Pod change highs

I asked my Doc last week about this, as I did finally experience one of these events. He had a quick answer, and it appeared he'd known about it. He said it was due to how well the pump was filled. He suggested making sure there were no bubbles at all, and that it was filled carefully. I do recall being in a hurry with that pump that I had the high BG readings. So, I did fill the pod quickly and I'm sure there were bubbles in the mix. Normally, I'm quite anal about getting zero bubbles, and usually fill the pod slowly. Slowly in that the beep usually occurs about 1/2 way through pushing the plunger down on filling the pod. Play with that idea in mind and let us know what your outcome is.

Terry - I just use the temp basil for one day....that works for me, it seems that the pod gets to being effective by day 2. What is the dogs name, if you dont mind my asking?

It's Norm. Who is the dog in your TuD picture?

Scott - Thanks for your slow-fill idea. I'll try it. If that's all it takes to fix this, it will be better than my bolus tactic to fill the gap. I'm tempted to waste one pod and one insulin load to examine what bubbles, if any, start out in a newly filled reservoir.

I went back and reread your post from before, and I see you had already told me his name was "Norm". I'm sorry I missed that! My dogs name is Brady.(and yes, we are EXTREME New England Patriots fans! Do you have a picture of Norm anywhere in Cyberspace?

Yep - I wore them to cross country meets in high school religiously! I'm sure that my mediocre stellar performances were entirely due to those socks. Same is true with wearing the old pod after I stick on a new one ;)

Looking into the "bubble hypothesis" regarding the reason for my post pod change hyperglycemia, I've now examined three pods out of my used pods collection. I took apart one pod that I was forced to abandon after filling. As you can see in the picture there is a very large air bubble in the pod reservoir. ![|373x480](upload://fHzQzrwoDGeCeVTsR1SdqHJSVny.jpeg)

Sorry for the rotated photo. The bubble is actually at the top of its reservoir!

I fished two more used pods out of the used heap and observed the same large air bubble in both! I thought my insulin filling technique was done per protocol. I had one on one training last July and the trainer watched me fill my first pod.

For those of you so inclined, it would be interesting if you found (or do not find) the same large air bubble in your used pod.

I intend to try the slow fill technique suggested by Scott and see if that doesn't eliminate the bubble.

I’m so McGayvering open some pods and checking. I have some pretty full failed ones!

I apologize to most readers of this thread for this off-topic excursion!

In this photo you can see the "bringsel" pendant that hangs from his neck. He puts it into his mouth to signal a low blood sugar.![|640x480](upload://bksHdhUkOsRJv61rk1eJNM0In8T.jpeg)

BTW, Tom Brady went to high school just a few miles down the SF Peninsula from where I live.

I have wanted a “sugar” dog for awhile. I’d much rather have a companion than a dexcom. I get crazy lows sometime! You are in my neck of the woods as well! How did you get one? How do you go about that?

Alison - If you are interested in applying for a low BG alert dog, you might look into Early Alert Canines. They are a not for profit agency that trains dogs in Concord, CA in the SF Bay Area.

I love living with my dog. He's obedient, warm, and completely conforms to my schedule. It's great to get low BG alerts, especially when I am not aware that I'm low.

I've seen the same on opening pods I removed that still had some insulin remaining. What I am wondering is if the bubbles were introduced post-shutdown/removal of the pod or whether they were there all along. It's possible that when the pod is shut down and the motor driving the plunger is turned off, air can come in via the cannula when you pull it off. Or, if the old pod has been sitting for awhile before taking it apart, fluid could evaporate and air could come in.

I wish the cover were clear so we could see it during filling and operation.

One of the three pods that I opened today was one that never went into service. For some reason, just after the filling step was done, the PDM told me that the pod was terminated and I had to begin again with a new pod. That would argue against the bubble being introduced during shutdown and physical removal from the site.

I'm not sure what to think about this. I can't imagine that these bubble's are intended or "will do no harm."

I think I'll give Insulet a call tomorrow and see if I can learn anything more. I may need to go back to a tubed pump. At least I could always visually verify the absence of bubbles in the entire insulin storage and delivery pathway.

Here is another 'bubble' discussion: Bubble Discussion Link

nevada - That was interesting. The thread occurred back in 2010 and a few comments mentioned post pod change highs. The pictures of the opened pod provided incredible detail. I learned that some people don't even try to get rid of all the bubbles in the fill syringe through the needle. Instead they turn the needle downward and tap the side to get all the bubbles up against the plunger o-ring and then stop short when filling the pod. The bubble depicted in this thread's photos is very small compared to the ones I've observed. Thanks for the link!

Bradford - I've now followed all the links you suggested. Thanks for sending them to me. What I've learned is that post pod change highs have affected many pod users going back to at least 2009. Many people have found successful adaptations through trial and error.

While there doesn't seem to be one magic formula, the solutions include: pre-change bolus (from 0.5 to 4 or more units), post change bolus with new pod, change pod before a meal and start new pod with a meal bolus (worked for some but not everyone), temp basal rates from 10-50% or more from 1 to 5 hours or more, and an extended bolus covering up to 5 hours.

My big take-away? I just need to do my own experimentation to find out what works for me. I've now successfully used a 7-unit syringe bolus just before changing two times. It's driven me mildly low and I've had to eat a few extra carbs to counteract, so perhaps I need to lower the dose.

I don't think bubbles are the cause as it seems that bubbles in the reservoir would have a hard time getting into the tube that feeds the cannula. I learned this from the link that nevada provided down thread. I was going to call Insulet customer service about the bubbles but now I don't think I need to.

Thanks again for your help.

Glad that some of the info was helpful!

Yes much like every other thing related to diabetes management, the "YMMV" adage seems to apply here too, unforunately :(
The good news is that you have a starting point (both your 7 u syringe bolus and the suggestions learned from others here on on the other link's forum) and so your experimentation process may not be as long or drawn out as it could have been :)

Keep us posted over the next few changes if you find something that works for you!