to not work. This may help prevent another coma and trip to ICU.
Maybe pod location or total insulin delivered via pod is impacting insulin absorption. Is air getting in pod during loading ? Is she thin?
Has this been happening always, or just recently? Possible bad batch of insulin or pods ?
With dexcom G5, is it apparent when pod/insulin is not working?
One of the things I love about being on an insulin pump is being able to have multiple basal rates throughout the day/night.
I’ve had problems with OmniPod tunneling, which is when the insulin backs up and isn’t delivered. I’ve gone to only bolusing with a syringe and vial of insulin for meals or correction doses.
My belly was overused (absorption issues) so to give it a long break I switched from it to other parts of my body for pod placement for my basal delivery.
I’ve learned from the DOC (Diabetes Online Community) about tunneling and that OmniPods don’t work as well, for some people – pointing to myself, when dosing over 4ish units. I’ve found using the syringe and vial for all boluses to work very well, for me.
If you search here for “tunneling” you will probably find several threads about it that might be of help to you @CaregiverDaughter.
Best of luck to you and to your Mom – that you get the answers you need to have your Mom stay healthy!
Hi, MM1! My mom’s Omnipod does seem to deliver basal insulin; it’s the boluses that are the problem. So we don’t use Tresiba, but we do frequently resort to a Novolog pen for boluses.
Nevertheless, it’s still a problem, because if she gives herself a bolus by Omnipod, and it doesn’t seem to be hitting, we have to wait until we’re sure before we repeat the dose with the pen.
To answer your questions, I think this has always been happening. We can’t discern any pattern, like location or bolus size. I don’t think air is getting into the pod. Yes, Mom is thin.
And mercifully, we can see when this is happening with the Dexcom – we made her start using it after the coma. But even so, we would rather not have it keep happening.
Hi, Tapestry! That is very interesting about the tunneling. I’d never heard of that before. I googled it quickly before replying, and I see that I will have to investigate it further. Many thanks for this advice!!
Some people don’t do well with the Omnipods cannulas. Some people with Omnipod pumps have to switch to a tubed pump so they can use steel sets.
I know I am attached to my Omnipod because of it being tubeless. So you might consider doing large boluses by MDI and keeping the Omnipod for small adjustments or basals to see if that solves the issue.
But I also have several places on my stomach that don’t work well for my pods. So I have learned to be quicker about switching them out. It is still aggravating because I can end up hitting 200 when a pod has a bad site, but it’s better than the over 300 I used to hit.
If I change a pod and my numbers start to go up above 160, or even just start to go up for no reason. I replace the pod right away and give myself an injection to make sure I am going to receive a correction dose of insulin. If you are changing it out you can use the syringe that comes with it to draw out most of the insulin out of the hole that you use to fill it up to help refill the new pod. Insulin does degrade next to your body over time so I would only do that if it’s the first or second day. Some people have said they even notice insulin not working as well the third day the pod is on. I’ve never noticed that personally.
Omnipod doesn’t encourage you to do that obviously. So the alternative is when you call in a bad pod you can also tell them you want to be reimbursed for the insulin wasted and they will calculate and send you a check for the wasted insulin.
I am a senior but 15 years younger than your mother. I tried out Omnipod for two months last summer and really hated it. Although I had some good days with reliable results, other days and nights were plagued with high blood sugars that didn’t respond to boluses. I had lots of bruising, bleeding, and inflammation from the cannula. I really felt that my tissue and skin were not durable enough for the Omnipod and the weight of the pod. Changing out pods every two days didn’t help.
Lots of people really like the Omnipod and many seniors are successful with it. But I was happy that I had a tubed pump to return to. My BG results are much better and my skin and tissue are much happier. I would go back to injections if Omnipod was my only other choice.
Hi, Marie20 and Laddie! Thank you for this very helpful advice. My mom really loves the tubelessness of Omnipod and the fact that she doesn’t have to stick herself with an insulin pen, but I am beginning to see that the cannula and tunneling might be the source of her problem.
So I think we might try using the pen for largish boluses (Mom rarely does more than 5 units, so maybe we’ll set our line at 3), using the pod for increments and smaller boluses.
One of the problems here is that, besides Mom’s age (83), her history full of severe hypo- and hyperglycemic events that have done some cognitive damage. So she has trouble adapting to new technological solutions. (It took weeks to teach her how to use the Dexcom G5!) Another problem is that my father insists that they continue living in Florida, thousands of miles from their children. This solution keeps her with devices she knows and is comfortable with.
Okay. I personally find NovoLog to be better than Humalog, and was wondering if that was part of the problem.
I also find that the absorption starts to get worse after a few days. It might be helpful to chart the problems by day of pod wear. See if the problems are more obvious on day 3.
I have a script for 2-day pod replacements because day 3 was not very good.
Hi, Eddie2, Our problem is actually (weirdly) the reverse; we get the worst performance on Day 1, but sometimes the pod starts working on Day 2 or even Day 3 (assuming we haven’t already replaced it by then).
I wondered whether that might negate the tunneling hypothesis, but we have a pod change in a few hours, so we’re going to try pressing it down hard when putting it on, taping it down with a single strip of tape across, and using the pen for larger boluses.
Some hardware is just not a good fit for some people.
I’ve, in the past, had trouble with Medtronic pump and am seeing current problems with my Dexcom G6.
In general, I would say that Omnipod has a higher tendency of failing on small people (kids) and people with a low proportion of body fat (that is NOT me).
Several years is a long time to be on a device that isn’t a good fit. I have done that myself, but I am starting to declare a device ‘not a good fit,’ much sooner now. Chalk it up to diabetes black magic and move to a T:Slim or Medtronic pump. Another alternate would to do manual injection for meals. You will know darn well that those are being delivered.
The problem that I had on the Omnipod was that you have to confirm
multiple screens. So on a few occasions, I have confirmed the bolus amt, got distracted and did not finish confirming everything else required and the bolus never happened, I believe even though it shows in the record history. Please confirm this with the omnipod people.
Second thing would happen when I would take large boluses over ten at a time, I would get an occlusion error Change pod now. Omnipod folks suggested that I take smaller boluses in essence breakup the dose.
Thank you, Typ1! My mom likewise has occasionally not completed the confirmation process, but we’re considering that a user error, not an Omnipod problem. She has never needed to take a bolus as large as 10 units, but based on all this advice, we’re planning to use the pen for larger boluses, and see how that works.
I second what Eddie2 says. If I don’t do an immediate bolus after starting a new pod I get terrible results on day 1 and sometimes it never straightens out over day 2 and 3. So no matter what time of day it is or what my current BS is, as soon as I start a pod, I bolus a half a unit (took experimenting to get that number for me). It’s a dose for “nothing” but it seems to saturate my cannula site then I get reliable responses to meal boluses. If I’m going to eat right after, I will do a second normal carb count mealtime bolus and ignore my starter bolus.
The second thing I started doing is to push straight down on the cannula end and push up skin under the other end when you press start. This lifts the other end and I get a better deeper angle in my skin on the cannula end. If I don’t the insertion seems shallower and sometimes will work out of my skin by day 3.
The third thing I do is extend a mealtime bolus if it’s over 4 units. If the cannula hit close to a little nerve larger boluses sting. I can’t prove anything but it just seems to work better if the larger boluses are extended over 30-60 mins. May be just in my head!!
I’ve never used a pump other than Omnipod and would hate giving it up Happy New Year
I third the advice to give an immediate bolus after your Mom starts a new Pod. I have been on the OmniPod since 2009, and I love it. Just this last year, I switched to the OmniPod DASH system, and that seems to work for me, too. With the original OmniPod, I always would give myself a half to a whole unit of insulin (depending on my blood glucose reading at the time) to get the pump “started” and the cannula flowing. I really helped with Day 1. I have noticed since changing to the OmniPod DASH system that I do not seem to have to do the immediate bolus. I do agree that the immediate bolus after change is something your Mom should try. You may have to do some experimenting to see what dose works the best for her, but it is worth the effort. Good luck!
